Actrapid HM Vial (Solution for Injection)-100IU/ml

✔️ Uses of Actrapid HM Vial

• Treats diabetes mellitus (both type I and type II)

✔️ Direction for use:

Follow the instructions below when using Actrapid HM Vial (Solution for Injection):

For Injections: Injections (vials or ampoules) should only be administered by a doctor or nurse, either into the vein (intravenously) or under the skin (subcutaneously). The appropriate dose, frequency, and injection site will be determined by your doctor based on factors such as age, body weight, and health condition.

For Pre-filled Syringes or Insulin Pens: Administer this medicine as directed by your doctor. Inject it under the skin (subcutaneously). If you are self-administering, carefully follow your doctor's instructions.

Before administration:

1. Gently rotate the device between your palms 10 times and invert it 10 times until the liquid becomes uniform. Avoid vigorous shaking to prevent frothing.
2. Insert a fresh needle before injecting. Ensure there are no lumps or air bubbles in the medicine.
3. After injection, promptly remove the needle from the pen and dispose of it.
4. Never share your needle, disposable pens, or pre-filled syringe with others to prevent the spread of infections.
5. Dispose of the pen or pre-filled syringe once it is empty.

Injection Site:

1. Avoid injecting repeatedly at the same site to prevent skin damage. Rotate the injection site.
2. Consult your doctor before changing the injection site as a precaution.

Important Notes:

• Actrapid HM Vial (Solution for Injection) should not be mixed with other insulins before use.
• Do not stop therapy with Actrapid HM Vial (Solution for Injection) without consulting your doctor.

✔️ Side Effects of Actrapid HM Vial (Solution for Injection)

• Low blood sugar
• Swelling in your hands or feet
• Weight gain
• Thickening of the skin at the injection

✔️ Quick Suggestions:

• Take it 20 to 30 minutes before a meal.
• Hypoglycemia (low blood sugar level) is a common side effect. Learn how to identify and manage its symptoms (sweating, rapid heartbeat, weakness, blurry vision, headache) and teach your family as well.
• Injection below the skin of the abdomen results in faster absorption than other injection sites.
• Injection sites must be rotated to prevent hard lumps from developing at one site.
• Opened vials/cartridges are good at room temperature for up to 4 weeks, while unopened vials must be placed in the refrigerator  (2°C–8°C).

✔️ Indication

HUMAN INSULIN contains a short-acting form of insulin known as Human Insulin. This medication is effective in reducing elevated blood sugar levels in adults and children. It operates by promoting the uptake of glucose into muscle and fat cells, concurrently inhibiting the liver's production of glucose. As a result, HUMAN INSULIN aids in achieving better control over blood sugar levels, which subsequently reduces the likelihood of developing diabetes-related complications such as retinopathy (retinal damage), nephropathy (kidney damage), neuropathy (nerve damage), delayed wound healing, diabetic foot ulcers, and other associated health issues.

✔️ Pharmacology

Insulin is a hormone that plays a crucial role in regulating blood glucose levels. It affects the metabolism of carbohydrates, proteins, and fats in the body. Its mechanism of action involves several processes:

• Inhibition of Glucose Production: Insulin suppresses the liver's production of glucose, preventing excessive release of glucose into the bloodstream.
• Inhibition of Lipolysis: Insulin inhibits the breakdown of stored fats (lipolysis) in adipose tissue, helping to reduce the release of fatty acids into the bloodstream.
• Enhancement of Glucose Uptake: Insulin promotes the uptake of glucose from the bloodstream into cells, particularly muscle and fat cells. This action helps lower blood glucose levels.

Insulin formulations are categorized based on their durations of action after subcutaneous (SC) injection. There are three main types:

• Short-Acting Insulin: This type, also known as soluble insulin, has a rapid onset of action and a relatively short duration of effect. It is often used to control blood sugar levels after meals.
• Intermediate-Acting Insulin: These formulations have a longer duration of action compared to short-acting insulin. They are designed to provide a more sustained effect throughout the day.
• Long-Acting Insulin: These formulations have an even longer duration of action, providing a basal level of insulin over an extended period to help maintain stable blood sugar levels between meals and overnight.
• To extend the duration of the action of insulin, two main methods are used:
• Protein Complexing: In this method, insulin is combined with proteins that slow down its absorption and release. Examples include protamine zinc insulin and isophane insulin (NPH insulin).
• Particle Size Modification: This approach involves modifying the size of insulin particles to control their release and absorption. Insulin zinc suspensions are an example of this method.

While all insulin formulations can be administered through subcutaneous injections, most can also be given via intramuscular (IM) injections. However, only soluble insulin can be administered intravenously (IV). Compared to subcutaneous injections, intramuscular administration generally has a faster onset of action but a shorter duration of effect.

It's important to note that the choice of insulin formulation and administration method depends on individual factors such as the patient's diabetes type, lifestyle, and blood glucose control goals. The healthcare provider will determine the most appropriate insulin regimen for each patient's needs.

✔️ Dosage & Administration of Actrapid HM Vial (Solution for Injection)

Adult Dose:

• Type 1 Diabetes Mellitus:
  • Initial: 0.2-0.4 units/kg/day SC divided q8hr or more frequently
  • Maintenance: 0.5-1 unit/kg/day SC divided q8hr or more frequently; higher doses may be needed in insulin-resistant patients
  • About 50-75% of total daily insulin requirements are given as intermediate- or long-acting insulin, with rapid- or short-acting insulin used before or during meals to meet the remaining balance.
• Type 2 Diabetes Mellitus inadequately controlled by diet, exercise, or oral medication:
  • Initial: 0.2-0.4 units/kg/day SC divided q8hr-q12hr
• Intramuscular Diabetic ketoacidosis:
  • Initial loading dose of 20 units, followed by 6 units/hr until blood glucose drops to 10 mmol/l, then given 2 hrly.
• Intravenous Diabetic ketoacidosis:
  • Given as 1 unit/ml using an infusion pump, starting at 6 units/hr; rate can be increased if blood glucose doesn't decrease by 5 mmol/l/hr; reduced to 3 units/hr when glucose is around 10 mmol/l.
• Hyperkalemia: 5-10 units IV insulin in 50 mL D50W infused over 15-30 min
• Combination with NPH/Intermediate acting insulin:
  • Morning: Give two thirds of daily insulin SC, with a regular insulin to NPH insulin ratio of 1:2
  • Evening: Give one third of daily insulin SC, with a regular insulin to NPH insulin ratio of 1:1

Child Dose:

• Type 1 Diabetes Mellitus:
  • Initial: 0.2-0.4 unit/kg/day SC divided q8hr or more frequently
  • Maintenance: 0.5-1 unit/kg/day SC divided q8hr or more frequently; higher doses may be needed in insulin-resistant patients
  • Adolescents during puberty may require up to 1.5 mg/kg/day
• Prepubertal children: Average total daily insulin requirement varies from 0.7-1 unit/kg/day, possibly lower

Renal Dose:

• Dose adjustments may be needed for renal impairment.

✔️ Interaction

Before using Actrapid HM Vial (Solution for Injection), it's important to inform your doctor if you are taking any of the following medications:

• Other diabetes medications (e.g., glimepiride, glyburide, gliclazide, rosiglitazone, pioglitazone)
• Asthma medications (e.g., salbutamol, terbutaline)
• Corticosteroids for pain and inflammation (e.g., hydrocortisone, prednisolone)
• Thyroid hormones for thyroid deficiency (e.g., thyroxine, levothyroxine)
• Thiazide diuretics for edema and hypertension (e.g., hydrochlorothiazide, chlorothiazide)
• Pain and inflammation medications (e.g., aspirin)
• High blood pressure medications (e.g., atenolol, propranolol, captopril, enalapril, ramipril, lisinopril, losartan, valsartan, olmesartan, telmisartan)
• Growth hormone supplements
• Medications for diarrhea (octreotide)
• Medications for abnormal body growth (lanreotide)
• Medications for uterine problems (danazol)
• Beta-blockers for heart problems (e.g., atenolol, propranolol, labetalol)
• Antidepressants (moclobemide, isocarboxazid, phenelzine, selegiline, tranylcypromine)

✔️ Contraindications

Avoid using Actrapid HM Vial (Solution for Injection) if you have an allergy to insulin or any of its components, or if you experience hypoglycemia (low blood sugar levels).

✔️ Pregnancy & Lactation

Before using this medication, it's important to consult your doctor if you are pregnant, suspect pregnancy, or intend to become pregnant. This insulin is considered safe for use during pregnancy. Your insulin dosage may require adjustment during pregnancy and after childbirth. Maintaining proper diabetes management is crucial to prevent hypoglycemia and ensure the well-being of your baby. Breastfeeding is not restricted while using this medication.

✔️ Precautions & Warnings

Do not use Actrapid HM Vial (Solution for Injection) if you are allergic to its components. Inform your doctor about conditions like hypoglycemia (low blood glucose levels), hypokalemia (low levels of potassium), heart, kidney, or liver issues. Consult a doctor before using Actrapid HM Vial (Solution for Injection) if pregnant or breastfeeding. Be cautious while driving due to possible dizziness. Avoid alcohol consumption to prevent adverse effects. Adjust your insulin schedule if traveling across multiple time zones, as advised by your doctor.

✔️ Storage Conditions

Store in a refrigerator (2 - 8°C). Do not freeze.