Insulin Regular (Soluble Insulin): Uses, Dosage, Side Effects & Price | DrugsAtlas
Authoritative Clinical Reference
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Therapeutic Class
Antidiabetic
Subclass
Short-acting human insulin
Speciality
Endocrinology
Schedule (India)
Schedule H
Routes
Subcutaneous (SC), Intravenous (IV), Intramuscular (IM — less common)
Formulations
- Injection: 40 IU/mL (10 mL vial)
- Injection: 100 IU/mL (10 mL vial)
- Cartridge: 100 IU/mL (3 mL for pen devices)
- Pre-filled pen: 100 IU/mL (3 mL)
Adult indications
INDICATIONS + DOSING — FOR CLINICIAN USE ONLY
Primary Indications (Approved / Standard in India)
1. Type 1 Diabetes Mellitus
| Parameter | Recommendation |
|---|---|
| Starting dose (total daily insulin) | 0.4–0.6 units/kg/day divided as basal + bolus |
| Titration | Adjust by 1–2 units every 2–3 days based on SMBG; target premeal glucose 80–130 mg/dL |
| Usual maintenance dose | 0.5–1.0 units/kg/day (total); Regular insulin as 50–60% of total daily dose divided before meals |
| Maximum dose | Individualised; no fixed ceiling; guided by glycaemic targets |
Clinical Notes:
- Administer SC 30 minutes before meals to align with pharmacokinetic profile
- Typically used in basal-bolus regimen with intermediate-acting (NPH) or long-acting insulin
- Onset: 30–60 minutes; Peak: 2–4 hours; Duration: 5–8 hours
2. Type 2 Diabetes Mellitus (Insulin-Requiring)
| Parameter | Recommendation |
|---|---|
| Starting dose | 4–6 units SC before the largest meal OR 0.1–0.2 units/kg/day as prandial insulin |
| Titration | Increase by 2–4 units every 3–4 days based on postprandial glucose |
| Usual maintenance dose | Individualised; typically 0.3–0.5 units/kg/day as bolus component |
| Maximum dose | No fixed ceiling; titrate to glycaemic targets |
Clinical Notes:
- May be initiated when oral agents fail to achieve glycaemic control
- Can be used as add-on to basal insulin or as part of premixed regimen
- Administer 30 minutes before meals
3. Diabetic Ketoacidosis (DKA) — Intravenous Protocol
| Parameter | Recommendation |
|---|---|
| Starting dose | 0.1 units/kg IV bolus (optional; omit if glucose <250 mg/dL) followed by 0.1 units/kg/hour continuous IV infusion |
| Titration | Adjust infusion rate to achieve glucose reduction of 50–75 mg/dL/hour |
| Usual maintenance dose | 0.05–0.1 units/kg/hour; reduce to 0.02–0.05 units/kg/hour when glucose <200 mg/dL (add 5% dextrose to IV fluids) |
| Maximum dose | Guided by glucose response; if no response, double infusion rate |
Clinical Notes:
- Initiate only after fluid resuscitation commenced
- Continue IV insulin until anion gap closes and patient can tolerate oral intake
- Transition to SC insulin with 1–2 hour overlap before discontinuing IV infusion
- Monitor hourly: blood glucose, electrolytes (especially potassium)
4. Hyperosmolar Hyperglycaemic State (HHS)
| Parameter | Recommendation |
|---|---|
| Starting dose | 0.05–0.1 units/kg/hour IV infusion (after initial fluid resuscitation) |
| Titration | Adjust to reduce glucose by 50–75 mg/dL/hour |
| Usual maintenance dose | 0.02–0.05 units/kg/hour once glucose <300 mg/dL |
| Maximum dose | Individualised based on response |
Clinical Notes:
- Priority is aggressive fluid replacement before insulin initiation
- Avoid rapid glucose reduction to prevent cerebral oedema
- Transition to SC insulin once clinically stable and eating
5. Perioperative and ICU Glycaemic Control
| Parameter | Recommendation |
|---|---|
| Starting dose | 0.5–2 units/hour IV infusion (or per institutional protocol) |
| Titration | Adjust hourly based on blood glucose; target typically 140–180 mg/dL in ICU |
| Usual maintenance dose | 1–4 units/hour; highly variable |
| Maximum dose | No fixed ceiling; guided by glucose levels |
Clinical Notes:
- Regular insulin is the only insulin approved for IV infusion
- Use dedicated IV line or Y-site compatible infusion
- Hourly blood glucose monitoring mandatory during IV insulin infusion
- Transition to SC insulin when patient stable and taking oral diet (overlap by 1–2 hours)
Secondary Indications — Adults (Off-label, if any)
| Indication | Dose | Duration | Label Status | Evidence Basis |
|---|---|---|---|---|
| Hyperkalaemia (emergency treatment) | 10 units Regular insulin IV with 25 g dextrose (50 mL of 50% dextrose) | Single dose; repeat as needed | OFF-LABEL | AIIMS/Indian hospital protocols; standard emergency medicine practice |
| Insulin-glucose infusion for cardiac protection (GIK therapy) | Variable protocols; typically 10–20 units in 500 mL 25% dextrose | Perioperative period | OFF-LABEL; Specialist only | Limited evidence; used in select Indian cardiac surgery centres |
Paediatric indications'
PAEDIATRIC DOSING (Specialist Only)
Primary Indications (Approved / Standard in India)
1. Type 1 Diabetes Mellitus in Children
| Age Group | Total Daily Dose | Regular Insulin Dosing | Notes |
|---|---|---|---|
| Prepubertal children | 0.5–0.7 units/kg/day | Divide prandial component (50–60% of TDD) into 3 premeal doses | Administer 20–30 min before meals |
| Pubertal children | 0.7–1.0 units/kg/day | Divide prandial component into 3 premeal doses | Higher requirements due to growth hormone and sex steroids |
| Newly diagnosed (honeymoon phase) | 0.3–0.5 units/kg/day | Adjust based on SMBG | May require very low doses initially |
Titration:
- Adjust by 0.5–1 unit every 2–3 days based on premeal and postprandial glucose
- Target: Premeal 90–130 mg/dL; Postprandial <180 mg/dL
2. Diabetic Ketoacidosis (DKA) in Children
| Parameter | Recommendation |
|---|---|
| Starting dose | 0.05–0.1 units/kg/hour IV infusion (NO IV bolus in children) |
| Titration | Maintain glucose reduction of 50–75 mg/dL/hour; reduce rate if faster decline |
| Usual maintenance dose | 0.05 units/kg/hour; reduce further when glucose <250–300 mg/dL |
| Maximum dose | 0.1 units/kg/hour initially; rarely need higher |
Clinical Notes:
- IV bolus NOT recommended in paediatric DKA due to risk of cerebral oedema
- Begin insulin infusion 1–2 hours after fluid resuscitation commenced
- Add 5% dextrose to IV fluids when glucose <250–300 mg/dL
- Monitor neurological status closely; signs of cerebral oedema include headache, altered sensorium, bradycardia
Safety Monitoring:
- Hourly blood glucose during IV insulin
- Electrolytes (especially potassium) every 2–4 hours
- Neurological assessment every hour
- Fluid balance charting
Secondary Indications — Paediatrics (Off-label, if any)
| Indication | Dose | Duration | Label Status | Evidence Basis |
|---|---|---|---|---|
| Hyperkalaemia | 0.1 units/kg IV with 0.5 g/kg dextrose | Single dose; repeat as needed | OFF-LABEL; Specialist only | IAP protocols; Indian PICU practice |
| Neonatal hyperglycaemia (NICU) | 0.01–0.05 units/kg/hour IV infusion | Until glucose controlled | OFF-LABEL; Specialist only | AIIMS Neonatology protocols |
Age Restriction: Not recommended in infants <1 year except under paediatric endocrinology or PICU/NICU specialist supervision.
Renal Adjustments
| Renal Function | Recommendation |
|---|---|
| eGFR ≥50 mL/min | No adjustment required |
| eGFR 30–49 mL/min | Anticipate increased insulin sensitivity; consider 25% dose reduction; monitor closely |
| eGFR 10–29 mL/min | Significant accumulation risk; reduce dose by 25–50%; frequent SMBG mandatory |
| eGFR <10 mL/min or dialysis | Marked hypoglycaemia risk; reduce dose by 50%; administer after dialysis session; close monitoring |
Clinical Notes:
- Renal impairment reduces insulin clearance and gluconeogenesis
- Hypoglycaemia risk substantially increased in CKD stages 4–5
- Regular insulin preferred over long-acting analogues in severe CKD due to shorter duration
Hepatic adjustment
Contraindications
- Hypoglycaemia (active or recurrent unexplained episodes)
- Known hypersensitivity to regular insulin or any excipient in the formulation
Cautions
- Renal or hepatic impairment (increased hypoglycaemia risk)
- Elderly and malnourished patients
- Irregular meal patterns or erratic food intake
- Gastroparesis (unpredictable absorption timing)
- Intercurrent illness, infection, or stress states (may increase insulin requirements)
- Adrenal or pituitary insufficiency (increased hypoglycaemia risk)
- Repeated injection at same site (lipohypertrophy risk)
- Hypokalaemia or risk of hypokalaemia (especially with IV use)
- Patients with impaired awareness of hypoglycaemia
Pregnancy
| Parameter | Recommendation |
|---|---|
| Safety status | Safe in pregnancy; preferred insulin for GDM and pre-existing diabetes |
| Preferred alternative | Human insulin (regular and NPH) preferred over analogues; analogues (lispro, aspart, detemir) also acceptable |
| When to use | Throughout pregnancy for diabetes management; essential for GDM not controlled by diet |
| Monitoring | Frequent SMBG (4–7 times daily); HbA1c monthly; fetal growth monitoring; dose adjustment each trimester |
Clinical Notes:
- Insulin requirements typically increase progressively, especially in 2nd and 3rd trimesters
- Risk of hypoglycaemia increased in 1st trimester
- Insulin requirements may drop rapidly postpartum
Lactation
| Parameter | Recommendation |
|---|---|
| Compatibility | Compatible with breastfeeding |
| Drug levels in milk | Not applicable; insulin is a large peptide, not secreted in milk in significant amounts |
| Preferred alternative | Human insulin is preferred; no concerns with any insulin type |
| Infant monitoring | No specific monitoring required; observe for normal feeding and growth |
Clinical Notes:
- Breastfeeding may increase maternal glucose utilisation; dose reduction may be needed
- Maintain adequate caloric intake to prevent hypoglycaemia
Elderly
- Starting dose: 0.1–0.2 units/kg/day (lower end of dosing range)
- Titration: Conservative; increase by 1–2 units every 3–5 days
- Extra risks:
-
- Hypoglycaemia more common and more dangerous (risk of falls, cardiac events, cognitive impairment)
- Hypoglycaemia unawareness may be present
- Reduced renal function (even with normal creatinine)
- Polypharmacy increasing interaction risk
- Visual impairment affecting self-administration
- Recommendations:
-
- Less stringent glycaemic targets (HbA1c 7.5–8.5%) may be appropriate
- Simplified regimens preferred (avoid complex basal-bolus if possible)
- Consider caregiver training for insulin administration
| Interacting Drug/Class | Mechanism/Effect | Recommendation |
|---|---|---|
| Beta-blockers (especially non-selective: propranolol) | Mask hypoglycaemia symptoms (tremor, tachycardia); may prolong hypoglycaemia | Use cardioselective beta-blockers if needed; educate patient on neuroglycopenic symptoms |
| Systemic corticosteroids | Increase insulin resistance; raise blood glucose | May require significant insulin dose increase (sometimes 2–3 fold); monitor closely |
| Fluoroquinolones (especially gatifloxacin) | Unpredictable glycaemic effects (hypo- or hyperglycaemia) | Avoid gatifloxacin; monitor closely with other fluoroquinolones |
| Thiazolidinediones (pioglitazone) | Additive hypoglycaemic effect; fluid retention | Monitor for hypoglycaemia and oedema; dose adjustment may be needed |
Moderate drug interactions
| Interacting Drug/Class | Mechanism/Effect | Recommendation |
|---|---|---|
| ACE inhibitors / ARBs | May enhance insulin sensitivity | Monitor for hypoglycaemia, especially when initiating |
| Thiazide diuretics | May cause hyperglycaemia | May require insulin dose increase |
| Alcohol | Potentiates hypoglycaemia; impairs counter-regulatory response | Counsel patients; avoid excess; ensure food intake with alcohol |
| Salicylates (high-dose aspirin) | May enhance hypoglycaemic effect | Monitor glucose if high-dose aspirin used |
| Octreotide | Variable effect on insulin requirements | Monitor closely; may reduce or increase requirements |
| MAO inhibitors | May enhance hypoglycaemic effect | Monitor glucose closely |
| Pentamidine | May cause hypoglycaemia initially, then hyperglycaemia | Close glucose monitoring during treatment |
Common Adverse effects
- Hypoglycaemia (most common and dose-limiting)
- Injection site reactions (pain, erythema, pruritus)
- Lipohypertrophy at injection sites
- Weight gain
- Peripheral oedema (insulin oedema; usually transient)
- Transient visual disturbances (refractive changes with initiation)
Serious Adverse effects
- Severe hypoglycaemia (neuroglycopenia, seizures, loss of consciousness, coma) — requires immediate intervention with glucose/glucagon
- Hypokalaemia (especially with IV insulin; can precipitate arrhythmias)
- Anaphylaxis and severe allergic reactions (rare)
- Lipoatrophy at injection sites (rare with human insulin)
- Insulin antibody formation (rare; may affect glycaemic control)
Monitoring requirements
| Timing | Parameters |
|---|---|
| Baseline | Blood glucose, HbA1c, renal function, hepatic function, lipid profile, electrolytes (if IV use planned) |
| After initiation/dose change | SMBG 4–7 times daily (premeal, 2-hour postprandial, bedtime); more frequent with IV insulin (hourly) |
| Long-term | HbA1c every 3 months; annual renal function, lipid profile, retinal examination; injection site inspection at each visit |
| IV insulin (DKA/HHS/ICU) | Hourly blood glucose; electrolytes (especially potassium) every 2–4 hours; fluid balance |
Brands in India
Human Regular Insulin (Soluble):
- Actrapid® (Novo Nordisk)
- Huminsulin®-R (Eli Lilly)
- Wosulin®-R (Wockhardt)
- Insuman® Rapid (Sanofi)
- Insugen®-R (Biocon)
- Recosulin®-R (Biocon)
- Human Insulin Injection IP (multiple generic manufacturers)
Note: Verify insulin type and concentration (40 IU/mL vs 100 IU/mL) before dispensing; use matching syringes.
Price range (INR)
| Formulation | Approximate Price | Notes |
|---|---|---|
| Vial 40 IU/mL (10 mL) | ₹50–80 per vial | Government supply; Jan Aushadhi |
| Vial 100 IU/mL (10 mL) | ₹80–150 per vial | |
| Cartridge 100 IU/mL (3 mL) | ₹100–180 per cartridge | |
| Pre-filled pen 100 IU/mL | ₹150–250 per pen |
NLEM Status: Soluble insulin injection is included in NLEM 2022; NPPA price-controlled.
Government Supply: Available through government hospitals, NHM, and Jan Aushadhi stores at subsidised rates.
Clinical pearls
- Regular insulin must be administered 30 minutes before meals; failure to do so results in postprandial hyperglycaemia followed by late hypoglycaemia
- Only Regular (soluble) insulin can be given intravenously; never use insulin analogues or cloudy insulin preparations IV
- For DKA management, continue IV insulin until anion gap closes, not just until glucose normalises; overlap SC insulin by 1–2 hours before stopping IV infusion
- Always verify insulin type and concentration; mixing up 40 IU/mL and 100 IU/mL formulations with incorrect syringes is a common and dangerous error
- Rotate injection sites systematically to prevent lipohypertrophy; injecting into lipohypertrophic areas causes erratic absorption
- When treating hyperkalaemia with insulin-dextrose, always co-administer dextrose to prevent hypoglycaemia; monitor glucose every 30–60 minutes for 4–6 hours
Version
v1.0 — 29 May 2025
Reference
-
- DSCO product database
- Indian Pharmacopoeia / National Formulary of India
- NLEM 2022
- API Textbook of Medicine
- ICMR Guidelines for Management of Type 2 Diabetes
- AIIMS Protocols for DKA and HHS Management
- IAP Guidelines for Paediatric Diabetes and DKA
- ISPAD Clinical Practice Consensus Guidelines (supportive reference for paediatric DKA)
- WHO Model List of Essential Medicines (supportive)
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Clinical Responsibility
This platform is designed strictly for healthcare professionals. Data provided is synthesized from authoritative pharmacological sources and clinical registries. Do not use for consumer medical decisions. Always verify critical dosing and contraindications with official institutional protocols and peer-reviewed journals.
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