Back to Basics: Insulin Quick & Dirty in the ED (Part 1)

Insulin Part 1 - Quick and dirty in the ED

By: Rachel Rafeq, PharmD & Karen O'Brien, DO

- Short acting (-LIN) > actually just regular insulin that mimics our body’s baseLINe insulin

o Humulin R (R = regular)

o Novolin R

- Rapid acting = Humalog (lispro), novolog (aspart), glulisine

o Quick on quick off mealtime insulin

- Ultra rapid acting = FIASP (aspart), Afrezza 

- Humulin N (NPH) = iNtermediate

o Acts longer

- Long acting = glargine or detemir

o 24 hours peakless

- Ultra-long = 25 hours half-life


- Mixed products such as insulin NPH suspension with regular (Humulin 70/30 or Novolin 70/30)

- Most insulins are injected but there is also an inhaled recombinant human regular insulin called Afrezza



- Standard concentration of insulin = 100 units per 1 mL

- Enter… insulin syringes - to avoid overdosing!

- But don’t use insulin syringes (markings are in units not mL) to dose concentrated insulin

- *Insulin syringes are designed to deliver 100 units for every 1 mL.  In a patient receiving U-500 concentrated insulin the dose by nature is 5x more concentrated.  This means that if an insulin syringe is utilized, it will deliver an overdose of an already concentrated medication.

- Ex. Patient takes U-500 regular insulin 170 units daily

- With an insulin syringes 170 units = 1.7 mL > 1.7 mL of U-500 is 850 units!  Therefore use of tuberculin syringe to draw up the dose which has markings by volume!



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