Insulin

Provider Level

RN/Paramedic

Class

Pancreatic hormone, Antidiabetic agent

Mechanism of Action

Facilitates cellular uptake of glucose, amino acids, and potassium. Promotes glycogenesis and lipogenesis while inhibiting gluconeogenesis and glycogenolysis.

Indications

Severe hyperglycemia, diabetic ketoacidosis (DKA), hyperosmolar hyperglycemic state (HHS), and hyperkalemia (administered with dextrose).

Contraindications

Hypoglycemia, known hypersensitivity to insulin or its excipients.

Routes

SQ, IV, IO

Onset / Duration

Onset: IV is rapid (minutes), SQ Regular insulin is 30 to 60 minutes. Duration: IV is 30 to 60 minutes, SQ Regular insulin is 5 to 8 hours.

Adverse Effects

Hypoglycemia, hypokalemia, hypomagnesemia, tachycardia, diaphoresis, confusion, seizure, and injection site reactions.

Precautions & Interactions

Continuous and frequent blood glucose monitoring is essential. When treating hyperkalemia, dextrose must be co-administered to prevent profound hypoglycemia. Monitor continuous ECG for signs of hypokalemia.

Special Considerations

High-alert medication. Authorized provider levels: RN/Paramedic. Always double-check syringe type (use U-100 syringes for U-100 insulin) and verify blood glucose prior to administration. Regular insulin is typically the only formulation given IV in the prehospital or critical care transport setting.