Humulin 50/50: Adult Dosing

Dosage forms: SC

diabetes mellitus

individualize dose SC qd-bid

Info: give 30-60min before a meal; onset 0.5h, peak 4-8h, duration 24h; usual total insulin requirement 0.5-1 units/kg/day

renal dosing

adjust dose amount

renal impairment: decr. dose, amount not defined; HD/CAPD: not defined

hepatic dosing

adjust dose amount

hepatic impairment: decr. dose, amount not defined

Humulin 50/50: Peds Dosing

Dosage forms: SC

diabetes mellitus

individualize dose SC qd-bid

Info: usual total insulin requirement 0.5-1 units/kg/day; adolescents may require higher doses; give 30-60min before a meal or hs; onset 0.5h, peak 4-8h, duration 24h (short-onset/intermediate-acting insulin)

renal dosing

adjust dose amount

renal impairment: decr. dose, amount not defined; HD: not defined

hepatic dosing

adjust dose amount

hepatic impairment: decr. dose, amount not defined

Humulin 50/50: Contraindications/Cautions

• hypersens. to drug/class/compon.
• IV administration
• hypoglycemia
• caution if infection, illness, or stress
• caution if hypokalemia
• caution if impaired renal fxn
• caution if impaired liver fxn

Humulin 50/50: Drug Interactions

Avoid/Use Alternative

• beta blockers, systemic

• repaglinide

Monitor/Modify Tx

• A2R blocker/HCTZ combos

• acarbose

• ACE inhibitor/HCTZ combos

• ACE inhibitors

• amitriptyline/perphenazine

• androgens

• antihist/decongest/DM combos

• antihist/decongestant combos

• antipsychotics, atypical

• baclofen

• beta blocker/thiazide combos

• budesonide

• contraceptives, oral combo

• contraceptives, other combo

• corticosteroids, systemic

• decongest/opiate combos

• decongestants

• diazoxide

• disopyramide

• diuretics, loop

• diuretics, potassium-sparing/HCTZ

• diuretics, thiazide

• enalapril/felodipine

• ethanol

• gatifloxacin

• growth hormone

• HRT, estrogen

• HRT, estrogen/progestin combo

• isoniazid

• isoniazid/pyrazinamide/rifampin

• isoniazid/rifampin

• lanreotide

• levofloxacin

• MAOIs, all

• mecasermin (recombinant)

• meperidine/promethazine

• metformin

• metformin/sulfonylurea combos

• miglitol

• nateglinide

• niacin

• niacin/lovastatin

• niacin/simvastatin

• nicotine

• octreotide

• ofloxacin

• pegvisomant

• pentamidine

• phenothiazines

• phenytoins

• promethazine/codeine

• protease inhibitors

• sitagliptin

• sitagliptin/metformin

• sotalol

• sulfonylureas

• sympathomimetics, all

• thiazolidinediones

• thyroid hormones

• vorinostat

Therapeutic Advantage

• pramlintide

Caution Advised

• bortezomib

Humulin 50/50: Adverse Reactions

Serious Reactions

• hypoglycemia, severe
• hypokalemia
• hypersensitivity rxn, generalized
• anaphylaxis (rare)

Common Reactions

• hypoglycemia
• injection site rxn
• lipodystrophy at injection site
• pruritus
• rash
• weight gain

Humulin 50/50: Safety Monitoring

Pregnancy: B

Lactation: Probably Safe

Monitoring Parameters: Cr at baseline

Noninterchangeable Forms: may need dose adjustment if change insulin strength, timing, type, source species, manufacturer, or manufacturing method

Humulin 50/50: Pharmacology

Metabolism: liver, kidney, fat; CYP450: none

Excretion: see individual drugs

Class: Diabetes Mellitus

Mechanism Of Action
stimulates peripheral glucose uptake, inhibits hepatic glucose production, inhibits lipolysis and proteolysis, regulating glucose metabolism

Humulin 50/50: Manufacturer/Pricing

Manufacturer: Eli Lilly and Co. DEA/FDA: OTC Approximate Retail Price suspension: 50-50 % (1 vial, 10 ml): $45.99

Humulin 50/50: Patient Education

• Generic Name: insulin isophane and insulin regular

• Pronounced: IN suh lin EYE sew fane and IN suh lin REH gue ler

• Brand Names: Humulin 50/50, Humulin 70/30, Humulin 70/30 Pen, Novolin 70/30, Novolin 70/30 Innolet

What is the most important information I should know about insulin isophane and insulin regular?

Know the signs and symptoms of low blood sugar (hypoglycemia), which include shaking; nausea; headache; drowsiness; weakness; dizziness; fast heartbeat; sweating; pale, cool skin; anxiety; and difficulty concentrating. Carry a piece of candy or glucose tablets with you to treat episodes of low blood sugar.

Follow any diet and exercise plan that you have developed with your doctor or nurse. Changes in what you eat or how much you exercise can change the amount of insulin that you need to control your blood sugar levels.

Ask your doctor or nurse what to do if you are sick with a cold, flu, or fever. These illnesses may change your insulin requirements.

Do not change the brand of insulin isophane and insulin regular or syringe that you are using without first talking to your doctor or pharmacist. Some brands of insulin isophane and insulin regular and syringes are interchangeable, while others are not. Your doctor and/or pharmacist know which brands can be substituted for one another.

What is insulin isophane and insulin regular?

Insulin is a hormone naturally produced by your pancreas. Insulin enables the body to use the sugar in food as a source of energy. When the body does not produce enough insulin, or when the insulin produced by the body is not effective enough, the condition is called diabetes mellitus. This condition allows sugar levels in the blood to become very high. Diabetics must use man-made insulin or insulin that comes from pigs (which is very similar to human insulin) to lower these high blood sugar levels.

Insulin isophane and insulin regular is used in the treatment of diabetes mellitus.

Insulin isophane and insulin regular may also be used for purposes other than those listed in this medication guide.

What should I discuss with my healthcare provider before using insulin isophane and insulin regular?

Do not use insulin isophane and insulin regular if you are allergic to insulin or if you have intolerance to a certain insulin isophane and insulin regular product.

Before using insulin, tell your doctor if you have any other medical conditions or if you take other prescription or over-the-counter medications, including vitamins, minerals, and herbal supplements.

Before using insulin isophane and insulin regular, tell your doctor if you have kidney or liver disease. You may require a dosage adjustment or special monitoring during treatment.

Most insulins can be used during pregnancy and breast-feeding. They are not expected to be harmful to an unborn baby. It is very important to control blood sugar levels during pregnancy and breast-feeding and insulin is often chosen as the treatment. Some types of insulin may be better than others for use during pregnancy and breast-feeding. Talk to your doctor about the use of insulin during pregnancy and breast-feeding.

How should I use insulin isophane and insulin regular?

Use insulin isophane and insulin regular exactly as directed by your doctor. If you do not understand these instructions, ask your doctor, nurse, or pharmacist to explain them to you.

If the insulin has been stored in the refrigerator, it can be warmed to room temperature before use.

Roll the container of insulin between your palms 10 times. Then, if you are using a pen or prefilled syringe, turn it upside down so that the glass ball moves from one end to the other. Do this at least 10 times. Repeat this procedure until the suspension appears uniformly white and cloudy. Do not shake the insulin vigorously. Inject immediately. Repeat this procedure before each subsequent injection.

Do not use the insulin if it is discolored, has particles in it, or looks different from previous vials, cartridges, or prefilled syringes of insulin isophane and insulin regular.

Use only the approved delivery device(s) for cartridges or prefilled syringes of insulin.

If you are mixing different types of insulins in the same syringe, follow your doctor's directions and always draw up the different insulins in the same order (usually the clear insulin first). Do not mix different insulins in the same syringe unless specifically directed to do so by your doctor.

Rotate injection sites exactly as directed by your doctor. Usually, you should not inject within 1 inch of the same site within 1 month.

Never reuse a needle or syringe. Dispose of all needles and syringes in an appropriate, puncture-resistant disposal container.

Do not change the insulin strength (e.g., U-100) or insulin type (e.g., 50/50 isophane-regular mixture, 70/30 isophane-regular mixture, etc.) unless your doctor recommends a change for you.

Do not change the brand of insulin isophane and insulin regular or syringe that you are using without first talking to your doctor or pharmacist. Some brands of insulin isophane and insulin regular and syringes are interchangeable, while others are not.

Follow any diet and exercise plan that you have developed with your doctor or nurse. Changes in what you eat or how much you exercise can change the amount of insulin that you need to control your blood sugar levels.

Ask your doctor or nurse what to do if you are sick with a cold, flu, or fever. These illnesses may change your insulin requirements.

Your healthcare provider may recommend regular monitoring of blood sugar levels with blood or urine tests.

Wear some type of medical identification bracelet, necklace, or other alert tag to inform others that you have diabetes and that you require insulin in the case of an emergency.

Proper foot care, eye care, dental care, and overall proper health care are important for people with diabetes. Visit your doctor, dentist, eye doctor, and other heath care practitioners as recommended by your doctor.

Store unopened vials, pens, and cartridges of insulin isophane and insulin regular in the refrigerator between 36 and 46 degrees Fahrenheit (2 and 8 degrees Celsius), in the original carton. Do not store insulin isophane and insulin regular in the freezer and do not allow it to freeze. Do not use insulin isophane and insulin regular if it has been frozen. Throw away any expired insulin.

Vials of insulin isophane and insulin regular can be kept unrefrigerated for up to 28 days, but should not be exposed to excessive heat or sunlight.

Once punctured, the vial of insulin in use, whether stored in the refrigerator or at room temperature, must be used within 28 days. Throw away any unused insulin 28 days after the vial is first punctured.

Insulin cartridges and pens in use, should be stored at room temperature (below 86 degrees Fahrenheit/30 degrees Celsius), but should not be exposed to excessive heat or sunlight. Novolin 70/30 PenFill and Prefilled cartridges and Humulin 70/30 cartridges in use can be kept unrefrigerated for one week. Humulin 70/30 Pens and Novolin 70/30 Innolets in use can be kept unrefrigerated for 10 days. Unrefrigerated cartridges, pens, and Innolets must be used within this time period or discarded.

What happens if I miss a dose?

Follow your doctor's directions if you miss a dose of insulin. To prevent missed doses, be sure to always have enough insulin on hand, especially if you are going on vacation.

What happens if I overdose?

Seek emergency medical attention if an overdose is suspected.

Symptoms of an insulin overdose reflect very low blood sugar levels and include headache, irregular heartbeat, increased heart rate or pulse, sweating, tremor, nausea, increased hunger, and anxiety.

What should I avoid while using insulin isophane and insulin regular?

Do not use alcohol without first talking to your doctor. It lowers blood sugar, and you may experience dangerously low blood sugar levels.

What are the possible side effects of insulin isophane and insulin regular?

Rarely, people have allergic reactions to insulin. Seek emergency medical attention if you experience an allergic reaction (difficulty breathing; closing of the throat; swelling of the lips, tongue, or face; or hives).

The side effects of insulin therapy result mostly from blood sugar levels that are either too high or too low. You should be familiar with the symptoms of both high and low blood sugar levels and know how to treat both conditions. Also, be sure your family and close friends know how to help you in an emergency.

Low blood sugar may occur when too much insulin is used; when meals are missed or delayed; if you exercise more than usual; during illness, especially with vomiting or diarrhea; if you take other medications; after drinking alcohol; and in other situations.

Hypoglycemia, or low blood sugar, has the following symptoms: shaking; nausea; headache; drowsiness; weakness; dizziness; fast heartbeat; sweating; pale, cool skin; anxiety; and difficulty concentrating.

Keep sugary candy, fruit juice, or glucose tablets on hand to treat episodes of low blood sugar.

Increased blood sugar may occur if not enough insulin is used, if you eat significantly more food than usual, if you exercise less than usual, if you take other medications, if you have a fever or other illness, and in other situations.

Hyperglycemia, or high blood sugar, has the following symptoms: increased thirst, increased hunger, and increased urination.

Monitor your blood sugar levels and ask your doctor how to adjust your insulin doses if your blood sugar levels are too high.

Side effects may also occur at the site of injection. If the area becomes thickened, hard, or pitted, talk to your doctor before injecting at that site again.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome.

What other drugs will affect insulin isophane and insulin regular?

Many drugs can interact with insulin or affect blood sugar levels. Do not take any other prescription or over-the-counter medicines, including vitamins, minerals, and herbal products, without first talking to your doctor or pharmacist during treatment with insulin.

Where can I get more information?

Your pharmacist has additional information about insulin isophane and insulin regular written for health professionals that you may read.

What does my medication look like?

Insulin isophane and insulin regular is available under the brand names Humulin 50/50, Humulin 70/30, Novolin 70/30, and Insulin Pork Mix. The insulin should be a clear, colorless or evenly colored liquid after it is gently rolled or shaken. Do not use it if it appears to be thick, looks sticky, has particles in it, or looks different from your previous bottles, cartridges, or pens of insulin isophane and insulin regular. Always use the same brand unless your doctor recommends a change. Ask your pharmacist, nurse, or doctor any questions you have about this medication.

• Humulin 50/50 U-100-10 mL vials
• Humulin 70/30 U-100-10 mL vials
• Humulin 70/30 U-100-1.5 mL cartridges
• Humulin 70/30 U-100-3 mL disposable pens
• Novolin 70/30 U-100-10 mL vials
• Novolin 70/30 U-100-1.5 mL PenFill cartridges
• Novolin 70/30 U-100-3 mL PenFill cartridges
• Novolin 70/30 U-100-1.5 mL Prefilled syringes

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Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.

Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise.

Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides.

The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Humulin 50/50: Pill Pictures