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Insulin Regular (Soluble Insulin): Uses, Dosage, Side Effects & Price | DrugsAtlas

Authoritative Clinical Reference

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

Major drug interactions

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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