porcine insulin: clinical use

Prescribing considerations

• Confirm the exact insulin name and formulation when prescribing, dispensing or switching.
• Requirements may change with illness, physical activity, pregnancy, endocrine disorders, coeliac disease, hepatic disease or severe renal impairment.
• Switching from another insulin requires clinical supervision and intensified glucose monitoring.
• Assess hypoglycaemia awareness, particularly in older people, longstanding diabetes, recurrent hypoglycaemia or concomitant beta-blocker or clonidine use.
• Avoid abrupt movement from repeatedly used abnormal injection sites without closer glucose monitoring because absorption may increase.

Contraindications and cautions

• Current hypoglycaemia
• Hypersensitivity to insulin or any formulation excipient
• Intravenous administration of the selected 30/70 formulation

Monitoring

• Blood glucose and clinical signs of hypo- or hyperglycaemia
• Ketones when clinically indicated or according to the patient's established plan
• Injection sites for lipodystrophy and cutaneous amyloidosis
• Potassium where clinically indicated, particularly after excess insulin or in vulnerable patients
• Weight, oedema and heart-failure symptoms if combined with pioglitazone

Clinical pharmacology

Exogenous insulin lowers blood glucose, promotes glycogen storage and suppresses ketone formation. The selected biphasic isophane formulation has an intermediate action profile. Insulin is metabolised mainly in the liver, with a small amount excreted in urine.

Formulation and product differences

• The selected product is a white suspension containing neutral and isophane porcine insulin.
• Protamine sulfate and zinc contribute to the depot formulation; m-cresol and phenol are preservatives.
• It is supplied as a multidose glass vial and must be gently resuspended before withdrawal.
• After first use, discard unused material after 28 days; do not freeze.