What is the recommended use and dosage of Actrapid (human insulin) for managing diabetes mellitus?

From the Guidelines

Actrapid (human insulin) is recommended for the management of diabetes mellitus with dosing that must be individualized based on the patient's blood glucose levels, weight, and insulin sensitivity. The typical starting dose for insulin-naïve patients is 0.2-0.6 units per kilogram of body weight daily, often divided into multiple injections. Actrapid is a short-acting insulin that begins working within 30 minutes, peaks in 2-3 hours, and lasts for approximately 8 hours, making it suitable for mealtime insulin coverage. It should be injected subcutaneously 15-30 minutes before meals, with dosage adjustments made based on pre-meal and bedtime blood glucose measurements, as suggested by 1.

For many patients, Actrapid is used in combination with intermediate or long-acting insulin to provide 24-hour coverage. Blood glucose monitoring is essential when using Actrapid, as is understanding how to adjust doses for exercise, illness, and changes in diet, as emphasized by 1. Hypoglycemia is the most common side effect, so patients should always have fast-acting carbohydrates available. Actrapid works by facilitating glucose uptake into cells and inhibiting hepatic glucose production, directly addressing the core physiological defect in diabetes—insufficient insulin action.

Key considerations for using Actrapid include:

• Individualized dosing based on patient factors such as blood glucose levels, weight, and insulin sensitivity
• Combination therapy with other types of insulin for comprehensive glycemic control
• Regular blood glucose monitoring to adjust dosages and prevent hypoglycemia
• Patient education on adjusting insulin doses in response to changes in diet, exercise, and health status, as outlined in 1 and 1.

From the Research

Recommended Use of Actrapid

• Actrapid, also known as human insulin, is used for managing diabetes mellitus, particularly for patients with type 1 diabetes mellitus (T1DM) and type 2 diabetes mellitus (T2DM) who require insulin therapy 2.
• The primary treatment for T1DM is insulin, and patients typically require multiple daily injections of short-acting or rapid-acting insulin analogue, given 0 to 15 minutes before meals, along with one or more daily separate injections of intermediate or long-acting insulin 2.

Dosage of Actrapid

• The dosage of Actrapid varies depending on the individual patient's needs and is usually determined by a healthcare professional.
• In one study, patients with T2DM were given 0.15 IU/kg body weight of Actrapid immediately before a test meal, or 30 minutes before the meal 3.
• Another study used a dose of 10 U Actrapid HM, given immediately before a standardized breakfast, either by a sprinkler needle or a conventional needle 4.
• A study comparing Actrapid with an insulin analogue used a dose of 10 U Actrapid or an equimolar amount of the analogue, injected immediately before a 500 kcal test meal 5.

Administration of Actrapid

• Actrapid can be administered subcutaneously using a conventional needle or a sprinkler needle, which has been shown to improve insulin absorption and glycaemic response to a meal 4.
• The use of a sprinkler needle has been found to result in a more rapid increase in plasma free insulin levels and a lower postprandial glucose excursion compared to a conventional needle 4.
• It is recommended to use the shortest needles available (currently 4-mm pen and 6-mm syringe needles) as they are safe, effective, and less painful, and to avoid intramuscular injections, especially with long-acting insulins, due to the risk of severe hypoglycemia 2.