Estimated by the World Health Organization as the seventh leading cause of death, globally, and a major cause of kidney failure, blindness, lower limb amputation, stroke, and heart attack, diabetes has been a major global health concern for a long time.[1] But, in view of the alarming increase in its prevalence, it is anticipated that the chronic, non-communicable disease may reach epidemic proportions in the 21st century.

Characterized by abnormal blood sugar levels, diabetes is a demanding disease that can affect a person’s life in many ways and can lead to many health complications. However, it can be effectively managed with medicine and lifestyle changes. According to the American Association of Diabetes Educators (AADE), diabetic patients should adopt the following self-care habits to keep their disease under control:

  • Healthy eating
  • Staying physically active
  • Self-monitoring your blood sugar levels on a daily basis, along with keeping an eye on blood pressure and weight.
  • Staying emotionally healthy by learning to cope with stress and life’s issues in general in healthy ways.
  • Educating yourself about the disease and improving your problem-solving skills, so you would be able to take quick and informed decisions whenever your blood sugar levels get disturbed.
  • Getting regular health checkups to prevent, or at least limit, the effects of diabetes on your body.
  • Taking medication as and when prescribed.

Diabetes Medications

Diabetes medications can be divided into two main categories:

  • Insulin – essential for people with type 1 diabetes, but is also prescribed to patients with type 2 diabetes who do not benefit from medicines. It is generally injected into the body through different methods.
  • Oral medications – generally the preferred treatment option for people with type 2 diabetes.

Treating Diabetes with Synthetic Insulin

Used for keeping the blood sugar levels in control in people with type 1 diabetes, synthetic insulin can be divided into different types according to the time they take to start working, their peak time, and the duration for which they stay in the body:

  1. Rapid-acting insulin
  2. Short-acting insulin
  3. Intermediate-acting insulin
  4. long-acting insulin
  5. Pre-mixed insulin (a combination of short and intermediate acting insulin).

Depending on the severity of the disease, the patient’s overall health, lifestyle, and many other factors, a patient may need to use one or more types of insulin. The type and dosage of insulin a patient needs to maintain healthy blood glucose levels can also change over time.

Humulin – Synthetic Insulin Injections

Manufactured by Eli Lilly and Company in 1982, Humulin was the first synthetic insulin, made using genetic engineering, to be approved by the Federal Drug Administration (FDA) for human use[2]. Ever since then, it has been widely used to help diabetic patients (both type 1 and type 2) keep their blood glucose levels within a healthy range.

Types of Humulin

Made from recombinant DNA, Humulin is identical to the natural insulin produced within the human body and is available in three different varieties:

1.     Humulin R

Humulin R is a short-acting regular insulin that is used along with a healthy diet and physical activity to help manage both type 1 and type 2 diabetes, in children and adults. It is available in the form of injections in U-100 and U-500 concentrations, but Humulin R U-500 is rarely used as it is highly concentrated.

Humulin R U-100 comes in two dosage strengths – 3 ml and 10 ml vials. The insulin needs to be injected about 30 minutes to an hour before a meal to ensure the food you are eating doesn’t cause a spike in your blood sugar level.

While the insulin starts to function within 30 to 60 minutes, the effects reach the peak after 2 to 4 hours, and last for about 5 to 8 hours in total.

Depending on your needs, your doctor may advise taking Humulin R dose before every meal or just before breakfast and dinner.

2.     Humulin N (NPH)

An insulin isophane suspension made with recombinant DNA technology to make it identical to the natural human insulin secreted inside the body, Humulin N is an intermediate-acting insulin that helps to prevent blood sugar spikes during the night and between meals.

Available in 10 ml vials and 3 ml prefilled Kiwi pens, Humulin N U-100 takes about 1 to 2 hours to start working and reach its peak action in 4 to 6 hours. It can keep your blood sugar in control for more than 12 hours. It can be used for both children and adults.

3.     Humulin 30/70

This type of Humulin is prepared by combining Humulin R (30%) and Humulin N (70%) and is supplied in 3 ml and 10 ml vials and 3 ml prefilled KiwiPen.

This combination insulin is highly effective because it has both short-term and long-term effects – it starts working within 10 to 20 minutes of administration and reaches peak effects in about 2 hours, but it continues to prevent blood sugar spikes for up to 24 hours.

Unlike Humulin R and Humulin N, Humulin 70/30 can only be used by adult diabetic patients.

Important Considerations for Humulin Use

No matter what type of Humulin insulin you are prescribed, here are some important things that you should follow:

  • While Humulin vials and pen can be stored at room temperature below 86 degrees Fahrenheit, it is better to store them in a refrigerator between 36 to 46 degrees Fahrenheit (2 -8 degrees centigrade).
  • Do not use Humulin if it is frozen.
  • Inspect insulin before use and do not use it if it has solid particles or if the white material (insulin substance) remains at the bottom of the vial even after mixing.
  • Use Humulin vials within 31 days and discard after that.
  • Open  Humulin pens should be not be stored in a refrigerator and should not be used after 14 days.
  • Do not shake the vial to mix the substance. Instead, roll it between your hands until the mixture is uniformly cloudy and white.
  • Always administer insulin injections subcutaneously (under the skin); do not inject them into a muscle or vein.
  • Never share your syringe, needle, or KiwiPen with anyone.
  • Do not use a different type of insulin or change your dose on your own; always consult your doctor if you think your insulin requirements have changed.
  • Abstain from consuming alcohols or any medicine that contains alcohol as it can cause blood sugar levels to drop and may also interfere with diabetes medications.
  • New users of Humulin should avoid driving and operating heavy machinery until they are fully aware of how insulin affects them.

Possible Side Effects of Humulin

While Humulin insulin injections are considered safe, they may cause any of the following negative effects in some cases:

  • Hypoglycemia i.e. low blood sugar. Symptoms of hypoglycemia include:
  • Sweating
  • Confusion
  • Headache
  • Dizziness
  • Blurred vision
  • Feeling shaky
  • Slurred speech
  • Anxiety
  • Hunger
  • Mood changes or irritability
  • Fast heartbeat
  • Allergic reactions causing rashes, sweating, difficulty in breathing, and increased heartbeat.
  • Itchiness
  • Lipodystrophy – pits or skin thickening at injection sites.

Immediately inform your doctor if you experience:

  • Hypokalemia – low blood potassium. Symptoms include constipation, fluttering in the chest, tingling or numbness in the body, leg cramps, muscle weakness, irregular heartbeat, increased third, and increased urination.
  • Fluid retention causing swelling of the hands and/or feet, shortness of breath, and weight gain.

Who Should Not Use Humulin

You must not use Humulin if you are allergic to insulin or to any of the ingredients present in Humulin, or often experience low blood sugar levels (hypoglycemia).

What to Tell Your Doctor before You Start Taking Humulin

Just like any other medication, it is important that you share all the details about your health with your doctor before you start taking Humulin. Make sure your doctor knows if you have or have had any of the following health problems and if you are taking any medicines for them:

  • Allergies to any food, medicines, dyes, and/or preservatives
  • Liver disease
  • Kidney issues
  • Hyperthyroidism – an overactive thyroid gland
  • Acromegaly – a rare disease caused by the overproduction of the growth hormone and leads to enlargement of the feet, hands, and face
  • Fluid retention in the body, particularly in the ankles, feet, and hands
  • Cushing’s syndrome – overactive adrenal glands
  • Pheochromocytoma – a tumor of the adrenal gland tissue
  • Heart disease

In addition to the medical conditions you have or had in the past, your doctor should also know if you are pregnant or planning to become pregnant. This is important because the body’s need for insulin changes at different stages of pregnancy and your dosage will need to be adjusted accordingly. In some cases, pregnancy can also make diabetes management difficult.

Similarly, breastfeeding can also affect women’s blood sugar levels. Since the body uses a large amount of sugar to produce milk, a diabetic nursing mother may need lower insulin dosage than she what was taking earlier. On the other hand, it may increase the risk of hypoglycemia in some people. This is why it is important to tell your doctor and discuss the potential risks and benefits if you are a nursing mother or plan to breastfeed.

Lastly, do tell your doctor if you consume alcohol. Alcohol consumption is known to increase insulin secretion in the body and hence, can cause the blood sugar level to drastically reduce, leading to hypoglycemia.

Possible Drug Interactions

While it is important to inform your doctor about all the prescription, non-prescription, and herbal medicines and supplements that you are taking, tell your healthcare advisor about the following medicines, in particular, as they may affect the functioning and efficiency of Humulin:

  • Oral hypoglycemic medications for type 2 diabetes
  • Thiazolidinediones (TZDs)
  • Corticosteroids, such as cortisone and prednisone, or any other medicine that affects the metabolic system
  • Antidepressants
  • Asthma medicines, such as terbutaline and salbutamol
  • Medicines for the treatment of tuberculosis, for example, isoniazid
  • Aspirin or other types of salicylates
  • Antibiotics
  • Any medicine that is used to treat tumors and growth disorders, such as octreotide
  • High blood pressure medicines
  • Medicines for heart-related issues
  • Oral contraceptives

Humulin Prescription Assistance

Lilly Cares Foundation Patient Assistance Program provides Humulin insulin injections free of cost to eligible patients.  Under this program, patients can get Humulin for up to a year, in 4 months supplies, with the option to apply for re-enrollment. But, in order to qualify for the Lilly Cares program, you have to meet all of the following eligibility requirements:

  • Be a permanent citizen or legal resident of the US or Puerto Rico.
  • Uninsured, underinsured, or have Medicare part D.
  • Not enrolled in Medicaid, Veterans benefits, or full Low-Income Subsidy.
  • Have Medicare part D and have spent $1100 on prescription medications in the current calendar year.
  • Falls under the annual income limit.

To find more details about the program, visit the website or dial 1-800-545-6962.

[1] https://www.who.int/news-room/fact-sheets/detail/diabetes

[2] https://www.nytimes.com/1982/10/30/us/a-new-insulin-given-approval-for-use-in-us.html