Human Actrapid (Regular/Soluble Insulin) - 65 kg Adult

What is Actrapid?

• Onset: ~30 minutes after SC injection
• Peak effect: 2-4 hours
• Duration: 5-8 hours

Step-by-Step Bolus Dose Calculation for 65 kg

Step 1 - Calculate Total Daily Dose (TDD)

Per the Textbook of Family Medicine 9e: "TDD = weight in kg × 0.7. For a 70-kg patient = 49 units/day." Per Goldman-Cecil Medicine: "Total daily insulin requirement for adults with Type 1 DM = 0.3-1.0 unit/kg/day."

Step 2 - Bolus (Actrapid) vs. Basal Split

Step 3 - Per-Meal Bolus Dose

• 65 kg × 0.1 = ~6-7 units per meal (as a starting dose)

From Textbook of Family Medicine: "Dose of prandial insulin = 0.1 units/kg/meal (a 70-kg patient requires 70 × 0.1 = 7 units rapid-acting insulin per meal)."

Step 4 - Correction Factor (Sliding Scale addition)

• 1 unit lowers blood glucose by approximately 20-50 mg/dL (varies by individual sensitivity)
• Common rule: 1 unit per 10-15 g of carbohydrate consumed

Practical Summary for 65 kg Adult

Important Cautions

1. These are starting/estimated doses - always titrate based on blood glucose monitoring (target fasting BG: 80-130 mg/dL, 2-hr postprandial: <180 mg/dL).
2. Type 1 DM requires insulin replacement - typical range 0.5-1.0 u/kg/day.
3. Type 2 DM starting on insulin - begin lower (0.1-0.2 u/kg/day basal first, then add bolus).
4. Actrapid must be given 30 minutes before meals - hypoglycemia risk if meal is delayed.
5. Adjust for renal impairment, elderly patients, poor oral intake, intercurrent illness.
6. Always monitor for hypoglycemia - especially overnight and post-exercise.

• Goldman-Cecil Medicine (International Edition) - Intermittent Subcutaneous Insulin, insulin dosing 0.3-1.0 u/kg/day
• Textbook of Family Medicine 9e - Basal-bolus initiation: TDD = weight × 0.7; prandial dose = 0.1 u/kg/meal
• Fuster and Hurst's The Heart, 15th Edition - 50% TDD as bolus/prandial insulin

Note: This is a clinical guide. Actual doses must be individualized by a treating physician based on the patient's glucose monitoring, HbA1c, diet, renal function, and clinical context.

Inj. Human Actrapid - STAT / Casualty Dosing (65 kg Adult)

The key question in casualty: Why is the insulin being given?

SCENARIO 1 - DKA (Diabetic Ketoacidosis) - Most Common Casualty Indication

STAT Bolus (IV):

0.1 units/kg IV bolus = 6.5 units IV STAT (round to 6-7 units)

Followed immediately by IV Infusion:

0.1 units/kg/hour = 6-7 units/hour as continuous IV infusion

If no response in 2-4 hours:

Double or triple the infusion rate (12-21 units/hour)

"Administer short-acting regular insulin: IV (0.1 units/kg), then 0.1 units/kg per hour by continuous IV infusion; increase two- to threefold if no response by 2–4 h."

CRITICAL: Check serum K+ FIRST. If K+ < 3.3 mmol/L - do NOT give insulin until potassium is corrected (risk of fatal hypokalemia).

SCENARIO 2 - HHS (Hyperosmolar Hyperglycaemic State)

• STAT IV Bolus: 6.5 units IV (0.1 u/kg)
• Followed by: 6.5 units/hour IV infusion
• Reduce to 0.02-0.1 u/kg/hr when glucose reaches 11-14 mmol/L (200-250 mg/dL)

SCENARIO 3 - Acute Hyperglycemia (Non-DKA, Casualty Walk-in)

Subcutaneous STAT correction dose (SC):

• Starting premeal SC dose: 0.1-0.2 units/kg
• For 65 kg = 6.5 to 13 units SC stat
• Plus correction factor: +1-2 units per 50 mg/dL above 140 mg/dL

These are approximations based on a correction factor of ~1 unit per 50 mg/dL above target (BG 140 mg/dL), starting point of ~6 units at BG ~200.

SCENARIO 4 - Severe Calcium Channel Blocker Overdose (Casualty)

• IV Bolus: 1 unit/kg = 65 units IV STAT
• Then 1 unit/kg/hour infusion
• With Dextrose 10% at 200 mL/hour to prevent hypoglycemia (Goldman-Cecil Medicine)

Practical STAT Casualty Summary

Critical Checks Before Giving Actrapid in Casualty

1. Check K+ level - Do NOT give if K+ < 3.3 mEq/L (give KCl first)
2. Check BG - Confirm hyperglycemia before dosing
3. Urine output - Ensure renal perfusion before K+ replacement
4. Route - IV only in critical/DKA/HHS; SC for non-critical hyperglycemia
5. Have 25% Dextrose (D25W) at bedside - to treat hypoglycemia if BG falls too fast
6. Monitor BG every 1 hour in ICU/emergency setting
7. Do not give SC Actrapid to hypotensive/shocked patients - absorption unreliable; use IV route

• Harrison's Principles of Internal Medicine 22E - DKA & HHS protocols: 0.1 u/kg IV bolus + 0.1 u/kg/hr infusion
• Washington Manual of Medical Therapeutics - Inpatient hyperglycemia: 0.1-0.2 u/kg starting SC dose + correction factor
• Goldman-Cecil Medicine - CCB overdose: 1 u/kg IV bolus protocol

Disclaimer: These are evidence-based reference doses. Final dosing must be decided by the treating emergency physician based on clinical state, BG level, electrolytes, and patient response.