INSULIN ZINC SUSPENSION (LENTE)

Availability

100 units/mL

Action

Intermediate-acting human insulin created by adding zinc ions to human regular insulin. It lowers blood glucose levels by increasing peripheral glucose uptake, especially by skeletal muscle and fat tissue, and by inhibiting the liver from changing glycogen to glucose. It is not the ideal basal insulin since its absorption is variable.

Therapeutic Effect

It lowers glucose level over a longer period of time than regular human insulin.

Uses

Hyperglycemia in diabetic patients allergic to other preparations of insulin. Also for patients with evidence of thrombotic phenomena in which protamine may be a factor.

Contraindications

During episodes of hypoglycemia or in patients sensitive to any ingredient in the formulation; insulin pump; intravenous administration; hyperosmolar hyperglycemic state; diabetic ketoacidosis.

Cautious Use

In insulin resistant patients, hyperthyroidism or hypothyroidism; lactation, older adults, pregnancy (category B), renal or hepatic impairment; children.

Route & Dosage

Administration

• Give insulin zinc suspensions 30 min before breakfast. Some patients require another injection 30 min before supper time or at bedtime.
• Note: Zinc insulin preparation (Lente) is compatible with regular insulin.
• Ensure complete dispersion by mixing thoroughly by gently rotating the vial between the palms and by inverting it end-to-end several times. Do not shake.
• Note: Time of action of insulin zinc (Lente) approximates that of isophane insulin suspension (NPH) allowing patients usually to be transferred directly to the latter on a unit-for-unit basis.
• Store unopened vial at 2°–8° C (36°–46° F). Avoid freezing and exposure to extremes in temperature or to direct sunlight.

Adverse Effects (≥1%)

Interactions

Pharmacokinetics

Nursing Implications

(see INSULIN INJECTION, REGULAR)

Patient & Family Education

• Be alert for S&S of hypoglycemia (see Appendix F); most apt to occur between mid-afternoon and dinner time (an early symptom may be a sense of extreme fatigue). Immediately take soluble carbohydrate (e.g., orange juice, honey). If the time between the midday and evening meal is prolonged, an afternoon snack may be needed.
• Do not overlook possibility of nocturnal hypoglycemia, especially during dose adjustment. Signs include restlessness or profuse sweating during sleep.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug