Insulin

Q: What is Insulin used for?

Insulin is evaluated for the following indications with varying evidence strength: Insulin-dependent type 2 diabetes mellitus (evidence tier A), Type 1 diabetes mellitus (evidence tier A), Muscle mass gain (bodybuilding self-use) (evidence tier F). See the full indication matrix with dosing and citations above on this page.

Q: What are the side effects of Insulin?

Common side effects of Insulin (≥ 1 in 100): Hypoglycaemia (most common adverse effect), Weight gain (in some patients on intensification), Local injection-site reactions: lipohypertrophy, lipoatrophy, bruising. See the Safety section for uncommon and serious reactions.

Q: Is Insulin safe during pregnancy?

FDA category B. Insulin is the treatment of choice for glycaemic control in gestational diabetes and in pregnant women with type 1/2 diabetes. Human insulin and modern analogues (aspart, lispro, detemir) with confirmed pregnancy safety are used. Glargine is discussed; degludec has limited data.

Q: Is Insulin compatible with breastfeeding?

Fully compatible with breastfeeding. Insulin is digested in the infant gastrointestinal tract and does not affect the child.

Q: Who should not take Insulin?

Insulin is contraindicated in: Hypersensitivity to insulin or excipients; Hypoglycaemia. Full list in the Safety section.

AEMPS

Insulins and analogues (general card; individual products require separate cards)

ATC code: A10A (Insulins and analogues)

Brand names

Humulin, Lantus, Toujeo, Tresiba, NovoRapid, Humalog, Apidra, Levemir, Fiasp

Mechanism of action

Insulin is a hormone of pancreatic beta cells. It binds the insulin receptor and initiates a phosphorylation cascade that increases glucose uptake in muscle and adipose tissue, stimulates hepatic glycogen synthesis, and suppresses gluconeogenesis and lipolysis. Modern preparations are recombinant human insulins and analogues with modified pharmacokinetics: ultra-short (lispro, aspart, glulisine), short (regular), intermediate (NPH), long (glargine, detemir), and ultra-long (degludec). Important: this is a general card; each specific insulin will have its own card in Evigrade.

Indications

Insulin-dependent type 2 diabetes mellitus

First line

Some patients with type 2 diabetes already require insulin: inadequate control on oral and non-insulin injectable agents, decompensation symptoms, marked catabolism, or severe hyperglycemia. For them, insulin is essential therapy. At earlier stages, first-line is metformin and non-insulin classes (GLP-1 agonists, SGLT2 inhibitors); clinicians add insulin when these are insufficient. Regimens: basal insulin, escalating to basal-bolus as needed.

Sources

ICD-10: E11.9 · ICD-11: 5A11

Type 1 diabetes mellitus

First line

Insulin therapy is the only life-sustaining treatment for type 1 diabetes. Recommended by 2024, ISPAD 2022, ESPE, and the Russian Ministry of Health. Modern standard is basal-bolus (long-acting analogue as basal plus ultra-short before meals) or pump therapy; in children and adolescents, sensor-augmented and closed-loop systems. Target < 7% in most adults; individual targets in children, adolescents, older adults, and pregnancy.

Initial daily requirement in a newly diagnosed adult is 0.4-0.5 U/kg, higher in ketoacidosis. In children and adolescents – 0.7-1.0 U/kg during puberty. Distribute 40-50% as basal and 50-60% as boluses.

Sources

ICD-10: E10 · ICD-11: 5A10

Marketing claims without evidence base

The drug is promoted for these uses outside international guidelines. Each entry below is analyzed against AEMPS, FDA, EMA, Cochrane and major RCTs.

Muscle mass gain (bodybuilding self-use)

Not recommended

Insulin is used illicitly by bodybuilders for mass gain based on its anabolic effect via IGF-1-like action and stimulation of muscle amino-acid uptake. The effect on mass is small and the risk of fatal hypoglycaemia is high. Cases of hypoglycaemic coma and sudden death in healthy bodybuilders are reported. Hypoglycaemia is recognised late – during training or sleep. WADA lists insulin as prohibited. Using insulin in a healthy person with normal beta-cell function is Russian roulette with several rounds in the cylinder.

Sources

Practical notes

Patient education

Insulin therapy requires structured patient education: injection technique, carbohydrate counting, dose adjustment for glycaemia and meals, hypoglycaemia recognition and treatment, sick-day and exercise management. Without education, insulin does not work even when correctly prescribed. International standards ( Standards of Care) list structured education as a mandatory component.

Monitoring

Continuous glucose monitoring (CGM) is the current standard in patients on insulin therapy. Time-in-Range (TIR) 3.9-10.0 mmol/L ≥ 70% correlates with target and reduced complications. In children with type 1 diabetes, CGM is recommended from diagnosis. Self-monitoring of blood glucose by meter remains an important backup, especially when CGM is unavailable.

Hypoglycemia

Hypoglycaemia is the main clinically significant complication of insulin therapy. With symptoms (tremor, sweating, hunger, confusion) and glucose < 3.9 mmol/L, give 15 g of fast-acting carbohydrate (glucose tablets, juice, sugar), recheck in 15 minutes, repeat if needed. For severe hypoglycaemia with impaired consciousness – nasal glucagon (Baqsimi) or subcutaneous. Current recommendations: in insulin-treated patients at high risk of hypoglycaemia, keep glucagon at home and train family members.

Drug–drug interactions

1 pair found. Sorted from critical to minor.

Moderate

carvedilol

Alpha and beta blocker (non-selective β + α1)

Mechanism

Beta-blockers mask adrenergic hypoglycaemia symptoms (tachycardia, tremor, sweating). In diabetics on insulin, the risk of severe unrecognised hypoglycaemia rises.

Symptoms

Confusion, vision changes, loss of contact, seizures. Tachycardia, tremor, and sweating are suppressed — the patient misses the hypoglycaemia.

Management

Prescribe carvedilol cautiously in diabetes. In heart failure with reduced ejection fraction, carvedilol remains first-line (improves survival) — teach the patient to recognise hypoglycaemia by any unusual sensation. On insulin, intensify glucose self-monitoring (4 times daily) for the first month. For hypertension without heart failure, alternatives: ACE inhibitor or ARB with a diuretic.

Sources

ADA: Standards of Care in Diabetes 2024 – pharmacologic approaches to glycemic treatment (2024)

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Official sources

Direct links to regulator labels. Open in a new tab.

AEMPS / CIMA

Spanish Medicines Information Centre (CIMA)

FDA / DailyMed

FDA — DailyMed Drug Labels

Label dated: 03/18/2026

GRLS

Russian State Register of Medicines

Safety

Contraindications

Hypersensitivity to insulin or excipients
Hypoglycaemia

Serious adverse effects

Severe hypoglycaemia with impaired consciousness, seizures, death
Diabetic ketoacidosis when insulin is missed in type 1 diabetes
Hypokalaemia during intensive therapy (insulin shifts potassium intracellularly)
Rare allergic reactions, both immediate and delayed

Common adverse effects

Hypoglycaemia (most common adverse effect)
Weight gain (in some patients on intensification)
Local injection-site reactions: lipohypertrophy, lipoatrophy, bruising

PregnancyFDA B

Insulin is the treatment of choice for glycaemic control in gestational diabetes and in pregnant women with type 1/2 diabetes. Human insulin and modern analogues (aspart, lispro, detemir) with confirmed pregnancy safety are used. Glargine is discussed; degludec has limited data.

Breastfeeding

Fully compatible with breastfeeding. Insulin is digested in the infant gastrointestinal tract and does not affect the child.

Calculate RID Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Frequently asked

What is Insulin used for?

Insulin is evaluated for the following indications with varying evidence strength: Insulin-dependent type 2 diabetes mellitus (evidence tier A), Type 1 diabetes mellitus (evidence tier A), Muscle mass gain (bodybuilding self-use) (evidence tier F). See the full indication matrix with dosing and citations above on this page.

What are the side effects of Insulin?

Common side effects of Insulin (≥ 1 in 100): Hypoglycaemia (most common adverse effect), Weight gain (in some patients on intensification), Local injection-site reactions: lipohypertrophy, lipoatrophy, bruising. See the Safety section for uncommon and serious reactions.

Is Insulin safe during pregnancy?

FDA category B. Insulin is the treatment of choice for glycaemic control in gestational diabetes and in pregnant women with type 1/2 diabetes. Human insulin and modern analogues (aspart, lispro, detemir) with confirmed pregnancy safety are used. Glargine is discussed; degludec has limited data.

Is Insulin compatible with breastfeeding?

Fully compatible with breastfeeding. Insulin is digested in the infant gastrointestinal tract and does not affect the child.

Who should not take Insulin?

Insulin is contraindicated in: Hypersensitivity to insulin or excipients; Hypoglycaemia. Full list in the Safety section.

Mechanism of action

Practical notes

Patient education

Monitoring

Hypoglycemia

Drug–drug interactions

1 pair found. Sorted from critical to minor.

Moderate

carvedilol

Alpha and beta blocker (non-selective β + α1)

Mechanism

Beta-blockers mask adrenergic hypoglycaemia symptoms (tachycardia, tremor, sweating). In diabetics on insulin, the risk of severe unrecognised hypoglycaemia rises.

Symptoms

Confusion, vision changes, loss of contact, seizures. Tachycardia, tremor, and sweating are suppressed — the patient misses the hypoglycaemia.

Management

Sources

ADA: Standards of Care in Diabetes 2024 – pharmacologic approaches to glycemic treatment (2024)

Pair details →

Safety

Contraindications

Hypersensitivity to insulin or excipients
Hypoglycaemia

Serious adverse effects

Severe hypoglycaemia with impaired consciousness, seizures, death
Diabetic ketoacidosis when insulin is missed in type 1 diabetes
Hypokalaemia during intensive therapy (insulin shifts potassium intracellularly)
Rare allergic reactions, both immediate and delayed

Common adverse effects

Hypoglycaemia (most common adverse effect)
Weight gain (in some patients on intensification)
Local injection-site reactions: lipohypertrophy, lipoatrophy, bruising

PregnancyFDA B

Breastfeeding

Fully compatible with breastfeeding. Insulin is digested in the infant gastrointestinal tract and does not affect the child.

Calculate RID Full profile on NIH LactMed ↗

Reference information, not a clinical decision. Discuss feeding pauses or changes with your physician or an IBCLC.

Frequently asked

What is Insulin used for?

What are the side effects of Insulin?

Is Insulin safe during pregnancy?

Is Insulin compatible with breastfeeding?

Fully compatible with breastfeeding. Insulin is digested in the infant gastrointestinal tract and does not affect the child.

Who should not take Insulin?

Insulin is contraindicated in: Hypersensitivity to insulin or excipients; Hypoglycaemia. Full list in the Safety section.