Insulin Pregnancy: B — insulin of choice in diabetes in pregnancy

Insulin (Soluble / Actrapid)

Brand names: Actrapid, Humulin S, NovoRapid (aspart), Novorapid

Adult dose

Dose: Sliding scale: 0–8 units SC based on capillary glucose. VRIII: 0–6 units/hr IV per local protocol

Route: Subcutaneous or Intravenous

Frequency: Per protocol

DKA: 0.1 unit/kg/hr IV infusion (after initial fluid resuscitation). HHS: lower doses. Hyperkalaemia: 10 units in 50mL 50% dextrose IV over 15min.

Dose: 0.1 units/hour/kg

Route: IV

DKA in children: 0.1 units/kg/hr after 1 hour of fluid resuscitation. Never bolus insulin in paediatric DKA.

Paediatric weight-based calculator

Patient weight (kg)

DKA in children: 0.1 units/kg/hr after 1 hour of fluid resuscitation. Never bolus insulin in paediatric DKA.

In DKA: start IV fluids FIRST, then insulin 1 hour later (prevents cerebral oedema risk)
Switch IV to SC insulin 30–60min BEFORE stopping IV infusion (prevent rebound hyperglycaemia)
Never use IM route routinely — unpredictable absorption
Insulin aspart/lispro/glulisine: rapid-acting analogues, onset 10–20min
Insulin glargine/detemir/degludec: basal insulins, 24h duration, no peak

Reference: BNFc; JBDS DKA Guidelines 2023; NICE NG17. Verify against your local formulary and the latest BNF before prescribing.

Curated clinical cross-links plus same-class fallbacks.

Calculators

Pathways