INSULIN NEUTRAL HUMAN
Glycaemic control when diet and exercise do not reach target
Regimen: gdm-insulin-basal-prandial
Forminjection
Individualised and titrated to glucose monitoring. The formulary's figure for the individual requirement is 0.3 to 1.0 international units/kg/day; the article divides the total daily dose in half, one half as basal insulin at bedtime and the other half split between the three meals as regular insulin before each. - Until delivery
Adult-only condition - paediatric section not applicable
Sourced preference. The condition's article puts insulin first-line on the ADA's recommendation, insulin not crossing the placenta to the fetus. On the oral alternative it records substantial treatment failure - 50% of patients ended up needing insulin anyway - and allows metformin as an alternative for the woman who refuses insulin or cannot afford it. Metformin is the alternative here, and cost makes it a real one in Cairo.
Egyptian National Drug Formulary - Endocrine System 2024 (short-acting insulin (soluble, neutral, or regular) monograph, Dosage Regimen and Pregnancy), with the basal-plus-prandial split from Gestational diabetes mellitus - disease-level clinical article (gestational-diabetes-full.txt)
Human regular insulin is what the Egyptian formulary itself names as the standard treatment for a pregnant patient with diabetes or with gestational diabetes, so the agent here is neither a guess nor glargine. The same short-acting monograph gives the requirement: usually 0.3 to 1.0 international units/kg/day for the individual patient. The indication is the article's too - insulin does not reach the fetus across the placenta, and the ADA recommends it first-line in gestational diabetes.
- The dose is individualised by design, not for want of a source. The formulary's own note is that what one patient needs bears little relation to what another does, so the dose is adjusted as it goes, under close medical supervision.
- Regimen shape, from the article: a basal insulin and a short-acting one together. The basal dose is aimed at the fasting glucose; the glucose after meals is handled by moving the short-acting dose up or down. What each patient gets is worked out from her own glucose readings.
- The article's split: take the total daily insulin, give half of it as basal insulin at bedtime, and divide the other half across 3 meals, with a rapid-acting or regular insulin taken before each.
- The formulary sanctions the pairing: regular insulin may be given alone, or before a meal or snack alongside an intermediate- or long-acting insulin. Isophane (NPH) is the intermediate-acting basal insulin registered in Egypt and its monograph carries the same gestational-diabetes pregnancy sentence.
- CONTRAINDICATED, from the formulary: hypersensitivity to regular insulin, or to anything else in the preparation; and hypoglycaemia.
- Glucose targets in pregnancy are tighter than outside it - the article gives fasting under 95 mg/dL and 1-hour postprandial 140 mg/dL or less, or 120 mg/dL at 2 hours.
- Insulin initiation and titration in pregnancy is shared care with obstetrics; this card is primary-care support, not a substitute for antenatal review.
| Egyptian brand | Manufacturer | Indicative price |
|---|---|---|
| HUMAN INSULIN R VACSERA-BIOTON 100I.U./ML VIAL | VACSERA > BIOTON CO. LTD-POLAND | 31.00 EGP |
| INSUMAN RAPID 100 I.U./ML 10ML VIAL | SANOFI > FRANCO | 55.00 EGP |
| INSULIN H BIO R 100I.U.VIAL | SEDICO | 77.00 EGP |
| ACTRAPID HM 100 I.U./ML 10 ML VIAL | NOVO NORDISK | 130.00 EGP |
| INSUMAN RAPID 100 I.U./ML 5*3ML PENFILLS | SANOFI > FRANCO | 133.00 EGP |
| HUMAXIN RAPID 100 I.U./ML 5*3ML PENFILLS | EVA PHARMA | 322.00 EGP |
| ACTRAPID HM 100 I.U./ML 5*3ML PENFILLS | NOVO NORDISK | 338.00 EGP |
| HUMULIN R 100 I.U./ML 5 CARTRIDGE | ELI LILLY | 338.00 EGP |