A 60-year-old man with diabetic nephropathy presents with serum potassium of 7.4 mEq/L and peaked T waves on ECG. Alongside calcium gluconate and salbutamol, insulin is chosen to shift potassium intracellularly. Which insulin preparation is appropriate for this purpose?
- A NPH insulin
- B Regular human insulin given intravenously ✓
- C Insulin glargine
- D Insulin detemir
Correct answer: B. Regular human insulin given intravenously
Explanation
Only regular human insulin may be given intravenously, because unlike all modified analogues and suspension preparations it exists as soluble monomers in solution with no added modifying proteins or altered amino acid sequences, allowing predictable kinetics when infused. It drives potassium into cells along with glucose uptake, making it standard therapy alongside calcium salts in severe hyperkalaemia. NPH, glargine and detemir are strictly subcutaneous preparations.
Reference: Harrison's Principles of Internal Medicine, 21st ed.
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Written and medically reviewed by the StethoPrep medical team.