Human Insulatard®
Pen Please read this
carefully before you start to take your insulin. This leaflet provides a
summary of the information available on your insulin. If you have any
questions or are not sure about anything, ask your doctor or pharmacist. The name of your insulin is: Human Insulatard Pen (Isophane Insulin
Injection BP) This preparation contains insulin [Human insulin (pyr)] which is
identical to the insulin produced by the human pancreas. Insulin preparations
supplement or replace the insulin that your own pancreas produced before you
developed diabetes. They allow your body to continue converting the
carbohydrates you eat into energy. Things to remember about Human
Insulatard Pen 1.
Take your insulin as directed by your doctor and read the instructions
below* 2.
Insulin sometimes causes problems You
can find these listed below** 3.
Ensure you have the correct insulin, your doctor may have prescribed more than
one type. 4.
Your insulin must be stored correctly Further details are given below*** More detailed information about Human Insulatard Pen is given below. Human Insulatard Pen is used for the treatment of insulin-requiring
diabetics. It is a disposable dial-a-dose insulin delivery device able to
deliver 2-78 units in increments of 2 units and containing isophane human
insulin (pyr). The insulin preparation in this device (Isophane Insulin
Injection BP)is an intermediate acting insulin, it is a suspension which
appears white and cloudy when shaken. * Taking your insulin Before taking your
insulin, be sure you do not have hypoglycaemia, i.e. low blood sugar or
'hypo'. You must not take insulin if you have hypoglycaemia (see **Possible
Problems). Be sure your insulin is the same as usual; changes in type of insulin
without your doctor’s knowledge can cause problems such as hypoglycaemia. It is important to take your insulin at the right times. Take it as
advised by your doctor. If you are unsure of anything ask your doctor. Before each injection make sure the injection site is clean.
Injections should not be given at exactly the same place each time, as they
might cause fatty lumps to develop at the injection site. This may affect
your diabetic control. Human Insulatard Pen must be resuspended before use by agitating the
device up and down until the insulin appears uniformly white and cloudy. A
glass ball is included in the insulin reservoir to make resuspension easier.
The dose should then be immediately injected. Carefully read the Instructions for Use, below, before using your Pen. Always perform an "air shot" prior to each injection, this
will release any air which may have collected and ensures the correct
functioning of the Pen. The insulin injection is usually given subcutaneously. Follow your
doctors instructions concerning injection techniques. Pregnancy If you are pregnant
consult your doctor immediately. If you are planning to become pregnant,
consult your doctor well in advance to discuss your diabetic control and
insulin requirements. Illness Illness is likely to alter (usually increase) your insulin requirements and your dose may need to be adjusted. |
Do not stop taking
your insulin even if you are eating much less than normal. Other medicines Other medicines can
affect your diabetic control. If you start on corticosteroids, oral
contraceptives (the "pill'') or thyroid hormone replacement therapy you
may require more insulin, whereas if you start on monoamine oxidase
inhibitors ( MAOI; some medicines used for the treatment of depression) or
beta blockers (medicines used for treating high blood pressure, heart disease
and glaucoma) you may require less insulin. Beta blockers may also blur the
symptoms of hypoglycaemia. Always notify your doctor if you are taking any
other medicines, even if obtained without a prescription. Exercise If you take physical
exercise you will probably need to lower your insulin dose. Get advice from
your doctor and always have extra carbohydrate (sugar or glucose tablets)
available. The effect of exercise on your blood sugar can last for many hours
after you have actually stopped exercising. Driving or operating machinery Hypoglycaemia (low
blood sugar) can seriously impair your ability to drive or operate machinery.
You should discuss with your doctor whether it is safe for you to drive or
operate machinery, particularly if you have just started on insulin, if you
have difficulty recognising the symptoms of hypoglycaemia, or if you have
recently experienced changes in your diabetic control. Never drive or operate
machinery for more than 2 hours without a break for a snack. Alcohol Remember, alcohol
should be taken with caution as it may lead to hypoglycaemia (low blood
sugar). Never drink alcohol on an empty stomach. **Possible problems with insulin treatment Hypoglycaemia (low blood sugar) It is important not
to let your blood sugar levels fall too low. You should always carry some
form of sugar with you . Low blood sugar levels or hypo's can be caused by: 1. Too much insulin 2. Eating too little or missing a meal 3. Unplanned exercise 4. Drinking alcohol 5. Some medicines The symptoms of low blood sugar differ from one person to another and
you will learn to recognise your own symptoms. Early symptoms and signs often
include: sweating, shakiness, mood changes, and paleness. If blood sugar
levels fall even lower, this may cause tiredness, dizziness, faintness,
hunger and tingling in the hands and feet. If your doctor has asked you to intensify your insulin treatment in
order to improve your blood sugar levels, you may at some point lose some of
the warning symptoms (such as shakiness, pounding heart beat, sweating and
feeling anxious) which usually occur when your blood sugar is falling too low
(hypoglycaemia). In this case it is important to think carefully about the
timing of your meals, to bear in mind the exercise you take, and to keep a
close watch on your blood sugar by frequent blood glucose testing. This is
particularly important if you are driving. Treatment of hypoglycaemia If you feel you may
be suffering a hypo you should, without delay eat food containing
carbohydrate, preferably as glucose tablets or sugar. If low blood glucose is not corrected this can lead to loss of
consciousness. It is, therefore, important that close friends and relatives
know what to do if this occurs. It is also advisable to carry or wear something
stating that you are being treated with insulin. If you lose consciousness due to hypoglycaemia your relatives or close
friends may have been taught to give you a subcutaneous or intramuscular
injection of glucagon. You should always take sugar or glucose on continued |
recovery. If you do
not respond to glucagon or it is not available, your relatives and close
friends should know to call a doctor immediately so that intravenous glucose
can be given. Hyperglycaemia (high blood sugar) This results from
taking too little insulin in relation to your food intake or exercise. If
your blood sugar is high you are likely to be very thirsty and will need to
pass urine frequently. Prolonged high blood sugar may eventually lead to
coma. If your blood sugar level rises to high levels check your urine for
ketones. If ketones are present contact your doctor immediately. Side effects Side effects to insulin are rare. The most common is itching or
redness at the site of injection. If you experience any skin reaction at the
injection side, tell your doctor as soon as possible. When insulin treatment is first started you may get swollen feet and
blurred vision in the first week or so. These problems usually disappear with
continued treatment; tell your doctor if they persist. Changing to human insulin You should only
change to human insulin on your doctor’s advice. Transfer from porcine to human insulin of the same type, does not
normally require a change in dosage. Transfer from bovine or mixed bovine/porcine insulins to human insulin
may require a dosage adjustment; follow your doctors advice on this. A few patients have reported that after being transferred to human
insulin, the early warning symptoms for hypoglycaemia were less pronounced
than they were with animal source insulins. ***Storage of disposable pen preparations As with all insulin
preparations, store your full packs of disposable pens, and pens not in use,
in a refrigerator at 2° to 8°C, but do not allow the insulin to freeze. Pens which are in use must not be kept in a refrigerator. Pens in use
or carried as a spare can be kept at normal surrounding temperature (e.g. in
the pocket or handbag) for up to one month, but should not be exposed to
excessive heat or sunlight. What's in your medicine Human Insulatard Pen
contains 3 ml of a suspension of Human insulin (pyr) in a strength of 100
iu/ml; it is a clear, colourless liquid. Human Insulatard Pen also contains
glycerol, sodium phosphate, protamine sulphate as retarding agent and
m-cresol and phenol as added preservative. Instructions for use Please read these
instructions carefully before using your disposable Pen. Human Insulatard Pen must only be used with NovoFine® needles. |
1.
Preparing the Pen Check that your Pen
contains the correct type of insulin. Pull off the cap. Disinfect the rubber membrane. |
Turn the Pen up and down between A
and B so the glass ball is moved
from one end of the reservoir to the other. Do this at least 10 times, until
the liquid appears uniformly white and cloudy. Disinfect the rubber membrane. C. Remove the protective tab from a NovoFine
needle and screw the needle onto the Pen. Pull off the outer and inner needle
caps. "Air shot": Small amounts of air may collect in the needle
and reservoir during normal use. To avoid the injection of air hold the Pen
with the needle upwards and tap the reservoir gently with the finger, so any
air bubbles collect in the top of the reservoir. D. Keeping the Pen with the needle upwards turn
the reservoir one click in the direction of the arrow. E. Still with the needle upwards press the push button fully home, and see if a drop of insulin appears at the needle tip. If not, repeat the procedure until a drop of insulin is seen at the needle tip. |
Some air may remain in the insulin reservoir after this but it will
not be injected. 2. Setting the dose F. Replace the cap so that 0 is opposite the dosage indicator. G. Hold the Pen horizontally and turn the cap in
the direction of the arrow to set the required dose. Be careful not to put your hand over the push button when dialling the
dose. If the button is not allowed to rise freely, insulin will be pushed out
of the needle. The scale on the cap shows 0,
2, 4, 6, 8,10,1 2, 14, 16 and 18
units. For every click you feel when you turn the cap 2 units are set. As the cap is turned the push button rises. The scale under the push
button shows 20, 40 and 60 units. Every time you fully turn
the cap 20 units will be set. H.
To check
the dose set add the figure on the cap opposite the dosage indicator to the
highest figure revealed on the push button scale. continued |
Dosage examples 8 units: Turn the cap until 8 is opposite the dosage indicator 52 units: Turn the cap 2 full
turns so 0 is opposite the dosage
indicator again. The 40 number will show on the push button scale. Continue
turning until 12 is opposite the
dosage indicator (see H). If you have a set a wrong dose, simply turn the cap forwards or
backwards until the right number of units has been set. 78 units is the maximum dose. If you attempt to set a higher dose,
excess insulin will be expelled from the needle and the dose will be wrong. If you set more than 78 units turn the cap back as far as you can
until the push button is firmly home and resistance is felt. Now start again,
remembering that 78 units is the maximum dose. After the dose is set, remove
the cap to make the injection. 3. Making
the injection Use the injection
technique advised by your doctor. Deliver the dose by pressing the push
button firmly home. To allow the insulin to distribute under the skin allow
the needle to remain in the skin for a few seconds. After injection the outer
needle cap is replaced, the needle is unscrewed and carefully discarded. The
cap is replaced with 0 opposite
the dosage indicator. 4. Subsequent
injections Always check that
the push button is fully home. If not, turn the cap until the push button is
completely down then proceed as described above 1-3. You cannot set a dose greater than the n umber of units remaining in the reservoir. The indicator for remaining insulin can be used to estimate the amount of insulin still to be used, but must not be used for dose selection. |
For any injection there must be at least 12 units left in the
reservoir to give the glass ball space to move when shaking the insulin. If
your dose is less than 12 units, and the reservoir is nearly empty, first
dial up to 12 (to check that 12 units are left) and then set the required
dose. If 12 cannot be dialled change to a new Pen. Discard the used Pen carefully, without the needle attached. 5. Important Expel air before
each injection, until a drop of insulin appears at the needle tip. The needle must be removed after each injection. If it is not removed,
temperature changes may expel liquid out of the needle and the insulin
concentration may change. Do not use the indicator for remaining insulin to measure the amount
of insulin to be injected. Care should be taken not to drop the Pen or subject it to impact or
misuse. Keep out of the reach of children. Used Pens can be discarded in household waste, but do not leave the
needle attached. Dispose of the needle carefully, as recommended by your
doctor or diabetic clinic. Remember These insulin pens
have been prescribed by your doctor for your use only. They must not be used
by anyone else. Are you a member of
a Diabetic Association ? If not, and you would like to have further
information about it, please write to: The British Diabetic
Association 10 Queen Anne Street London W1M 0BD |