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Insulin

General Information and Indications:

Insulin is a hormone produced in the pancreas. Insulin is necessary to move sugar from the blood into other body tissues where it is needed for energy. Insulin also helps the body to metabolize (process) carbohydrates, fats, and proteins from the diet. In a person with diabetes, the pancreas does not produce enough insulin for the body's needs, so additional insulin is required. It must be injected because stomach acid would destroy it if taken by mouth. Insulin controls, but does not cure, diabetes. It must be taken regularly. People with diabetes gradually develop serious nerve, blood vessel, kidney, and eye problems, especially if the diabetes is not controlled properly.

Information For Users:

Insulin usually is given by subcutaneous (beneath the skin) injection. The amount of insulin you need depends on diet, other diseases, exercise, and other drugs you are taking and may change with time. Your doctor will determine how often and at what time of day to inject your insulin, as well as what type of insulin will best control the level of sugar in your blood.

Insulin controls high blood sugar but does not cure diabetes. Continue taking insulin even if you feel well. Do not discontinue taking insulin without informing your doctor.

The different types of insulin vary as to how quickly they start to work and how long they go on reducing the amount of blood sugar. For example, rapid-acting insulins, such as regular insulin and Semilente, start to work in 30–60 minutes and go on working for 5–16 hours; long-acting insulins, such as Ultralente, start to work in 4–8 hours and continue working for 36 hours.

All insulin bottles are marked with large black letters to indicate what type of insulin they contain. For example, regular = R and Ultralente = U. You must know both the type of insulin you use and how many units (or how many units of each type of insulin if you take more than one) to take with each injection. There are two different strengths of insulin: U-100 and U-500. Your doctor will determine which strength you should use.

U-100 syringes must be used with U-100 insulin, and different syringes must be used with U-500 insulin. Be sure to get the right kind and the same brand each time.

Plastic syringes are disposable; use a new one for each injection. Used needles will hurt more and may cause an infection. Do not use the insulin if it has changed color or if the expiration date on the bottle has passed. Regular insulin should be a clear, colorless solution (U-500 may be straw colored). Discard the bottle if the solution is cloudy or thickened. Other forms of insulin should be cloudy.

Roll the bottle between the palms of your hands and turn it upside down gently several times to mix it and warm it before preparing your dose. Do not shake the bottle vigorously. Do not use it if the insulin has clumped, if lumps or particles are stuck to the sides of the bottle.

Ask your pharmacist or doctor to show you how to prepare your insulin dose. Wipe the rubber cap with an alcohol pad or cotton dipped in rubbing alcohol. It is easier to withdraw insulin if you first inject air into the bottle. Pull the syringe plunger back to draw up the same number of units of air as insulin that you will be taking. Insert the needle through the rubber cap and inject the air into the bottle. Invert the bottle and syringe, pull back on the plunger to draw insulin into the syringe, and measure the correct number of units of insulin. Be sure that there are no bubbles in the syringe. While the bottle is still inverted, you can tap gently on the syringe to eliminate these bubbles.
Preparing Your Dose:

If you have trouble seeing the small markings on the syringe, have someone help you. Also, let your doctor and pharmacist know about this problem. They can provide syringes that are easier to read, special tools to help you fill the syringe, or prefilled syringes. If you take two types of insulin at the same time, such as regular and NPH, do not change the order of mixing. Whenever you mix regular insulin with another type of insulin, draw up the regular insulin (the clear solution) first.

You will be shown how to inject insulin correctly. You can inject it into your abdomen, buttocks, thighs, and arms. Clean the skin at the injection site with an alcohol pad or rubbing alcohol. Pinch a fold of skin with your fingers at least 3 inches apart and insert the needle at a 45–90-degree angle. Then inject the insulin, withdraw the needle, and press lightly (do not rub) on the skin.
Injecting Your Dose:

Use a different site for each injection, about 1 inch away from the previous injection but in the same general area (e.g., thigh). Use all available sites in the same general area before switching to a different area (e.g., arm). Do not use the same injection site more often than once every month or two.

Special precautions:

o Inform your doctor and pharmacist if you have had an allergic reaction to beef or pork, insulin, or any other medications.
o Inform your doctor and pharmacist what prescription and nonprescription medications you are taking, including vitamins. Other medications can affect the action of insulin and can cause inaccurate results in urine tests for sugar or ketones. Do not take nonprescription medications, particularly cold and allergy medications, and medications that contain alcohol or sugar without informing your doctor or pharmacist.
o inform your doctor if you are breast-feeding thyroid, liver, or kidney disease or a severe infection.
o Inform your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while taking insulin, call your doctor.
o if you are having surgery, including dental surgery, Inform your doctor or dentist that you are taking insulin.

Be sure to follow all exercise and dietary recommendations made by your doctor or dietitian. It is important to eat a healthful diet. Do not start a diet or an exercise program without informing your doctor. Your insulin dose may need to be changed.

Alcohol may cause a decrease in blood sugar. Ask your doctor about the safe use of alcoholic beverages while you are using insulin.

To monitor the effectiveness of insulin, measure the amount of sugar (glucose) in your blood or urine (when blood sugar is above a certain high level, you will have sugar in your urine). For these measurements, you will need special paper tapes, tablets, or plastic strips that change color depending on how much sugar is present. You also can use a blood glucose meter to measure the amount of sugar in your blood. Your doctor also may ask you to test your urine for ketones (substances present when diabetes is not under control). Follow your doctor's recommendations for testing your urine and blood and for recording the results. If your blood sugar is high or if sugar or ketones are present in your urine, call your doctor.


Possible Adverse Effects:

You should know the symptoms of low and high blood sugar and what to do if you have them.

Eat or drink a food or beverage with sugar in it, such as hard candy or fruit juice, and call your doctor without delay if you have any of the symptoms of hypoglycemia (low blood sugar):

o shakiness
o lightheadedness or dizziness
o sweating
o confusion
o nervousness or irritability
o sudden changes in behavior or mood
o headache
o numbness or tingling around the mouth
o weakness
o pale skin
o sudden hunger
o clumsy or jerky movements
o seizures

call your doctor without delay if you have any of the following symptoms of hyperglycemia (high blood sugar):

o extreme thirst
o frequent urination
o extreme hunger
o weakness
o blurred vision (Impaired vision)

If high blood sugar is not treated, a serious, life-threatening condition called diabetic ketoacidosis could develop. call your doctor without delay if you have any of the these symptoms:

o dry mouth
o upset stomach and vomiting
o shortness of breath
o breath that smells fruity
o decreased consciousness

Insulin may cause adverse effects. Inform your doctor if any of the following symptoms are severe or do not go away:

o redness, swelling, and itching at the injection site
o changes in the feel of your skin, fat build-up, or fat breakdown

If you have any of the following symptoms, call your doctor without delay:

o exaggerated sunburn
o yellowing of the skin or eyes, jaundice
o light-colored stools
o dark urine
o unusual bruising or bleeding
o fever
o sore throat

Brand Name(s):

o Humulin®
o Iletin®
o Novolin®
o Velosulin®

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