$Unique_ID{BRK03192} $Pretitle{} $Title{insulin} $Subject{Humulin L N R Lilly Iletin I II Insulatard NPH Novo Nordisk Mixtard Novolin Velosulin Antidiabetic insulin hormone pancreas regulation blood sugar diabetes mellitus sugar} $Volume{} $Log{} Copyright (C) 1993 Publications International, Ltd. insulin ------------------------------------------------------------------------------ BRAND NAMES (Manufacturers) Humulin L (Lilly) Humulin N (Lilly) Humulin R (Lilly) Iletin I (Lilly) Iletin II (Lilly) Insulatard NPH (Novo Nordisk) Mixtard (Novo Nordisk) Novolin (Novo Nordisk) Velosulin (Novo Nordisk) TYPE OF DRUG Antidiabetic INGREDIENT insulin DOSAGE FORM Injectable (all types) (100 units/ml) Injectable (regular) (100 units/ml, 500 units/ml) This drug is available only as an injectable (if swallowed, it is destroyed by stomach acid). Various types of insulin provide different times of onset and durations of action (see below). ----------------------------------------------------- Insulin type Onset of action Duration of action (in hours) (in hours) ----------------------------------------------------- Regular insulin 1/2 6 Insulin zinc 1 1/2 14 suspension, prompt (Semilente) Isophane insulin 1 24 (NPH) Insulin zinc 1 24 suspension (Lente) Protamine zinc 6 36 insulin (PZI) Insulin zinc 6 36 suspension, extended (Ultralente) ----------------------------------------------------- STORAGE After opening, keep most forms (except 500 units/ml strength) at room temperature if used in six months. Refrigerate unopened vials. Never freeze insulin. USES Insulin is a hormone that is normally produced by the pancreas; it functions in the regulation of blood sugar levels. This medication is used to treat diabetes mellitus (sugar diabetes) a disorder that results from an inability of the pancreas to produce enough insulin. Injectable insulin is used only to treat those patients whose blood sugar levels cannot be controlled by diet or by oral antidiabetic medications. TREATMENT Your doctor, nurse, dietitian, or pharmacist will show you how to inject insulin, using a specially marked hypodermic syringe. This medication is packaged with printed instructions that should be carefully followed. You may prefer to use presterilized disposable needles and syringes, which are used once and then discarded. If you use a glass syringe and metal needle, you must sterilize them before reuse. Make sure that the insulin you are using is exactly the kind your doctor ordered and that its expiration date has not passed. Do not shake the bottle; tip it gently, end to end, to mix. ALWAYS CHECK THE DOSE in the syringe at least twice before injecting it. Clean the site of the injection thoroughly with an antiseptic, such as rubbing alcohol. Change the site of the injection daily, and avoid injecting cold insulin. NEVER use a vial of insulin if there are lumps in it. Make your insulin injection a regular part of your schedule, so that you do not miss any doses. Ask your doctor what to do if you have to take a dose later than the scheduled time. SIDE EFFECTS Minor. Insulin can cause redness and rash at the site of injection. Try to rotate injection sites in order to avoid this reaction. Major. Be sure to tell your doctor about any side effects that are persistent or particularly bothersome. IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about palpitations, fainting, shortness of breath, skin rash, or sweating. Too much insulin can cause hypoglycemia (low blood sugar), which can lead to anxiety, chills, cold sweats, drowsiness, fast heart rate, headache, loss of consciousness, nausea, nervousness, tremors, unusual hunger, or unusual weakness. If you experience these symptoms, eat a quick source of sugar (such as table sugar, orange juice, honey, or a nondiet cola). You should also tell your doctor that you have had this reaction. Too little insulin can cause symptoms of hyperglycemia (high blood sugar), such as confusion, drowsiness, dry skin, fatigue, flushing, frequent urination, fruit-like breath odor, loss of appetite, or rapid breathing. If you experience any of these symptoms, contact your doctor; he or she may want to modify your dosing schedule or change your insulin dosage. INTERACTIONS Insulin interacts with several other types of medications: 1. Insulin can increase digoxin's side effects to the heart. 2. Oral contraceptives (birth control pills), adrenocorticosteroids (cortisone-like medicines), danazol, dextrothyroxine, furosemide, ethacrynic acid, thyroid hormone, thiazide diuretics (water pills), phenytoin, or nicotine (from smoking) can increase insulin requirements. 3. Monoamine oxidase (MAO) inhibitors, phenylbutazone, fenfluramine, guanethidine, disopyramide, sulfinpyrazone, tetracycline, alcohol, anabolic steroids, or large doses of aspirin can increase the effects of insulin, leading to hypoglycemia. 4. Beta blockers (acebutolol, atenolol, betaxolol, carteolol, esmolol, labetalol, metoprolol, nadolol, penbutolol, pindolol, propranolol, timolol) may prolong the effects of insulin and mask the signs of hypoglycemia. BE SURE TO TELL YOUR DOCTOR about any medications you are currently taking, especially any of those listed above. WARNINGS * Tell your doctor about unusual or allergic reactions you have had to any medications, especially to insulin. * Before starting to take this medication, be sure to tell your doctor if you now have or if you have ever had high fevers, infections, kidney disease, liver disease, thyroid disease, or severe nausea and vomiting. * If your doctor prescribes two types of insulin to achieve better glucose control and recommends mixing the insulin into one syringe, always draw the regular insulin (clear) into the syringe first. * Some insulin mixtures won't interact with each other for some time. Others react quickly and require immediate injection. Consult your doctor or pharmacist about this. * Make sure that your friends and family are aware of the symptoms of an insulin reaction and know what to do should they observe any of the symptoms in you. * Carry a card or wear a bracelet that identifies you as a diabetic. * Always have insulin and syringes available. * When traveling, always carry an ample supply of your diabetic needs and, if possible, a prescription for insulin and syringes. Carry insulin and syringes on your person; baggage can be lost, delayed, or stolen. * Do not store insulin in your car's glove compartment. * To avoid the possibility of hypoglycemia (low blood sugar levels), you should eat on a regular schedule and should avoid skipping meals. * Before having surgery or other medical or dental treatment, tell your doctor or dentist you are taking insulin. * Check with your doctor or pharmacist before taking any over-the-counter (nonprescription) cough, cold, diet, allergy, asthma, or sinus medications. Some of these products affect blood sugar levels. * If you become ill--if you catch a cold or the flu or become nauseated--your insulin requirements may change. Consult your doctor. * Be sure to tell your doctor if you are pregnant. Insulin dosing requirements often change during pregnancy. ---------------- The material contained here is "FOR INFORMATION ONLY" and should not replace the counsel and advice of your personal physician. Promptly consulting your doctor is the best path to a quick and successful resolution of any medical problem.