Insulin Injection

Why is this medication prescribed?

Insulin injection is used to control blood sugar in people who have type 1 diabetes
(condition in which the body does not make insulin and therefore cannot control the
amount of sugar in the blood) or in people who have type 2 diabetes (condition in which
the blood sugar is too high because the body does not produce or use insulin normally)
that cannot be controlled with oral medications alone. Insulin injection is in a class of
medications called hormones. Insulin injection is used to take the place of insulin that is
normally produced by the body. It works by helping move sugar from the blood into other
body tissues where it is used for energy. It also stops the liver from producing more
sugar. All of the types of insulin that are available work in this way. The types of insulin
differ only in how quickly they begin to work and how long they continue to control blood
sugar.

How should this medicine be used?

Insulin comes as a solution (liquid) and a suspension (liquid with particles that will settle
on standing) to be injected subcutaneously (under the skin). Insulin is usually injected
several times a day, and more than one type of insulin may be needed. Your doctor will
tell you which type(s) of insulin to use, how much insulin to use, and how often to inject
insulin. Follow these directions carefully. Do not use more or less insulin or use it more
often than prescribed by your doctor.

Insulin controls high blood sugar but does not cure diabetes. Continue to use insulin
even if you feel well. Do not stop using insulin without talking to your doctor. Do not
switch to another brand or type of insulin or change the dose of any type of insulin you
use without talking to your doctor.

Insulin comes in vials, pre-filled disposable dosing devices, and cartridges. The
cartridges are designed to be placed in dosing pens. Be sure you know what type of
container your insulin comes in and what other supplies, such as needles, syringes, or
pens, you will need to inject your medication. Make sure that the name and letter on
your insulin are exactly what your doctor prescribed.

If your insulin comes in vials, you will need to use syringes to inject your dose. Be sure
that you know whether your insulin is U-100 or U-500 and always use a syringe marked
for that type of insulin. Always use the same brand and model of needle and syringe.
Ask your doctor or pharmacist if you have questions about the type of syringe you
should use. Carefully read the manufacturer's instructions to learn how to draw insulin
into a syringe and inject your dose. Ask your doctor or pharmacist if you have questions
about how to inject your dose.

If your insulin comes in cartridges, you may need to buy an insulin pen separately. Talk
to your doctor or pharmacist about the type of pen you should use. Carefully read the
instructions that come with your pen, and ask your doctor or pharmacist to show you
how to use it.

If your insulin comes in a disposable dosing device, read the instructions that come with
the device carefully. Ask your doctor or pharmacist to show you how to use the device.

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Never reuse needles or syringes and never share needles, syringes, cartridges, or pens.
If you are using an insulin pen, always remove the needle right after you inject your
dose. Throw away needles and syringes in a puncture-resistant container. Ask your
doctor or pharmacist how to dispose of the puncture-resistant container.

Your doctor may tell you to mix two types of insulin in the same syringe. Your doctor will
tell you exactly how to draw both types of insulin into the syringe. Follow these directions
carefully. Always draw the same type of insulin into the syringe first, and always use the
same brand of needles. Never mix more than one type of insulin in a syringe unless you
are told to do so by your doctor.

Always look at your insulin before you inject. If you are using a regular insulin (Humulin
R, Novolin R), the insulin should be as clear, colorless, and fluid as water. Do not use
this type of insulin if it appears cloudy, thickened, or colored, or if it has solid particles. If
you are using an NPH insulin (Humulin N, Novolin N) or a pre-mixed insulin that contains
NPH (Humulin 70/30, Humulin 50/50, Novolin 70/30), the insulin should appear cloudy or
milky after you mix it. Do not use these types of insulin if there are clumps in the liquid or
if there are solid white particles sticking to the bottom or walls of the bottle. Do not use
any type of insulin after the expiration date printed on the bottle has passed.

Some types of insulin must be shaken or rotated to mix before use. Ask your doctor or
pharmacist if the type of insulin you are using should be mixed and how you should mix
it if necessary.

Talk to your doctor or pharmacist about where on your body you should inject insulin.
Insulin is usually injected in the stomach (except for 2 inches [5 centimeters] around the
belly button), upper arm, upper leg, or buttocks. Do not inject insulin into muscles, scars,
or moles. Use a different site for each injection, at least 1/2 inch (1.25 centimeters) away
from the previous injection site but in the same general area (for example, the thigh).
Use all available sites in the same general area before switching to a different area (for
example, the upper arm).

Other uses for this medicine

This medication may be prescribed for other uses. Ask your doctor or pharmacist for
more information.

What special precautions should I follow?

Before using insulin,

tell your doctor and pharmacist if you are allergic to any type of insulin or any
other medications.
tell your doctor and pharmacist what prescription and nonprescription
medications, vitamins, nutritional supplements, and herbal products you are
taking or plan to take. Be sure to mention any of the following: alpha blockers
such as doxazosin (Cardura), prazosin (Minipress), terazosin (Hytrin), tamsulosin
(Flomax), and alfuzosin (Uroxatral); angiotensin-converting enzyme (ACE)
inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec),
fosinopril (Monopril), lisinopril (Zestril), moexipril (Univasc), perindopril, (Aceon),
quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); antidepressants;
asparaginase (Elspar); beta blockers such as atenolol (Tenormin), carvedilol
(Coreg), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol
(Corgard), pindolol, propranolol (Inderal), sotalol (Betapace, Sorine), and timolol
(Blocadren); diazoxide (Proglycem); diuretics ('water pills'); medications for
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 asthma and colds; monoamine oxidase (MAO) inhibitors such as isocarboxazid
(Marplan), phenelzine (Nardil), selegiline (Eldepryl, Emsam, Zelapar), and
tranylcypromine (Parnate); hormonal contraceptives (birth control pills, patches,
rings, injections, or implants); niacin (Niacor, Niaspan, Slo-Niacin); octreotide
(Sandostatin);oral medications for diabetes; oral steroids such as dexamethasone
(Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone);
quinine; quinidine; salicylate pain relievers such as aspirin; sulfa antibiotics; and
thyroid medications. Your doctor may need to change the doses of your
medications or monitor you carefully for side effects.
tell your doctor if you have or have ever had nerve damage caused by diabetes;
or adrenal (a small gland near the kidneys), pituitary (a small gland in the brain),
thyroid, liver, or kidney disease.
tell your doctor if you are pregnant, plan to become pregnant, or are breast-
feeding. If you become pregnant while using insulin, call your doctor.
if you are having surgery, including dental surgery, tell the doctor or dentist that
you are using insulin.
ask your doctor what to do if you get sick, experience unusual stress, plan to
travel across time zones, or change your exercise and activity level. These
changes can affect your blood sugar and the amount of insulin you may need.

What special dietary instructions should I follow?

Be sure to follow all exercise and dietary recommendations made by your doctor or
dietitian. It is important to eat a healthy diet and to eat about the same amounts of the
same kinds of foods at about the same times every day. Skipping or delaying meals or
changing the amount or kind of food you eat can cause problems with your blood sugar
control.

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

What should I do if I forget a dose?

When you first start using insulin, ask your doctor what to do if you forget to inject a dose
at the correct time. Write down these directions so that you can refer to them later.

What side effects can this medication cause?

This medication causes changes in your blood sugar. You should know the
symptoms of low and high blood sugar and what to do if you have these
symptoms.

You may experience hypoglycemia (low blood sugar) while you are using this
medication. Your doctor will tell you what you should do if you develop
hypoglycemia. He or she may tell you to check your blood sugar, eat or drink a
food or beverage that contains sugar, such as hard candy or fruit juice, or get
medical care. Follow these directions carefully if you have any of the following
symptoms of hypoglycemia. You should be especially alert to these symptoms if
you previously used an animal-source insulin and have switched to a human
insulin. Your hypoglycemia symptoms may be different or less noticeable while
you are using a human insulin. Symptoms of hypoglycemia include:

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

If hypoglycemia is not treated, severe symptoms may develop. Be sure that your
family, friends, and other people who spend time with you know that if you have
any of the following symptoms, they should get medical treatment for you
immediately.

confusion
seizures
loss of consciousness

Call your doctor immediately if you have any of the following symptoms of
hyperglycemia (high blood sugar):

extreme thirst
frequent urination
extreme hunger
weakness
blurred vision

If high blood sugar is not treated, a serious, life-threatening condition called

diabetic ketoacidosis could develop. Call your doctor immediately if you have any
of the these symptoms:

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

Insulin may cause side effects. Tell your doctor if any of these symptoms are
severe or do not go away:

redness, swelling, and itching at the injection site

changes in the feel of your skin, fat build-up, or fat breakdown

Some side effects can be serious. If you experience any of the following
symptoms, call your doctor immediately:

rash and/or itching over the whole body

shortness of breath
wheezing
dizziness
blurred vision
fast heartbeat
sweating
difficulty breathing or swallowing

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If you experience a serious side effect, you or your doctor may send a report to the Food
and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at
http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

What storage conditions are needed for this medicine?

Store unopened vials of insulin, unopened disposable dosing devices and unopened
insulin pens in the refrigerator. Do not freeze insulin and do not use insulin that has been
frozen. Opened vials of insulin should be stored in the refrigerator but may also be
stored at room temperature, in a cool place that is away from heat and direct sunlight.
Store opened insulin pens and opened dosing devices at room temperature. Check the
manufacturer's information to find out how long you may keep your pen or dosing device
after the first use. Throw away any medication that is outdated or no longer needed. Talk
to your doctor or pharmacist about the proper disposal of your medication.

In case of emergency/overdose

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim
has collapsed or is not breathing, call local emergency services at 911.

Symptoms of overdose may include the hypoglycemia symptoms listed above as

well as the following:

loss of consciousness
seizures
confusion

What other information should I know?

Keep all appointments with your doctor and the laboratory. Your blood sugar and
glycosylated hemoglobin (HbA1c) should be checked regularly to determine your
response to insulin. Your doctor will also tell you how to check your response to insulin
by measuring your blood or urine sugar levels at home. Follow these directions carefully.

You should always wear a diabetic identification bracelet to be sure you get proper
treatment in an emergency.

Do not let anyone else use your medication. Ask your pharmacist any questions you
have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription
(over-the-counter) medicines you are taking, as well as any products such as vitamins,
minerals, or other dietary supplements. You should bring this list with you each time you
visit a doctor or if you are admitted to a hospital. It is also important information to carry
with you in case of emergencies.
Brand names
Humulin R®
Humulin N®
Humulin 70/30®
Humulin 50/50®
Humulin R U-500®
Novolin R®
Novolin N®
Novolin 70/30®
Last Reviewed - 02/01/2009
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