It may occur if the insulin dose is too high in relation to the insulin requirement. The symptoms of hypoglycaemia usually occur suddenly. They may include cold sweats, cool pale skin, fatigue, nervousness or tremor, anxiousness, unusual tiredness or weakness, confusion, difficulty in concentration, drowsiness, excessive hunger, vision changes, headache, nausea and palpitation. Lipodystrophy: Lipodystrophy is reported as uncommon.
Lipodystrophy may occur at the injection site. Drug Interactions. A number of medicinal products are known to interact with the glucose metabolism. The following substances may reduce the patient's insulin requirement: Oral anti-diabetic products, monoamine oxidase inhibitors MAOI , non-selective beta-blocking agents, angiotensin converting enzyme ACE inhibitors, salicylates, anabolic steroids and sulphonamides.
The following substances may increase the patient's insulin requirement: Oral contraceptives, thiazides, glucocorticoids, thyroid hormones, sympathomimetics, growth hormone and danazol. Beta-blocking agents may mask the symptoms of hypoglycaemia and delay recovery from hypoglycaemia. Alcohol may intensify or reduce the hypoglycaemic effect of insulin. Caution For Usage. For intravenous use, infusion systems with Actrapid at concentrations from 0.
Although stable over time, a certain amount of insulin will initially be absorbed to the material of the infusion bag. Monitoring of blood glucose is necessary during the infusion. Cartridges and Pens should only be used in combination with products that are compatible with them and allow the cartridge or flexpen to function safely and effectively.
Needles and Actrapid Penfill, Actrapid Flexpen must not be shared. The container must not be refilled. Insulin preparations which have been frozen must not be used. Insulin solutions should not be used if they do not appear clear and colourless. Actrapid should not be used in insulin pumps for continuous subcutaneous insulin infusion. The patient should be advised to discard the needle after each injection.
In case of emergency in current Actrapid users hospitalisation or insulin pen malfunction , Actrapid can be withdrawn with an U insulin syringe from the cartridge or from the Flexpen.
Incompatibilities: Insulin products should only be added to compounds with which it is known to be compatible. Medicinal products added to the insulin solution may cause degradation of the insulin, e. Keep away from the cooling element. Do not freeze. Actrapid must be protected from excessive heat and light. After first opening or if carried as a spare: Do not refrigerate.
Actrapid Penfill: Keep the cartridge in the outer carton in order to protect from light. Actrapid Flexpen: Keep the pen cap on Flexpen in order to protect from light. Patient Counseling Information.
Actrapid solution for injection in Penfill: Do not use Actrapid: In insulin infusion pumps. If you are allergic hypersensitive to human insulin or any of the other ingredients in Actrapid. If you suspect hypoglycaemia low blood sugar is starting.
If the cartridge or the device containing the cartridge is dropped, damaged or crushed. If it has not been stored correctly or been frozen.
If the insulin does not appear clear and colourless. Before using Actrapid: Check the label to make sure it is the right type of insulin. Always check the cartridge, including the rubber stopper.
Do not use it if any damage is seen or if there is a gap between the rubber stopper and the white label band. Take it back to the supplier. See the delivery system manual for further instructions. Always use a new needle for each injection to prevent contamination. Needles and Actrapid Penfill must not be shared.
How to use this insulin: Actrapid is for injection under the skin subcutaneously. Always vary the sites you inject within the same region, to reduce the risk of developing lumps or skin pitting.
The best places to give the patient an injection are: the front of your waist abdomen ; your buttocks; the front of your thighs or upper arms. Your insulin will work more quickly if you inject it around the waist. How to inject this insulin: Inject the insulin under the skin. Use the injection technique advised by the doctor or nurse and described in the delivery system manual.
Keep the needle under your skin for at least 6 seconds. Keep the push button fully depressed until the needle has been withdrawn. This will ensure correct delivery and limit possible flow of blood into the needle or insulin reservoir.
After each injection, be sure to remove and discard the needle and store Actrapid without the needle attached. Otherwise the liquid may leak out which can cause inaccurate dosing. Do not refill Actrapid Penfill. Penfill cartridges are designed to be used with Novo Nordisk insulin delivery systems and NovoFine or NovoTwist needles.
If you are treated with Actrapid Penfill and another insulin Penfill cartridge, you should use two insulin delivery systems, one for each type of insulin.
As a precautionary measure, always carry a spare insulin delivery system in case your Penfill is lost or damaged. Actrapid solution for injection in pre-filled pen: Your FlexPen is a unique dial-a-dose insulin pen. You can select doses from 1 to 60 units in increments of 1 unit.
As a precautionary measure, always carry a spare insulin delivery device in case your FlexPen is lost or damaged. Maintenance: Your FlexPen is designed to work accurately and safely. It must be handled with care. If it is dropped or crushed, there is a risk of damage and leakage of insulin. You can clean the exterior of the FlexPen by wiping it with a medicinal swab. Do not soak it, wash or lubricate it as it may damage the pen. Do not refill your Actrapid FlexPen. Pull off the pen cap.
Remove the protective tab from a new disposable needle. Screw the needle straight and tightly onto the FlexPen. Pull off the big outer needle cap and keep it for later. Pull off the inner needle cap and dispose of it. Be careful not to bend or damage the needle before use. To reduce the risk of unexpected needle sticks, never put the inner needle cap back on when you have removed it from the needle.
Checking the insulin flow: Prior to each injection, small amounts of air may collect in the cartridge during normal use. To avoid injection of air and ensure proper dosing: E. Turn the dose selector to select 2 units. Hold the FlexPen with the needle pointing upwards and tap the cartridge gently with your finger a few times to make any air bubbles collect at the top of the cartridge.
Keeping the needle upwards, press the push-button all the way in. The dose selector returns to 0. A drop of insulin should appear at the needle tip.
If not, change the needle and repeat the procedure no more than 6 times. If a drop of insulin still does not appear, the pen is defective, and you must use a new one. Selecting your dose: Check that the dose selector is set at 0: H. Turn the dose selector to select the number of units needed to inject. The dose can be corrected either up or down by turning the dose selector in either direction until the correct dose lines up with the pointer. When turning the dose selector, be careful not to push the push-button as insulin will come out.
You cannot select a dose larger than the number of units left in the cartridge. Do not use the residual scale to measure the dose of insulin. Making the injection: Insert the needle into the skin. Use the injection technique shown by the doctor or nurse: I. Inject the dose by pressing the push-button all the way in until 0 lines up with the pointer.
Be careful only to push the push-button when injecting. Turning the dose selector will not inject insulin. Keep the push-button fully depressed after the injection until the needle has been withdrawn from the skin.
The needle must remain under the skin for at least 6 seconds. This will ensure that the full dose has been injected. Lead the needle into the big outer needle cap without touching the big outer needle cap. When the needle is covered, carefully push the big outer needle cap completely on and then unscrew the needle. Dispose of it carefully and put the pen cap back on. Always remove the needle after each injection and store your FlexPen without the needle attached. Caregivers should be most careful when handling used needles to avoid needle sticks.
Dispose of the used FlexPen carefully without the needle attached. Over time, most people with type 2 diabetes will need diabetes tablets to help keep their blood glucose levels in the target range.
Regular blood glucose monitoring may be necessary in order to keep track of the effectiveness of the treatment. The starting time for diabetes tablets varies according to individual need. Women who have had gestational diabetes have an increased risk of developing type 2 diabetes later on. The management of gestational diabetes includes seeing a dietitian to assist with healthy eating strategies to help manage blood glucose levels. Where possible, regular exercise such as walking also helps.
Measuring blood glucose levels with a blood glucose meter gives information about whether these management strategies are able to keep blood glucose levels in the recommended range. Some women may need to also inject insulin to help manage their blood glucose levels until their baby is born.
Insulin is a hormone our body makes to keep our blood glucose levels within the normal range. It is made by beta cells in the pancreas. Insulin's main job is to move glucose from our bloodstream into the body's cells to make energy.
With type 1 diabetes, the body does not make any insulin and therefore insulin has to be injected regularly every day to stay alive. With type 2 diabetes, the body does not make enough insulin, or the insulin that is made does not work well. Insulin injections are sometimes needed to manage blood glucose levels. People with type 1 diabetes must inject insulin every day, often up to 4 or 5 times per day. They may use a pump to deliver insulin which means they insert a new cannula very fine plastic tube under the skin every 2 to 3 days.
Sometimes, people with type 2 diabetes also need to begin using insulin when diet, physical activity and tablets no longer effectively control their blood glucose levels.
Having to start injecting insulin can be frightening. However, injecting insulin is much easier than most people imagine. There are different devices that can be used to make insulin delivery easy. Pen needles are very fine and so are cannulas. Often people needing insulin feel much better once they start having insulin. If you need to start using insulin, your doctor or diabetes nurse educator can help with education and support.
They will teach you about:. Your doctor or diabetes nurse educator will help you to adjust your insulin. An important part of insulin adjustment is regular blood glucose monitoring and recording. When you start using insulin it is important to have a review by an accredited practising dietitian to understand how carbohydrates and insulin work together. If you have type 1 diabetes, learning how to count carbohydrates and matching your insulin to the food you eat is the ideal way to manage it.
Depending on what you eat, your mealtime insulin doses may therefore vary from meal to meal and day to day. Insulin is grouped according to how long it works in the body. Both help manage blood glucose levels. The 5 different types of insulin range from rapid- to long-acting. Some types of insulin look clear, while others are cloudy. Check with your pharmacist whether the insulin you are taking should be clear or cloudy.
Before injecting a cloudy insulin, the pen or vial needs to be gently rolled between your hands to make sure the insulin is evenly mixed until it looks milky. Often, people need both rapid- and longer-acting insulin. Everyone is different and needs different combinations. Rapid-acting insulin starts working somewhere between 2.
Its action is at its greatest between one and 3 hours after injection and can last up to 5 hours. When you use this type of insulin, you must eat immediately or soon after you inject. Fiasp — released in Australia June — is a new, rapid acting insulin with faster onset of action. It is designed to improve blood glucose levels after a meal.
Short-acting insulin begins to lower blood glucose levels within 30 minutes, so you need to have your injection 30 minutes before eating. It has its maximum effect 2 to 5 hours after injection and lasts for 6 to 8 hours. These insulins begin to work about 60 to 90 minutes after injection, peak between 4 to 12 hours and last for between 16 to 24 hours.
Mixed insulin contains a pre-mixed combination of either very rapid-acting or short-acting insulin, together with intermediate-acting insulin. In Australia, the strength of the above insulins is units per ml. Some countries have different strengths. The exception to this is the once-daily long-acting insulin Toujeo which was released in and has a strength of units per ml. Do not change between Lantus and Toujeo without consulting a health professional. Different insulin delivery devices are available.
The main choices are syringes, insulin pens and insulin pumps. Syringes are manufactured in unit 0. The size of the syringe needed will depend on the insulin dose. For example, it is easier to measure a 10 unit dose in a 30 unit syringe and 55 units in a unit syringe. The needles on the syringes are available in lengths ranging from 6 to 8 mm.
Your doctor or diabetes nurse educator will help you decide which syringe and needle size is right for you. Most Australian adults no longer use syringes to inject insulin. They now use insulin pens for greater convenience. Insulin companies have designed insulin pens disposable or reusable to be used with their own brand of insulin. Disposable insulin pens already have the insulin cartridge in the pen. They are discarded when they are empty, when they have been out of the fridge for one month, or when the use-by date is reached.
Reusable insulin pens require insertion of a 3 ml insulin catridge. The insulin strength per ml is units. When finished, a new cartridge or penfill is inserted. Pen cartridges also need to be discarded one month after commencing if insulin still remains in the cartridge. Your doctor or diabetes nurse educator will advise you about the right type of pen for your needs. Pen needles are disposable needles that screw on to an insulin pen device to allow insulin to be injected. They are available in different lengths, ranging from 4 to However research recommends that size 4 to 5 mm pen needles are used.
The thickness of the needle gauge also varies — the higher the gauge, the finer the needle. It is important that a new pen needle is used with each injection. Your diabetes nurse educator can advise you on the appropriate needle length and show you correct injection technique. An insulin pump is a small programmable device that holds a reservoir of insulin and is worn outside the body.
The insulin pump is programmed to deliver insulin into the fatty tissue of the body usually the abdomen through thin plastic tubing known as an infusion set or giving set. Only rapid-acting insulin is used in the pump. The infusion set has a fine needle or flexible cannula that is inserted just below the skin. This is changed every 2 to 3 days.
The pump is pre-programmed by the user and their health professional to automatically deliver small continual amounts of insulin to keep blood glucose levels stable between meals. Individuals can instruct the pump to deliver a burst of insulin each time food is eaten, similar to the way the pancreas does in people without diabetes. The insulin pump isn't suitable for everyone. If you're considering using one, you must discuss it first with your diabetes healthcare team.
The cost of an insulin pump is generally covered by private health insurance for people with type 1 diabetes a waiting period applies.
Insulin is injected through the skin into the fatty tissue known as the subcutaneous layer. It shouldn't go into muscle or directly into the blood, as this changes how quickly the insulin is absorbed and works. Absorption of insulin varies depending on where in the body it is injected. The abdomen absorbs insulin the fastest and is used by most people. The upper arms, buttocks and thighs have a slower absorption rate and can also be used.
Variation in insulin absorption can cause changes in blood glucose levels. Insulin absorption is increased by:. Used syringes, pen needles, cannulas and lancets must be disposed of in an Australian Standards-approved sharps container, which is puncture-proof and has a secure lid. These containers are usually yellow and are available through pharmacies, local municipal councils and state or territory diabetes organisations such as Diabetes Victoria.
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