Intermediate-acting insulin (Injection)

Introduction

Treats diabetes mellitus.

Brand Name(s)

When This Medicine Should Not Be Used

How to Use This Medicine

Injectable

• Your doctor will prescribe your exact dose and tell you how often it should be given. This medicine is given as a shot under your skin.
• NPH insulin usually starts to work about 2 to 4 hours after it has been injected. This insulin may keep working for as long as 18 to 24 hours after the injection, but it slowly works less and less. The way NPH insulin works for you might be different. You and your health caregiver must work together to know the best times for you to use your insulin.
• Lente insulin usually starts to work about 3 to 4 hours after it has been injected. The strongest effects are from about 4 hours until about 12 hours after the injection. Lente insulin may keep working for as long as 18 to 20 hours after the injection, but it slowly works less and less. The way this insulin works for you might be different. You and your health caregiver must work together to know the best times for you to use your insulin.
• You will be taught how to give your medicine at home. Make sure you understand all instructions before giving yourself an injection. Do not use more insulin or use it more often than your doctor tells you.
• There are many different devices available for giving an insulin injection. You may be taught how to use a regular syringe, the Humulin® Pen, the Novolin® Innolet®, or some other device. Each device has special instructions that you must follow. Read and follow these instructions carefully. Make sure you understand all the instructions for your device before you use it.
• If you are using a pre-filled insulin pen, such as the Humulin® Pen, carefully read and follow the patient instructions on how to use it. This type of pen requires you to follow certain steps before you use the medicine. These steps can include preparing the pen, putting on a new needle, priming the pen, and setting your dose. You must follow these steps to make sure you receive the right dose of insulin.
• Know what your usual kind of insulin should look like. Before every injection, look at the insulin to make sure it still looks the same. Most insulin should not be used if it has changed color or looks too cloudy or thick.
• You will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas.
• Use only syringes that are specially made for insulin. It is best to always use the same brand and type of syringe. Some types of insulin must be used with a certain type of syringe. Ask your pharmacist if you are not sure which one to use.
• Use a new needle and syringe each time you inject your medicine.Some people might be able to use special reusable needles or syringes. Your health caregiver must teach you how to reuse needles or syringes before you give yourself an injection.
• Do not change the brand or type of your insulin unless your health caregiver tells you to. If you must change the brand or type, ask your health caregiver before giving yourself an injection.
• Do not mix one kind of insulin with another kind or with water, unless your health caregiver has told you to. Never mix Lantus® (insulin glargine) with any other insulin.
• Carefully follow your doctor's instructions about any special diet.Your doctor may suggest that you follow an exercise program. You may also be taught to check your own blood sugar levels at home. Diet, exercise, medicine, and checking your blood sugar are all important to manage your diabetes.

If a dose is missed:

• Call your doctor or pharmacist for instructions.

How to Store and Dispose of This Medicine

• Store unopened insulin in the refrigerator. Do not freeze. If you cannot refrigerate the insulin you will use for the day, keep it in a cool place away from heat and light. Do not use insulin that has been frozen or overheated. Follow any special storage instructions that come with your specific brand of insulin.
• Once your Humulin® Pen has been opened, store it at room temperature, away from direct light and heat. Do not refrigerate the opened Humulin® Pen. Remove the needle from the pen after your injection. Do not store the Humulin® Pen with a needle attached.
• Do not use insulin if it is past the expiration date stamped on the bottle or pen. Throw away any Humulin® Pen that is kept out of a refrigerator for longer than 2 weeks.
• Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.
• Ask your pharmacist, doctor, or health caregiver about the best way to dispose of any outdated medicine or medicine no longer needed.
• Keep all medicine out of the reach of children. Never share your needles, syringes, or medicine with anyone else.

Drugs and Foods to Avoid

Ask your doctor or pharmacist before using any other medicine, including over-the-counter medicines, vitamins, and herbal products.

• Some medicines can affect the amount of insulin you need to use. Make sure your doctor knows about all other medicines you are using.
• Make sure your doctor knows if you are also using birth control pills, or if you are also using steroid medicines, such as dexamethasone, prednisolone, prednisone, or Medrol®.
• Make sure your doctor knows if you are also using a thyroid medicine, or if you are also using a diabetes medicine you take by mouth.
• Make sure your doctor knows if you are also using pain medicine, such as aspirin, or if you are also using medicine to treat an infection or medicine to treat depression.
• Make sure your doctor knows if you are also using a blood pressure medicine, such as atenolol, metoprolol, propranolol, Inderal®, Lopressor®, or Tenormin®. These medicines may cover up the symptoms of hypoglycemia.

Warnings While Using This Medicine

• Make sure your doctor knows if you are pregnant or breastfeeding, or if you are planning to become pregnant. Make sure your doctor knows if you have kidney disease or liver disease.
• Never share insulin pens or cartridges with others under any circumstances. It is not safe for one pen to be used for more than one person. Sharing needles or pens can result in transmission of hepatitis viruses, HIV, or other blood-borne illnesses.
• You may sometimes have low blood sugar while you are using insulin. This is more likely if you miss a meal, exercise for a long time, or drink alcohol. If your blood sugar gets too low, you may feel weak, drowsy, confused, anxious, or very hungry. You may also sweat, shake, or have blurred vision, a fast heartbeat, or a headache that will not go away.
• If you have symptoms of low blood sugar (hypoglycemia), check your blood sugar. If your blood sugar is 70 mg/dL (milligrams per deciliter) or below, do one of the following: Drink 4 ounces (one-half cup) of fruit juice, or eat 5 to 6 pieces of hard candy, or take 2 or 3 glucose tablets. Re-check your blood sugar 15 minutes later. If your blood sugar is above 70 mg/dL, eat a snack or a meal. If your blood sugar is still below 70 mg/dL, drink one-half cup juice, or eat 5 to 6 pieces of candy, or take 2 to 3 glucose tablets.
• Learn what to do if your blood sugar gets too low. Teach friends, co-workers, and family members what they can to do help if you have low blood sugar.
• Your body may react differently to this insulin medicine than it did to insulin medicines you used in the past. Watch for early signs of low blood sugar, since these signs may be different or weaker than you are used to.
• Your correct insulin dose may change slightly with changes in your diet or activity. Your dose needs may change if you are pregnant, traveling, using a new medicine, exercising more or less than usual, or eating more or less than usual. Your dose needs may also change if you are ill, especially if you are vomiting or have diarrhea. Inform your health caregiver if you have any of these changes in your diet, activity, or health. Follow your health caregiver's instructions about changes in your insulin dose.

Possible Side Effects While Using This Medicine

Call your doctor right away if you notice any of these side effects:

• Allergic reaction: Itching or hives, swelling in your face or hands, swelling or tingling in your mouth or throat, chest tightness, trouble breathing.
• Increased thirst, loss of appetite.
• Unusual tiredness, breath that smells fruity, warmth or redness in your face, neck, arms, or upper chest.

Call your doctor right away if you notice any of these side effects:

• Redness, itching, swelling, or skin changes where the shot is given.

If you notice other side effects that you think are caused by this medicine, tell your doctor