human insulin (prb) 30% soluble insulin 70% isophane insulin A Guide to Starting Humulin M3

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1 human insulin (prb) 30% soluble insulin 70% isophane insulin A Guide to Starting Humulin M3 This booklet is intended only for those who have been Prescribed Humulin M3. It is intended to be used in addition to the Patient Information Leaflet (PIL) which is included in your medicine and should also be read.

2 Contents What should I have from the pharmacist? Why have I been given this booklet? What is Humulin M3 and how does it work? When do I take Humulin M3? Who decides how much Humulin M3 I need? When do I check my blood glucose levels? Instruction for self adjustment of my insulin How do I inject my Humulin M3? What if I forget an injection? What is a hypo and why does it happen? How do I deal with hypos? What should I do if I feel unwell?

3 What should I have from the pharmacist? Cartridge KwikPen Vial You have been prescibed an insulin called Humulin M3. Ensure that your medicine has Humulin M3 on the packaging, as shown above Your insulin should be - please tick 3ml Humulin M3 cartridge for use in a reusable pen device e.g the HumaPen Savvio 3ml Humulin M3 KwikPen (prefilled) 10ml Humulin M3 vial (for use with a syringe)

4 Why have I been given this booklet? You have been prescribed Humulin M3 (your insulin), to help you manage your diabetes. The aim of this booklet is to allow you to learn more about your insulin and help you make the right decisions about adjusting your insulin, and taking control of your diabetes. It is intended to be used in addition to the Patient Information Leaflet provided with your medicine.

5 What is Humulin M3 & how does it work? Humulin M3 is made from a combination of two types of insulin: 30% Soluble Insulin (short acting) 70% Isophane Insulin (intermediate acting) Putting together a short acting insulin and an intermediate acting insulin produces a quick rise in insulin activity after injection, which gradually subsides over time. This is how the Humulin M3 works over a 24 hour period. 24 hour action profile Breakfast Injection Lunch Evening Injection approx 30 min before breakfast approx 30 mins before meal Theoretical representation of Humulin M3 insulin activity profile twice per day Expected insulin production during the day in people without diabetes Time of injection - approx 30 minutes before meal

6 When do I take Humulin M3? This insulin should usually be taken about 30 minutes before breakfast and about 30 minutes before your evening meal. You may be advised to take it more or less frequently; this will be decided between you and your healthcare professional. How much will I need? Please complete: approx. 30 mins before breakfast approx. 30 mins before evening meal Dose This is your starting dose and may increase. Your dose may need to change based on your blood glucose readings.

7 Who decides how much Humulin M3 I will need? Your insulin dose will be adjusted by yourself and/or your healthcare professional according to the blood glucose tests you do. Do not worry if it takes a while before you reach your target blood glucose levels and you need more insulin. Each person is different and what is important is that it is the right amount for you. Why do I need to test my blood glucose levels? It is important that you are aware of your own blood glucose levels in order for you to take the appropriate action, for example, adjusting your insulin dose. There are a number of reasons why you may need to adjust your insulin dose, including: High blood glucose levels (hyperglycaemia) Low blood glucose levels (hypoglycaemia) Stress/illness

8 When do I check my blood glucose levels? To test the effect of your insulin, the recommended blood glucose tests are pre-meals and pre-bed. Your healthcare professional will discuss with you how often to test. What should your blood glucose levels be? Please complete: Your pre-breakfast... mmol/l Your pre-lunch Your pre-evening meal Your pre-bed... mmol/l... mmol/l... mmol/l It may take a while to achieve these levels and you may require an increase of your insulin. Do I need to adjust my insulin and how do I do it? You might not need to adjust your insulin. If you do need to adjust your insulin your healthcare professional will talk you through the next few steps. You may feel apprehensive at first, but it is important that you take control to make it work for you.

9 Instruction for self-adjustment of my insulin When testing your blood glucose, if you have consistently high readings for more than three days at any testing point, then you will need to adjust your insulin. Your healthcare professional will explain to you how to adjust your insulin and will complete the following table for you needs. Humulin M3 twice daily Before Breakfast Before Lunch Before Evening Meal Before Bed Above Below Above Below Above Below Above Below Adjust dose Adjust Evening dose Adjust Morning dose Adjust Evening dose Dose reduction is recommended if any results are consistently less than 4 mmol/l at any time.

10 How do I inject my Humulin M3? Your healthcare professional will explain how to inject your insulin. Injection is usually via approved pen devices or insulin syringe. Where do I inject? Your insulin can be injected in the places shown below. The site of the injection should be rotated within the chosen area to prevent complications developing at your injection site and aid absorption. Check with your healthcare professional for suitability of injection sites.

11 Preparing your injection It is important that before you inject your insulin you rotate it between the palms of the hands ten times and invert it through 180 ten times immediately before use. This is to ensure the insulin is mixed properly. It should appear uniformly cloudy or milky. The image above is a KwikPen, if you have been prescribed Humulin M3 in a cartridge you should load the cartridge into the pen device and then mix similarly to that shown above.

12 What if I forget an injection? Forgetting your insulin is rarely an emergency situation. Seek advice from your diabetes team. The advice will vary depending on when you have realised you have forgotten to take your insulin What if I cannot remember if I had my insulin? If you are in any doubt, do not take again. In both cases your blood glucose may run a little higher after the injection you have forgotten. Do not worry. It is very important that you know the name of your Pen device, your insulin and the name of your blood glucose meter My insulin is: My pen is: My blood glucose meter is:

13 What is a hypo and why does it happen? A blood glucose reading of 4 mmol/l and under is hypoglyceamia (a hypo). A hypo occurs when blood glucose falls too low. People feel different things when a hypo is starting, you may also find some of your hypos feel different from others. A hypo can happen for a number of reasons; If you ve missed a meal or had one later than usual If you ve not had enough food or eaten less food than normal If you ve had more insulin than necessary If you ve been more active than usual If you ve been drinking alcohol If you ve experienced extremes in temperature, either hot or cold If your diabetes is well controlled occasional hypos are a normal part of life for people with diabetes, but they shouldn t take over your life. If you are having frequent hypos, speak with your diabetes team.

14 Hypos begin quickly, but there are usually warning signs. Symptoms can vary from person to person, but may include the following: Sweating Thumping heart Looking pale Weakness or tiredness Pins and needles sensation Dizziness/ feeling tipsy, drunk Disturbed vision Mild confusion Slurred speech Hunger Aggression or altered behaviour Headache If hypoglycaemia isn t corrected it can lead to more serious conditions such as loss of consciousness.

15 How do I deal with hypos? If you experience a hypo, you should deal with it by taking 15-20g of quick acting carbohydrate such as: 5-7 Dextrosol tablets or, ml of original Lucozade or, ml of pure fruit juice such as orange juice Your healthcare professional may also advise you of quick acting carbohydrate such as: It is advisable to re-check your blood glucose level to ensure your blood glucose levels are rising.

16 If you are not about to eat a meal, ensure you eat grams of slow acting carbohydrate, to maintain your blood glucose levels until you next eat. This can be: half a sandwich fruit a small bowl of cereal biscuits and milk Your healthcare professional may also advise you of slow acting carbohydrate such as: The exact quantity will vary from person to person Remember to carry your identity card and glucose tablets with you in case of an emergency. If you have regular hypos consider adjusting your insulin and/or contacting your nurse or doctor.

17 What should I do if I feel unwell? A number of common illnesses can cause your blood glucose to rise. When you are unwell you may not want to eat or take your insulin treatment as normal, but it is important to follow these basic rules: 1. Keep on taking your insulin However ill you feel and however little food you are eating, you may still need insulin. Sometimes in these circumstances you need more than your usual dose. Ask your healthcare professional for specific advice on what action to take when you are ill. 2. Monitor your blood glucose Monitor your blood glucose. Test at least 4 times daily as your blood glucose levels will indicate whether you require extra insulin doses. 3. Take carbohydrates in liquid form Take unsweetened fluids if your blood glucose is high. If you still do not feel like eating as your blood glucose returns to normal then substitute food with sweetened fruit juices or drinks that contain glucose.

18 Notes Page

19 Notes Page

20 Side effects should be reported. This includes any possible side effects not listed in the package leaflet. If you experience side effects talk to your doctor or other healthcare professional. Any side effects from your medication can be reported at Side effects and product complaints can also be reported to Lilly: please call Lilly UK on By reporting side effects you can help provide more information on the safety of medicines. Eli Lilly & Company Ltd Priestley Road Basingstoke RG24 9NL This booklet has been developed with the Diabetes Specialist Nurses in Sheffield and Mid-Yorks NHS Trust and funded by Lilly as a service to patient care. The booklet has been reviewed for medical accuracy and printed by Lilly. UKHML00057c(1) March 2014

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