isophane human insulin (prb) A Guide to Starting Humulin I
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1 isophane human insulin (prb) A Guide to Starting Humulin I This leaflet is intended only for those individuals who have been prescribed Humulin I. 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 received from the Pharmacist? Why have I been given this booklet? What is Humulin I and how does it work? When do I take my insulin? Who decides how much insulin I need? When do I check my blood glucose levels? Instructions for self-adjustment of my insulin How do I inject my insulin? Preparing your injection 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? When should my treatment be reviewed? 2
3 What should I have received from the Pharmacist? KwikPen Cartridge Vial You have been prescibed an insulin called Humulin I. Ensure that your medicine has Humulin I on the packaging, as shown above Your insulin should be - please tick 3ml Humulin I cartridge for use in a durable pen device e.g The HumaPen Savvio 3ml Humulin I KwikPen (prefilled) 10ml Humulin I vial (for use with a syringe) 3
4 Why have I been given this booklet? You have been prescribed Humulin I (your insulin), to help you manage your diabetes. The aim of this booklet is to assist you in learning 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. The information in this booklet is specific for Humulin I. You may be on other medication for your diabetes and should refer to the information you have been given for that. 4
5 What is Humulin I and how does it work? Humulin I is an intermediate acting insulin. Humulin I reduces your blood glucose levels. This is how Humulin I works over a 24 hour period. 24 hour action profile Insulin Activity This profile may vary with factors such as size of dose, site of injection, temperature and physical activity. 5
6 When do I take my insulin? You may need to take Humulin I in the morning (before breakfast) and/or in the evening (either before your evening meal or before bed). Your healthcare professional will advise you how often you need to take your insulin. How much will I need? Before Breakfast Before Evening Meal Before Bed Dose This is your starting dose and may change. Your dose may need to be increased or decreased based on your blood glucose readings. 6
7 Who decides how much insulin I will need? Your insulin dose will be adjusted by you and/or your healthcare professional according to the results of 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 7
8 When do I check my blood glucose levels? It is likely that you will need to check your blood glucose levels first thing in the morning before breakfast (fasting blood glucose). However your healthcare professional will discuss with you how often and when to test. This may change during the course of your diabetes. What should your blood glucose levels be? Please complete: Your before breakfast Your before lunch Your evening meal Your before bed time... mmol/l... 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. 8
9 Instructions 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 your needs. Night-time Humulin I Adjust units of insulin Night-time Humulin I only Fasting (before breakfast) mmol/l above... below... Morning Humulin I only Before evening meal mmol/l Morning Humulin I above... below... Adjust units of insulin 9
10 Twice daily Humulin I Twice daily Humulin I Fasting (before breakfast) mmol/l above below Before evening meal mmol/l above below Adjust units of insulin adjust evening dose adjust morning dose Dose reduction is recommended if any results are consistently less than 4 mmol/l (hypo) at any time. 10
11 How do I inject my insulin? 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 insulin absorption. Check with your healthcare professional which are the most suitable injection sites. 11
12 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 I in a cartridge you should load the cartridge into the pen device and then mix similarly to that shown above. 12
13 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 your insulin 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
14 What is a hypo and why does it happen? A blood glucose reading of 4mmol/L and under is hypoglycaemia (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
15 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
16 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 after taking carbohydrate to ensure your blood glucose levels are rising. 16
17 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
18 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, according to your blood glucose levels 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
19 When should my treatment be reviewed? If you have type 2 diabetes then we recommend that you contact your healthcare professional when you have reached a total of... units. This is so your treatment can be discussed with you and you may also be advised to monitor blood glucose tests at different times of the day or night. You should contact your healthcare professional earlier if you have any questions or are unsure what to do with your insulin. 19
20 If you have type 2 diabetes it is important to note that diabetes is a progressive condition. Over time your pancreas makes less and less insulin. In the future you may need mealtime insulin. Mealtime insulin is taken with food. Your current basal insulin covers your blood glucose (sugar) levels between meals and at night while mealtime insulin can help you control the rise in your levels when you eat. It requires you to add injections and possibly increase the number of blood glucose tests each day. Your management plan will be individually developed to meet your needs and lifestyle. 20
21 Notes Page 21
22 Notes Page 22
23 Notes Page 23
24 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 Priestley Road Basingstoke RG24 9NL This booklet has been developed with the Diabetes Specialist Nurses in Sheffield, Middlesbrough and Salford Royal Foundation Trusts and Diabetes Specialist Nurses from Dumfries & Galloway Royal Infirmary. The booklet has been reviewed for medical accuracy and printed by lilly. UKHML00004c(1) March 2014
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