A Guide to Starting Humalog Mix25 This booklet is intended only for those individuals who have been prescribed Humalog Mix 25. 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.
Contents What should I have received from the pharmacist? 3 Why have I been given this booklet? 4 What is Humalog Mix25 and how does it work? 5 When do I take my insulin? 6 Who decides how much insulin I need? 7 When do I check my blood glucose levels? 8 Instructions for self-adjustment of my insulin 9 How do I inject my insulin? 10 Preparing your injection 11 What if I forget an injection? 12 What is a hypo and why does it happen? 13 How do I deal with hypos? 15 What should I do if I feel unwell? 17 2
What should I have received from the Pharmacist? Cartridge Vial KwikPen You have been prescibed an insulin called Humalog Mix25. Ensure that your medicine has Humalog Mix25 on the packaging, as shown above Your insulin should be - please tick 3ml Humalog Mix25 cartridge for use in a reusable pen device e.g the HumaPen Savvio 3ml Humalog Mix25 KwikPen (prefilled) 10ml Humalog Mix25 vial (for use with syringe) 3
Why have I been given this booklet? You have been prescribed Humalog Mix25 (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 found in your medicine pack. 4
What is Humalog Mix25 and how does it work? Humalog Mix25 contains a combination of two types of insulin: 25% insulin lispro (a rapid acting insulin) 75% insulin lispro protamine suspension (a slower acting insulin specially developed for combination with insulin lispro) 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 Combining a rapid acting insulin and a slower acting insulin produces a rapid rise in insulin activity after injection, which gradually subsides over time. This pattern is similar to the body s rapid insulin reaction to food in people without diabetes. Insulin Activity 24 hour action profile 0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 5
When do I take my insulin? Many people can manage their diabetes using 2 injections of insulin a day. Two injections of Humalog Mix25 will provide a continual background supply of insulin, plus rapid acting insulin to handle the rise in blood glucose levels after your breakfast and evening meal. This insulin should be taken directly before your meal, but if necessary, can be taken up to fifteen minutes before or after your meal. This may be helpful when you are eating out. How much will I need? Before Breakfast Before Evening Meal 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
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
When do I check my blood glucose levels? 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: Before breakfast After breakfast Before lunch After lunch Before evening meal After evening meal Before bed time During night 8... mmol/l... mmol/l... mmol/l... mmol/l... 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 dose. 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.
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. If your results fall outside of your target range as described on page 8, the following table will enable you to identify which insulin injection will need adjusting and by how much Adjust Insulin Dose by... Units Before Breakfast Evening Injection Humalog Mix25 twice daily After Breakfast Before Lunch After Lunch Morning Injection. Before Evening Meal After Evening Meal Before Bed Evening Injection During Night Dose reduction is recommended if any results are consistently less than 4 mmol/l (hypo) at any time. 9
How do I inject my insulin? Your healthcare professional will explain how to inject your insulin. Injection is usually via approved pen devices. 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. Front Back 10
Preparing your injection Its 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. Do not use if clumps of materials are present or stick to the bottom or wall of the cartridge, pen or vial. The image above is a KwikPen, if you have been prescribed Humalog Mix25 in a cartridge you should load the cartridge into the pen device and then mix similarly to that shown above. 11
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: 12
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 the blood glucose level 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. 13
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. 14
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, 90-120ml of original Lucozade or, 150-200ml 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. 15
If you are not about to eat a meal, ensure you eat 10-20 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 insulin passport 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. 16
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. 17
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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 www.mhra.gov.uk/yellowcard. Side effects and product complaints can also be reported to Lilly: please call Lilly UK on 01256 315 000. By reporting side effects you can help provide more information on the safety of medicines. This booklet has been developed and printed by Lilly as a service to patients. Eli Lilly & Company Priestley Road Basingstoke RG24 9NL 01256 315 000 www.lillydiabetes.co.uk/patients UKHMG00230a(1) March 2014