Insulin (Systemic)

Before Using This Medicine

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For insulin, the following should be considered:

Allergies - Tell your doctor if you have ever had any reactions to insulin, especially in the skin area where you injected the insulin. Also, tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy - The amount of insulin you need changes during and after pregnancy. It is especially important for your health and your baby's health that your blood sugar be closely controlled. Close control of your blood sugar can reduce the chance of your baby gaining too much weight, having birth defects, or having high or low blood sugar. Be sure to tell your doctor if you plan to become pregnant or if you think you are pregnant.

Breast-feeding - Insulin does not pass into breast milk and will not affect the nursing infant. However, most women need less insulin while breast-feeding than they needed before. You will need to test your blood sugar often for several months in case your insulin dose needs to be changed.

Children - Children are especially sensitive to the effects of insulin before puberty (the time when sexual changes occur). Therefore, low blood sugar may be especially likely to occur.

Adolescents - Use in teenagers is similar to use in older age groups. The insulin need may be higher during puberty and lower after puberty.

Older adults - Use in older adults is similar to use in other age groups. However, sometimes the first signs of low or high blood sugar are missing or not easily seen in older patients. This may increase the chance of low blood sugar during treatment. Also, some older people may have vision problems or other medical problems that make it harder for them to measure and inject the medicine. Special training and equipment may be needed.

Other medicines - Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. Do not take any other medicine, unless prescribed or approved by your doctor . When you are using insulin, it is especially important that your health care professional know if you are taking any of the following:

• Alcohol - Small amounts of alcohol taken with meals do not usually cause a problem; however, larger amounts of alcohol taken for a long time or in one sitting without food can increase the effect of insulin to lower the blood sugar level. This can keep the blood sugar low for a longer period of time than normal

• Beta-adrenergic blocking agents (acebutolol [e.g., Sectral], atenolol [e.g., Tenormin], betaxolol [e.g., Kerlone], bisoprolol [e.g., Zebeta], carteolol [e.g., Cartrol], labetalol [e.g., Normodyne], metoprolol [e.g., Lopressor], nadolol [e.g., Corgard], oxprenolol [e.g., Trasicor], penbutolol [e.g., Levatol], pindolol [e.g., Visken], propranolol [e.g., Inderal], sotalol [e.g., Sotacor], timolol [e.g., Blocadren]) - Beta-adrenergic blocking agents may increase the chance of developing either high or low blood sugar levels. Also, they can cover up symptoms of low blood sugar (such as fast heartbeat). Because of this, a person with diabetes might not recognize that he or she has low blood sugar and might not take immediate steps to treat it. Beta-adrenergic blocking agents can also cause a low blood sugar level to last longer than normal

• Corticosteroids (e.g., prednisone or other cortisone-like medicines) - Corticosteroids taken over several weeks, applied to the skin over a long period of time, or injected into a joint may increase the blood sugar level. Higher doses of insulin may be needed during corticosteroid treatment and for a period of time after corticosteroid treatment ends

• Pentamidine (e.g., NebuPent) - Your dose of pentamidine or insulin or both may need to be adjusted if your pancreas can still make some insulin because pentamidine may cause your pancreas to release its insulin too fast. This effect at first lowers the blood sugar but then causes high blood sugar

Other medical problems - The presence of other medical problems may affect the dose of insulin you need. Be sure to tell your doctor if you have any other medical problems, especially:

• Changes in female hormones for some women (e.g., during puberty, pregnancy, or menstruation) or
• High fever or
• Infection, severe or
• Mental stress or
• Overactive adrenal gland, not properly controlled or
• Other conditions that cause high blood sugar - These conditions increase blood sugar and may increase the amount of insulin you need to take, make it necessary to change the time when you inject the insulin dose, and increase the need to take blood sugar tests

• Diarrhea or
• Gastroparesis (slow stomach emptying) or
• Intestinal blockage or
• Vomiting or
• Other conditions that delay food absorption or stomach emptying - These conditions may slow the time it takes to break down and absorb your meal from your stomach or intestines, which may change the amount of insulin you need, make it necessary to change the time when you inject the insulin dose, and increase the need to take blood sugar tests

• Injury or
• Surgery - Effects of insulin may be increased or decreased; the amount and type of insulin you need may change rapidly

• Kidney disease or
• Liver disease - Effects of insulin may be increased or decreased, partly because of slower removal of insulin from the body; this may change the amount of insulin you need

• Overactive thyroid, not properly controlled - Effects of insulin may be increased or decreased, partly because of faster removal of insulin from the body. Until your thyroid condition is controlled, the amount of insulin you need may change, make it necessary to change the time when you inject the insulin dose, and increase the need to take blood sugar tests

• Underactive adrenal gland, not properly controlled or
• Underactive pituitary gland, not properly controlled or
• Other conditions that cause low blood sugar - These conditions lower blood sugar and may lower the amount of insulin you need, make it necessary for you to change the time when you inject the insulin dose, and increase the need to take blood sugar tests