Insulin (Systemic)

Precautions While Using This Medicine

It is very important that your doctor check your progress at regular visits , especially during the first few weeks of insulin treatment.

It is very important to follow carefully any instructions from your health care team about :

• Alcohol - Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team.
• Tobacco - If you have been smoking for a long time and suddenly stop, your dosage of insulin may need to be reduced. If you decide to quit, tell your doctor first.
• Other medicines - Do not take other medicines unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
• Counseling - Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes, especially teenagers, may need special counseling about insulin dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur in women with diabetes who become pregnant.
• Travel - Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones, keep your meal times as close as possible to your usual meal times, and store insulin properly.

In case of emergency - There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to:

• Wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and lists all of your medicines.
• Keep an extra supply of insulin and syringes with needles on hand in case high blood sugar occurs.
• Keep some kind of quick-acting sugar handy to treat low blood sugar.
• Have a glucagon kit available in case severe low blood sugar occurs. Check and replace any expired kits regularly.

Too much insulin can cause low blood sugar (also called hypoglycemia or insulin reaction). Symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out) . Different people may feel different symptoms of low blood sugar. It is important that you learn what symptoms of low blood sugar you usually have so that you can treat it quickly .

• Symptoms of low blood sugar can include: anxious feeling, behavior change similar to being drunk, blurred vision, cold sweats, confusion, cool pale skin, difficulty in concentrating, drowsiness, excessive hunger, fast heartbeat, headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, and unusual tiredness or weakness.
• The symptoms of low blood sugar may develop quickly and may result from:
  • delaying or missing a scheduled meal or snack.
  • exercising more than usual.
  • drinking a significant amount of alcohol.
  • taking certain medicines.
  • using too much insulin.
  • sickness (especially with vomiting or diarrhea).
• Know what to do if symptoms of low blood sugar occur. Eating some form of quick-acting sugar when symptoms of low blood sugar first appear will usually prevent them from getting worse. Good sources of sugar include:
  • Glucose tablets or gel, fruit juice or nondiet soft drink (4 to 6 ounces [one-half cup]), corn syrup or honey (1 tablespoon), sugar cubes (six one-half inch size), or table sugar (dissolved in water).
    • If a snack is not scheduled for an hour or more you should also eat a light snack, such as cheese and crackers, half a sandwich, or drink an 8-ounce glass of milk.
    • Do not use chocolate because its fat slows down the sugar entering into the blood stream.
  • Glucagon is used in emergency situations such as unconsciousness. Have a glucagon kit available and know how to prepare and use it. Members of your household also should know how and when to use it.

High blood sugar (hyperglycemia) is another problem related to uncontrolled diabetes. If you have any symptoms of high blood sugar, contact your health care team right away . If high blood sugar is not treated, severe hyperglycemia can occur, leading to ketoacidosis (diabetic coma) and death.

• The symptoms of mild high blood sugar appear more slowly than those of low blood sugar. Symptoms can include: blurred vision; drowsiness; dry mouth; flushed and dry skin; fruit-like breath odor; increased urination (frequency and volume); loss of appetite; stomachache, nausea, or vomiting; tiredness; troubled breathing (rapid and deep); and unusual thirst.
• Symptoms of severe high blood sugar (called ketoacidosis or diabetic coma) that need immediate hospitalization include: flushed and dry skin, fruit-like breath odor, ketones in urine, passing out, and troubled breathing (rapid and deep).
• High blood sugar symptoms may occur if you:
  • have diarrhea, a fever, or an infection.
  • do not take enough insulin or skip a dose of insulin.
  • do not exercise as much as usual.
  • overeat or do not follow your meal plan.
• Know what to do if high blood sugar occurs. Your doctor may recommend changes in your insulin dose or meal plan to avoid high blood sugar. Symptoms of high blood sugar must be corrected before they progress to more serious conditions. Check with your doctor often to make sure you are controlling your blood sugar. Your doctor might discuss the following with you:
  • Increasing your insulin dose when you plan to eat an unusually large dinner, such as on holidays. This type of increase is called an anticipatory dose.
  • Decreasing your dose for a short time for special needs, such as when you cannot exercise as you normally do. Changing only one type of insulin dose (usually the first dose) and anticipating how the change may affect other doses during the day. Contacting your doctor if you need a permanent change in dose.
  • Delaying a meal if your blood glucose is over 200 mg/dL to allow time for your blood sugar to go down. An extra insulin dose may be needed if your blood sugar does not come down shortly.
  • Not exercising if your blood glucose is over 240 mg/dL and reporting this to your doctor immediately.
  • Being hospitalized if ketoacidosis or diabetic coma occurs.