Humalog Mix25 (25% insulin lispro [rDNA origin] injection 75 ...

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
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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

Notes Page
18

Notes Page
19

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