Humalog Mix25 (25% insulin lispro [rDNA origin] injection 75 ...
Humalog Mix25 (25% insulin lispro [rDNA origin] injection 75 ...
Humalog Mix25 (25% insulin lispro [rDNA origin] injection 75 ...
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A Guide to Starting<br />
<strong>Humalog</strong> <strong>Mix25</strong><br />
This booklet is intended only for those individuals who have been<br />
prescribed <strong>Humalog</strong> Mix 25. It is intended to be used in addition<br />
to the Patient Information Leaflet (PIL) which is included in your<br />
medicine and should also be read.
Contents<br />
• What should I have received from the pharmacist 3<br />
• Why have I been given this booklet 4<br />
• What is <strong>Humalog</strong> <strong>Mix25</strong> and how does it work 5<br />
• When do I take my <strong>insulin</strong> 6<br />
• Who decides how much <strong>insulin</strong> I need 7<br />
• When do I check my blood glucose levels 8<br />
• Instructions for self-adjustment of my <strong>insulin</strong> 9<br />
• How do I inject my <strong>insulin</strong> 10<br />
• Preparing your <strong>injection</strong> 11<br />
• What if I forget an <strong>injection</strong> 12<br />
• What is a hypo and why does it happen 13<br />
• How do I deal with hypos 15<br />
• What should I do if I feel unwell 17<br />
2
What should I have received from<br />
the Pharmacist<br />
Cartridge<br />
Vial<br />
KwikPen<br />
You have been prescibed an <strong>insulin</strong> called<br />
<strong>Humalog</strong> <strong>Mix25</strong>.<br />
Ensure that your medicine has <strong>Humalog</strong> <strong>Mix25</strong><br />
on the packaging, as shown above<br />
Your <strong>insulin</strong> should be - please tick<br />
• 3ml <strong>Humalog</strong> <strong>Mix25</strong> cartridge for use in a<br />
reusable pen device e.g the HumaPen Savvio<br />
• 3ml <strong>Humalog</strong> <strong>Mix25</strong> KwikPen (prefilled)<br />
• 10ml <strong>Humalog</strong> <strong>Mix25</strong> vial (for use with syringe)<br />
3<br />
❑<br />
❑<br />
❑
Why have I been given this booklet<br />
You have been prescribed <strong>Humalog</strong> <strong>Mix25</strong> (your<br />
<strong>insulin</strong>), to help you manage your diabetes. The aim<br />
of this booklet is to allow you to learn more about<br />
your <strong>insulin</strong> and help YOU make the right decisions<br />
about adjusting your <strong>insulin</strong>, and taking control of<br />
your diabetes.<br />
It is intended to be used in addition to the patient<br />
information leaflet found in your medicine pack.<br />
4
What is <strong>Humalog</strong> <strong>Mix25</strong> and how<br />
does it work<br />
<strong>Humalog</strong> <strong>Mix25</strong> contains a combination of two types<br />
of <strong>insulin</strong>:<br />
• <strong>25%</strong> <strong>insulin</strong> <strong>lispro</strong> (a rapid acting <strong>insulin</strong>)<br />
• <strong>75</strong>% <strong>insulin</strong> <strong>lispro</strong> protamine suspension (a slower<br />
acting <strong>insulin</strong> specially developed for combination<br />
with <strong>insulin</strong> <strong>lispro</strong>)<br />
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28<br />
Combining a rapid acting <strong>insulin</strong> and a slower acting<br />
<strong>insulin</strong> produces a rapid rise in <strong>insulin</strong> activity after<br />
<strong>injection</strong>, which gradually subsides over time.<br />
This pattern is similar to the body’s rapid <strong>insulin</strong> reaction<br />
to food in people without diabetes.<br />
Insulin Activity<br />
24 hour action profile<br />
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28<br />
5
When do I take my <strong>insulin</strong><br />
Many people can manage their diabetes using 2<br />
<strong>injection</strong>s of <strong>insulin</strong> a day. Two <strong>injection</strong>s of <strong>Humalog</strong><br />
<strong>Mix25</strong> will provide a continual “background” supply of<br />
<strong>insulin</strong>, plus rapid acting <strong>insulin</strong> to handle the rise in<br />
blood glucose levels after your breakfast and evening<br />
meal.<br />
This <strong>insulin</strong> should be taken directly before your meal,<br />
but if necessary, can be taken up to fifteen minutes<br />
before or after your meal. This may be helpful when you<br />
are eating out.<br />
How much will I need<br />
Before<br />
Breakfast<br />
Before<br />
Evening Meal<br />
Dose<br />
This is your starting dose and may change.<br />
Your dose may need to be increased or decreased<br />
based on your blood glucose readings.<br />
6
Who decides how much <strong>insulin</strong><br />
I will need<br />
Your <strong>insulin</strong> dose will be adjusted by you and/or your<br />
healthcare professional according to the results of<br />
blood glucose tests you do.<br />
Do not worry if it takes a while before you reach<br />
your target blood glucose levels and you need more<br />
<strong>insulin</strong>. Each person is different and what is important<br />
is that it is the right amount for you.<br />
Why do I need to test my blood glucose levels<br />
It is important that you are aware of your own blood<br />
glucose levels in order for you to take the appropriate<br />
action, for example, adjusting your <strong>insulin</strong> dose.<br />
There are a number of reasons why you may need to<br />
adjust your <strong>insulin</strong> dose, including:<br />
• High blood glucose levels (hyperglycaemia)<br />
• Low blood glucose levels (hypoglycaemia)<br />
• Stress/illness<br />
7
When do I check my<br />
blood glucose levels<br />
Your healthcare professional will discuss with you how<br />
often and when to test. This may change during the<br />
course of your diabetes.<br />
What should your blood glucose levels be<br />
Please complete:<br />
Before breakfast<br />
After breakfast<br />
Before lunch<br />
After lunch<br />
Before evening meal<br />
After evening meal<br />
Before bed time<br />
During night<br />
8<br />
............... mmol/L<br />
............... mmol/L<br />
............... mmol/L<br />
............... mmol/L<br />
............... mmol/L<br />
............... mmol/L<br />
............... mmol/L<br />
............... mmol/L<br />
It may take a while to achieve these levels and you<br />
may require an increase of your <strong>insulin</strong> dose.<br />
Do I need to adjust my <strong>insulin</strong> and how do I do it<br />
You might not need to adjust your <strong>insulin</strong>. If you<br />
do need to adjust your <strong>insulin</strong> your healthcare<br />
professional will talk you through the next few steps.<br />
You may feel apprehensive at first, but it is important<br />
that you take control to make it work for you.
Instructions for self-adjustment<br />
of my <strong>insulin</strong><br />
When testing your blood glucose, if you have<br />
consistently high readings for more than three days<br />
at any testing point, then you will need to adjust your<br />
<strong>insulin</strong>.<br />
Your healthcare professional will explain to you how to<br />
adjust your <strong>insulin</strong> and will complete the following table<br />
for your needs.<br />
If your results fall outside of your target range as<br />
described on page 8, the following table will enable you<br />
to identify which <strong>insulin</strong> <strong>injection</strong> will need adjusting and<br />
by how much<br />
Adjust<br />
Insulin<br />
Dose by<br />
... Units<br />
Before<br />
Breakfast<br />
Evening<br />
Injection<br />
<strong>Humalog</strong> <strong>Mix25</strong> twice daily<br />
After<br />
Breakfast<br />
Before<br />
Lunch<br />
After<br />
Lunch<br />
Morning Injection.<br />
Before<br />
Evening<br />
Meal<br />
After<br />
Evening<br />
Meal<br />
Before<br />
Bed<br />
Evening Injection<br />
During<br />
Night<br />
Dose reduction is recommended if any results are<br />
consistently less than 4 mmol/L (hypo) at any time.<br />
9
How do I inject my <strong>insulin</strong><br />
Your healthcare professional will explain how to<br />
inject your <strong>insulin</strong>. Injection is usually via approved<br />
pen devices.<br />
Where do I inject<br />
Your <strong>insulin</strong> can be injected in the places shown<br />
below. The site of the <strong>injection</strong> should be rotated<br />
within the chosen area to prevent complications<br />
developing at your <strong>injection</strong> site and aid <strong>insulin</strong><br />
absorption. Check with your healthcare professional<br />
which are the most suitable <strong>injection</strong> sites.<br />
Front<br />
Back<br />
10
Preparing your <strong>injection</strong><br />
Its important that before you inject your <strong>insulin</strong> you<br />
rotate it between the palms of the hands ten times and<br />
invert it through 180° ten times immediately before use.<br />
This is to ensure the <strong>insulin</strong> is mixed properly. It should<br />
appear uniformly cloudy or milky. Do not use if clumps<br />
of materials are present or stick to the bottom or wall of<br />
the cartridge, pen or vial.<br />
The image above is a KwikPen, if you have been<br />
prescribed <strong>Humalog</strong> <strong>Mix25</strong> in a cartridge you should<br />
load the cartridge into the pen device and then mix<br />
similarly to that shown above.<br />
11
What if I forget an <strong>injection</strong><br />
Forgetting your <strong>insulin</strong> is rarely an emergency<br />
situation. Seek advice from your diabetes team.<br />
The advice will vary depending on when you have<br />
realised you have forgotten to take your <strong>insulin</strong><br />
What if I cannot remember if I had my <strong>insulin</strong><br />
If you are in any doubt, do not take your <strong>insulin</strong> again.<br />
In both cases your blood glucose may run a little<br />
higher after the <strong>injection</strong> you have forgotten.<br />
Do not worry.<br />
It is very important that you<br />
know the name of your pen device,<br />
your <strong>insulin</strong> and the name<br />
of your blood glucose meter<br />
My <strong>insulin</strong> is:<br />
My pen is:<br />
My blood glucose meter is:<br />
12
What is a “hypo” and why does it happen<br />
A blood glucose reading of 4mmol/L and under is<br />
hypoglycaemia (a “hypo”). A hypo occurs when the<br />
blood glucose level falls too low. People feel different<br />
things when a hypo is starting, you may also find<br />
some of your hypos feel different from others.<br />
A hypo can happen for a number of reasons:<br />
• If you’ve missed a meal or had one later than usual<br />
• If you’ve not had enough food or eaten less food<br />
than normal<br />
• If you’ve had more <strong>insulin</strong> than necessary<br />
• If you’ve been more active than usual<br />
• If you’ve been drinking alcohol<br />
• If you’ve experienced extremes in temperature,<br />
either hot or cold<br />
If your diabetes is well controlled, occasional hypos<br />
are a normal part of life for people with diabetes, but<br />
they shouldn’t take over your life. If you are having<br />
frequent hypos, speak with your diabetes team.<br />
13
Hypos begin quickly, but there are usually warning<br />
signs. Symptoms can vary from person to person,<br />
but may include the following:<br />
• Sweating<br />
• Thumping heart<br />
• Looking pale<br />
• Weakness or tiredness<br />
• Pins and needles sensation<br />
• Dizziness/ feeling tipsy, drunk<br />
• Disturbed vision<br />
• Mild confusion<br />
• Slurred speech<br />
• Hunger<br />
• Aggression or altered behaviour<br />
• Headache<br />
If hypoglycaemia isn’t corrected it can lead to more<br />
serious conditions such as loss of consciousness.<br />
14
How do I deal with hypos<br />
If you experience a hypo, you should deal with it by<br />
taking 15-20g of quick acting carbohydrate such as:<br />
• 5 - 7 Dextrosol ® tablets or,<br />
• 90-120ml of <strong>origin</strong>al Lucozade ® or,<br />
• 150-200ml of pure fruit juice such as orange juice<br />
Your healthcare professional may also advise you of<br />
quick acting carbohydrate such as:<br />
It is advisable to re-check your blood glucose level<br />
after taking carbohydrate to ensure your blood<br />
glucose levels are rising.<br />
15
If you are not about to eat a meal, ensure you eat<br />
10-20 grams of slow acting carbohydrate, to maintain<br />
your blood glucose levels until you next eat.<br />
This can be:<br />
• half a sandwich<br />
• fruit<br />
• a small bowl of cereal<br />
• biscuits and milk<br />
Your healthcare professional may also advise you of<br />
slow acting carbohydrate such as:<br />
The exact quantity will vary from person to person.<br />
Remember to carry your <strong>insulin</strong> passport and glucose<br />
tablets with you in case of an emergency.<br />
If you have regular hypos consider adjusting your<br />
<strong>insulin</strong> and/or contacting your nurse or doctor.<br />
16
What should I do if I feel unwell<br />
A number of common illnesses can cause your blood<br />
glucose to rise. When you are unwell you may not<br />
want to eat or take your <strong>insulin</strong> treatment as normal,<br />
but it is important to follow these basic rules:<br />
1. Keep on taking your <strong>insulin</strong><br />
However ill you feel and however little food you<br />
are eating, according to your blood glucose levels<br />
you may still need <strong>insulin</strong>. Sometimes in these<br />
circumstances you need more than your usual dose.<br />
Ask your healthcare professional for specific advice<br />
on what action to take when you are ill.<br />
2. Monitor your blood glucose<br />
Monitor your blood glucose. Test at least 4 times<br />
daily as your blood glucose levels will indicate<br />
whether you require extra <strong>insulin</strong> doses.<br />
3. Take carbohydrates in liquid form<br />
Take unsweetened fluids if your blood glucose is<br />
high. If you still do not feel like eating as your blood<br />
glucose returns to normal then substitute food with<br />
sweetened fruit juices or drinks that contain glucose.<br />
17
Notes Page<br />
18
Notes Page<br />
19
Side effects should be reported.<br />
This includes any possible side effects not listed in<br />
the package leaflet. If you experience side effects talk<br />
to your doctor or other healthcare professional.<br />
Any side effects from your medication can be reported at<br />
www.mhra.gov.uk/yellowcard.<br />
Side effects and product complaints can also be<br />
reported to Lilly: please call Lilly UK on 01256 315 000.<br />
By reporting side effects you can help provide more<br />
information on the safety of medicines.<br />
This booklet has been developed and printed by Lilly as a service to patients.<br />
Eli Lilly & Company<br />
Priestley Road<br />
Basingstoke<br />
RG24 9NL<br />
01256 315 000<br />
www.lillydiabetes.co.uk/patients<br />
UKHMG00230a(1) March 2014