Do not use the drug Protamine-insulin ChS, if after shaking the suspension does not turn white and evenly cloudy.
On the background of insulin therapy, a constant control of the concentration of glucose in the blood is necessary.
Causes hypoglycemia, in addition to an overdose of insulin, may include: drug substitution, skipping meals, vomiting, diarrhea, increased physical activity, diseases that reduce the need for insulin (liver and kidney dysfunction, hypofunction of the adrenal cortex, pituitary gland or thyroid gland), injection site change, as well as interaction with other medicinal products.
Special care must be taken to ensure thatintensive counterol blood glucose concentrations in patients in whom hypoglycemic conditions may have a particular clinical significance - with severe stenosis of the coronary or cerebral arteries, as well as in patients with proliferative retinopathy, especially if they have not been photocoagulated, because they have a risk of transient amaurosis (full blindness).
Under certain circumstances, the symptoms of hypoglycemia may be mild or may be absent. Such situations are noted in elderly patients, in the presence of neuropathy, with concomitant mental illnesses, concomitant therapy with other drugs, with low maintenance glucose concentration at blood, when changing the type of insulin.
Incorrect dosing or breaks in the administration of insulin, especially in patients with type I diabetes, can lead to hyperglycemia. Usually the first symptoms of hyperglycemia develop gradually, over a period of several hours or days. They include the appearance of thirst, increased urination, nausea, vomiting, dizziness, redness and dryness of the skin, dry mouth, loss of appetite, odor of acetone in the exhaled air. If not treated, hyperglycemia in type 1 diabetes mellitus can lead to the development of life-threatening diabetic ketoacidosis.
The dose of insulin must be corrected in case of thyroid dysfunction, Addison's disease, hypopituitarism, liver and kidney dysfunction and diabetes mellitus in persons over 65 years of age.
Correction of the dose of insulin may also be required if the patient increases the intensity of physical activity or changes the habitual diet.
Concomitant diseases, especially infections and Conditions accompanied by fever increase the need for insulin.
The transition from one type of insulin to another should be carried out under the control of the concentration of glucose in the blood.
Cases of chronic heart failure in the treatment of patients with thiazolidinediones in combination with insulin preparations have been reported, especially if such patients have risk factors for developing chronic heart failure. This fact should be taken into account when appointing patients combination therapy with thiazolidinediones and insulin preparations. In the appointment of such combination therapy, it is necessary to conduct medical examinations of patients to identify signs and symptoms of chronic heart failure, increase body weight and the presence of peripheral edema. In the casea deterioration in patients with symptoms heart failure, treatment with thiazolidinediones should be discontinued. The drug lowers tolerance to alcohol.
Due to the possibility of precipitation in some catheters, the use of the drug in insulin pumps is not recommended.
The technique of injection with the use of insulin in vials
Do not use the drug Protamine-insulin ES, if, while stirring the contents of the bottle according to the instructions for use, insulin does not become uniformly white and cloudy.
Do not use the drug Protamine-insulin ChS, if it is after mixing, there are flakes.
Do not use the drug Protamine-insulin ChS, if solid white particles stick to the bottom or walls of the vial, creating the effect of a "frosty pattern."
If the patient uses only one type of insulin
1. Disinfect the rubber membrane of the vial.
2. Draw the air into the syringe in the volume corresponding to the desired dose of insulin. Insert air into the vial with insulin.
3. Turn the bottle with the syringe upside down and type the desired dose of insulin into the syringe. Remove the needle from the vial and remove air from the syringe. Check the correctness of the dose of insulin.
4. Immediately inject.
If the patient needs to mix two types of insulin
1. Disinfect the rubber membranes of the vials.
2. Directly before typing, roll a vial of long-acting insulin ("cloudy") between the palms until the insulin becomes evenly white and cloudy.
3. Draw the air into the syringe in a volume corresponding to the dose of "cloudy" insulin. Enter the air into the bottle with a "cloudy" insulin and remove the needle from the bottle ("muddy" insulin at this stage until you type).
4.Put the air in the syringe in the volume corresponding to the dose of insulin of short action ("transparent"). Insert air into the bottle with "transparent" insulin. Turn the bottle with the syringe upside down and type the desired dose of "transparent" insulin. Remove the needle and remove air from the syringe. Check the correctness of the dialed dose.
5. Insert the needle into the vial with "cloudy" insulin, flip the bottle with the syringe upside down and type the desired dose of insulin. Remove air from the syringe and check the correctness of the dialed dose. Immediately inject the dialed mixture of insulin.
6. Always take the insulin in the same sequence described above.
Injection procedure
- With two fingers, assemble the skin fold, insert the needle into the base of the fold at an angle of about 45 ° and insert insulin under the skin.
- After injection, the needle should remain under the skin for at least 6 seconds to ensure that insulin is injected completely.
- If after removing the needle at the injection site, blood appears, gently press the site of the injection with a swab moistened with disinfectant solution (for example, alcohol).
- It is necessary to change the injection site.