Do not apply the drug if after stirring 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, there may be: 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, and interaction with other drugs.
Incorrect dosing or breaks in the administration of insulin, especially in patients with type 1 diabetes, can lead to hyperglycemia. Usually the first symptoms of hyperglycemia develop gradually over 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 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.
In view of the increased risk of cardiac and cerebral complications of hypoglycemia, it is necessary to use the drug with caution in patients with severe stenosis of the coronary and cerebral arteries.
The drug should be used with caution in patients with proliferative retinopathy, especially those who do not receive photocoagulation (laser coagulation) because of the risk of amaurosis (complete blindness).
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.
Transfer of the patient to a new type of insulin or an insulin preparation of another manufacturer must be carried out under the supervision of a doctor.
When using insulin preparations in combination with preparations of the thiazolidinedione group in patients with type 2 diabetes mellitus, fluid retention in the body may occur, which increases the risk of developing and progressing chronic heart failure, especially in patients with cardiovascular disease and the presence of risk factors for chronic heart failure. Patients receiving this therapy should be screened regularly for signs of heart failure. When heart failure occurs, her therapy is carried out in accordance with current treatment standards. It is necessary to consider the possibility of removing thiazolidinedione or reducing its dose.
Using cartridges using reusable syringes
Cartridges with Rinsulin® NPH can be used with an Autopen Classic 3ml 1 Unit (1-21 units) AN3810, Autopen Classic 3ml 2 Unit (2-42 units) AN3800) manufactured by Owen Mumford Ltd. , United Kingdom.
Carefully follow the instructions for using the Autopen Classic pen for insulin administration.
INSTRUCTION FOR THE USE OF THE SYNDROME-HANDLE RINASTER
(single-dose multidose for multiple injections)
Provision of aseptic injection
Wash your hands with soap and water and choose a place for injection. Wipe the skin at the injection site with an alcoholic napkin only after the insulin dose has been set in the syringe pen. Before injection, allow the alcohol to dry at the injection site.
Syringe pen - see Fig. 1.
Attention: The syringe pen should be rolled between the palms horizontally 10 times and shaken to resuspend insulin until it becomes a homogeneous cloudy liquid or milk.
Assembly
A) Hold the syringe handle with one hand and remove the Cap by pulling the other with your other hand. Wipe the rubber membrane (Partition) with an alcohol cloth (see Figure A).
Note: The use of alcohol wipes helps to minimize the risk of infection.
B) Select the needle from the kit. Remove the Protective Sticker from the new Needle (see Figure B).
AT) Using the Outer nozzle, place the needle directly on the cartridge holder. Tighten securely (see Figure B).
Attention: Always use a new needle for the syringe pen.
D) Slightly pulling, remove the outer nozzle. Save the outer nozzle for the subsequent removal of the used Needle (see Figure D).
Preparation
E) Carefully remove the inner nozzle and discard. Hold the Syringe handle with the needle up. Lightly tap your finger on the cartridge to help air bubbles rise up. Small bubbles may remain, but this is permissible (see Figure E).
Note: The needle becomes visible (exposed) as the inner nozzle is removed.
Checking the suitability of the syringe pen before injection It is necessary to remove air from the needle.
Attention: Check the suitability of the syringe-pen before each injection.
E) Scroll the Dosing selector and set the dose to 2 units so that the number 2 coincides in the Dosage window with a pointer.When typing each unit, you will hear a click (see Figure E).
Note: If the Dose selector has skipped the required dose, simply reverse it in order to adjust the dose.
Attention: Do not press the Start button during dose setting.
G) Holding the syringe handle with the needle pointing upwards, press the Start button all the way. The dose selector will click when it reaches zero (see Figure F).
Check that a drop of liquid leaves the needle. If this does not happen, repeat steps E and F, but no more than 6 times. If the drop still does not come out, remove the Needle (see step A) and repeat your actions from step B (with the selection of a new needle).
Attention: In order for the dose to be complete, before every dose administration, it is always necessary to check the outlet of the liquid drop from the needle.
A small "loss" of insulin is allowed
Attention: Have you checked the Syringe Pen with a dose set to 2 units to remove air from the needle? If not, go back to "E".
Dose setting
H) Scroll the Dosage selector until the desired dose matches the pointer in the Dosage window (see Figure 3).
For example, if you need a dose of 40 units, scroll the Dose Selector to 40 (as shown in the figure).
Attention: You can not select a dose that exceeds the number of units remaining in the cartridge. In the event that the Dosing selector does not scroll, this means that there is not enough of the drug in the Syringe Pen. Discard the syringe pen or enter the remaining dose units and use a new syringe pen to complete the required dose.
Dosing Introduction
AND) Make sure you get the required dose.
Wipe the skin with an alcoholic wipe at the injection site. Pinch the skin in the right place and insert the needle under the skin with one continuous movement (see Figure I).
To avoid accidental injury from a needle stick:
- CLICK at least 2.5 cm of leather;
- DO NOT insert the needle at an angle in the direction of the fingers.
TO) Press the Start button until the value "0" matches the pointer in the Dosage window. Hold the button depressed, and the Syringe handle at the injection site for 10 seconds after the click stops (see Figure K).
Attention: Failure to follow these steps can lead to an incorrect dose.
If you do not hold the Syringe handle at the injection site for a full 10 seconds, you may not receive the required dose of the medication.
If the insulin continues to flow out of the needle after the injection, hold the needle in the skin for longer injections.
Disposing of the needle and storage of the syringe pen
L) Carefully put the outer nozzle on the needle until it stops. Unscrew the needle and discard it with the Outer nozzle (see Figure A).
M) Wear the cap of the syringe pen and store the syringe pen until the next use (see Figure M).
Care of the Syringe handle and recycling
- Keep the syringe-pen away from direct sunlight.
- The syringe pen is designed for individual use and can not be used by several persons.
- Do not attempt to repair the Syringe pen by yourself. Report on the occurrence of the problem to the Organization accepting the claims specified in the Instruction for Medical Use.
An empty syringe pen should not be reused and must be destroyed.