Do not use Vozulim-H if the suspension does not turn white or evenly turbid after shaking.
On the background of insulin therapy, a constant control of the concentration of glucose in the blood is necessary.
In case of insufficient glycemic control or a tendency to episodes of hypo- or hyperglycemia, before making a decision to correct the dose of insulin, it should be checked that the prescribed mode of insulin administration has been fulfilled; make sure,that insulin is injected into the recommended area; to check the correctness of the injection technique and all other factors that may affect the action of insulin. Since the simultaneous administration of a number of drugs can weaken or intensify the hypoglycemic effect of the drug Vozulim-H (see the section "Interaction with other drugs"), it can not be taken with other drugs without special permission from the doctor.
Hypoglycaemia
Hypoglycemia can develop if too high a dose of insulin is administered relative to the patient's need.
The risk of hypoglycemia is high at the beginning of treatment with insulin, when another insulin preparation, patients with low maintenance concentration of glucose in the blood.
The causes of hypoglycemia, in addition to an overdose of insulin, can be: switching to another preparation of insulin; skipping meals; vomiting; diarrhea; increased physical activity; diseases that reduce the need for insulin (violations of liver and kidney function, hypofunction of the adrenal cortex, pituitary gland or thyroid gland); change of injection site; alcohol consumption; as well as interaction with other drugs.
As with all insulin preparations, special care should be taken and careful monitoring of blood glucose concentrations should be carried out in cases where episodes of hypoglycemia may be of particular clinical significance in patients with severe coronary artery stenosis or cerebral vessels (risk of developing cardiac or cerebral complications of hypoglycemia), as well as in patients with proliferative retinopathy, especially if they did not undergo photocoagulation (the risk of transient loss of vision (amaurosis) due to ipoglikemii).
It is necessary to inform the doctor immediately about the development of hypoglycemia, so that he makes a decision about the need to correct the dose of insulin.
Under certain circumstances, the symptoms-precursors of hypoglycemia may change, become less pronounced or absent. Such situations occur in patients with significant improvement in glycemic control; patients with gradual development of hypoglycemia; elderly patients; patients with mental disorders; in the presence of neuropathy; with a long course of diabetes mellitus; with concomitant therapy with other medications (see section "Interaction with Other Drugs").Such situations can lead to the development of severe hypoglycemia (with possible loss of consciousness) before the patient realizes that he is developing hypoglycemia. Patient compliance with the dosing regimen and diet, proper insulin administration and knowledge of hypoglycaemic precursors contribute to a significant reduction in the risk of developing hypoglycemia.
Hyperglycaemia
Insufficient dose of the drug or discontinuation of treatment, especially in type 1 diabetes, non-compliance with diet, increased need for insulin as a result of infectious or other diseases, decreased physical activity may lead to increased blood glucose (hyperglycemia). Typically, the first symptoms of hyperglycemia appear gradually, within a few hours or days.
Symptoms of hyperglycemia are a feeling of thirst, frequent urination, nausea, vomiting, drowsiness, redness and dryness of the skin, dry mouth, loss of appetite, and the appearance of an odor of acetone in the exhaled air. Without proper treatment, hyperglycemia in patients with type 1 diabetes mellitus can lead to the development of life-threatening diabetic ketoacidosis.When the first signs of ketoacidosis appear, urgent medical intervention is necessary. When a doctor changes (for example, during hospitalization for an accident, a sickness during a vacation), the patient should inform the doctor that he has diabetes mellitus.
In patients with renal insufficiency, the need for insulin can be reduced as a result of changes in its metabolism.
In patients with severe impairment of liver function, the need for insulin can also be reduced as a result of changes in its metabolism and a decrease in gluconeogenesis.
The dose of insulin must also be corrected in case of thyroid dysfunction, hypofunction of the adrenal cortex and pituitary gland; in elderly patients.
Correction of the dose of insulin may also be required if the intensity of physical activity increases or the usual diet changes.
Concomitant diseases, especially infections and conditions accompanied by fever, increase the need for insulin.
The transfer of patients to another type of insulin or to the insulin of another manufacturer must be carried out only under medical supervision.If the concentration, producer, type, species (human insulin, human insulin analog) and / or manufacturing method changes, a change in the insulin dose may be required.
Patients switching to treatment with Vozulim-H may require a dose change or an increase in the frequency of injections compared to previously used insulin preparations. If you need to adjust the dose for the treatment of Vazulim-H with the drug, this can be done already with the introduction of the first dose or in the first weeks or months of therapy.
The transition from one type of insulin to another should be carried out under the control of the concentration of glucose in the blood.
As with other insulin preparations, reactions can occur at the site of administration, which is manifested by pain, redness, hives, inflammation, bruising, swelling and itching. Regular injection site changes within the same anatomy will help reduce symptoms or prevent the development of these reactions. Reactions usually disappear for a few days to several weeks. In rare cases, it may be necessary to cancel the drug Vozulim-H due to reactions at the site of administration.
Before the trip associated with the change of time zones, the patient should consult with his attending physician, as changing the time zone means that the patient should take food and inject insulin at another time.
The drug can not be used in insulin pumps.
Simultaneous use of insulin preparations and preparations of the thiazolidinedione group 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. When using this combination therapy, it is necessary to conduct medical examinations of patients to identify signs and symptoms of chronic heart failure, increase in body weight and the presence of peripheral edema. If the symptoms of heart failure worsen in patients, treatment with thiazolidinediones should be discontinued.
The drug reduces tolerance to alcohol.