Risk of hyperglycaemia w/ inadequate dosage or discontinuation of treatment, especially in type 1 DM. Risk of hypoglycaemia w/ excessive insulin dose, omitted meal or unplanned, strenuous physical exercise. Change in usual warning symptoms of hypoglycaemia in patients w/ greatly improved blood glucose control eg, by intensified therapy; disappearance of usual warning symptoms in patients w/ longstanding diabetes. Dose adjustment may be necessary if patients change physical activity or their usual diet, or during concomitant illness (especially infections & feverish conditions; concomitant diseases in the kidney, liver or affecting the adrenal, pituitary or thyroid gland); when transferring from other insulin prep [change in strength, brand (manufacturer), type, origin (human insulin, insulin analogue) &/or method of manufacture]; patients travelling between different time zones. Always rotate inj sites w/in the same region to reduce risk of lipodystrophy & cutaneous amyloidosis. Blood glucose monitoring is recommended after change in the inj site from an affected area (inj site w/ lipodystrophy, cutaneous amyloidosis) to an unaffected area, & dose adjustment of antidiabetic medications may be considered. Do not use in insulin pumps for continuous SC insulin infusion. Cases of CHF in combination w/ thiazolidinediones. May impair ability to drive & use machines. Intensified blood glucose control & monitoring during pregnancy. Dosage &/or diet may need to be adjusted during lactation.
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