Patient should consult physician before travelling between different time zones. Inadequate dosing or discontinuation of treatment, especially in type 1 diabetes, may lead to hyperglycaemia & diabetic ketoacidosis. Omission of a meal or unplanned strenuous exercise may lead to hypoglycaemia. May experience a change in usual warning symptoms of hypoglycaemia in patients whose blood glucose control is greatly improved. Consider concomitant diseases or medication where a delayed absorption of food might be expected. Concomitant illness, especially infections & feverish conditions, usually increases the patient's insulin requirement; diseases of the kidney, liver or affecting the adrenal, pituitary or thyroid gland can require insulin dose changes. Transferring to another type or brand of insulin should be done under strict medical supervision. Continuous rotation of the inj site reduces the risk of developing inj site reactions, lipodystrophy & cutaneous amyloidosis. Monitor blood glucose after the change in inj site from an affected to an unaffected area; consider dose adjustment of antidiabetic medications. Cases of CHF have been reported when thiazolidinediones were used in combination w/ insulin. Thiazolidinediones should be discontinued if any symptoms of deterioration in cardiac function occurs. Insulin label must always be checked before each inj to avoid accidental mix-ups/medication errors. May cause insulin Abs to form. Intensify blood glucose monitoring in patients w/ renal or hepatic impairment, pregnancy & elderly. May impair ability to concentrate & react when driving or using machines. Insulin requirements usually fall in the 1st trimester & increase subsequently during the 2nd & 3rd trimesters. No restrictions on treatment during breast-feeding. No studies in childn <2 yr.
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