Insulin nph and regular (Subcutaneous)

Insulin human isophane and insulin human regular is a mix of an intermediate-acting insulin and a short-acting insulin. Insulin is one of several hormones that help the body turn food into energy by using glucose (sugar) in the blood for quick energy. Insulin also helps store energy for later use. If you have diabetes mellitus, your body either does not produce enough insulin or does not use insulin properly, leading to high blood sugar levels. Like other types of insulin, insulin human isophane and insulin human regular combination is used to maintain your blood sugar level as close to normal as possible.

This medicine is available only with your doctor's prescription.

Never share insulin needles or syringes with others under any circumstances. It is not safe for one pen to be used for more than one person. Sharing needles can lead to the transmission of hepatitis viruses, HIV, or other bloodborne illnesses.

It is very important that your doctor checks your progress at regular visits to ensure that this medicine is working properly. Blood and urine tests may be needed to look for unwanted effects.

It is very important to carefully follow any instructions from your health care team about:

• Alcohol—Drinking alcohol (including beer and wine) may cause severe low blood sugar. Discuss this with your health care team.
• Other medicines—Do not take other medicines while using this medicine unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
• Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about changes in diabetes medicine dosing that might happen due to lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy may be needed because of the problems that can occur in patients with diabetes during pregnancy.
• Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you normally would. Make allowances for changing time zones and try to keep your meal times as close as possible to your usual meal times.

In case of emergency: There may be times when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to:

• Wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that states you have diabetes and lists all of your medicines.
• Keep an extra supply of Humulin® and syringes with needles or injection devices on hand in case high blood sugar occurs.
• Keep some kind of quick-acting carbohydrate handy, such as raisins or crackers, to treat low blood sugar.
• Have a glucagon kit available in case severe low blood sugar occurs. Check and replace any expired kits regularly.

This medicine may cause a serious allergic reaction, including anaphylaxis, which can be life-threatening and requires immediate medical attention. Tell your doctor right away if you have a rash, itching, swelling of the face, tongue, and throat, trouble breathing, or chest pain after you get the injection.

Using this medicine with other diabetes medicines (e.g., pioglitazone, rosiglitazone, Actos®, Actoplus Met®, Avandia®) may cause serious heart problems or edema (fluid retention). Check with your doctor immediately if you are rapidly gaining weight, having chest pain or discomfort, extreme tiredness or weakness, trouble breathing, an uneven heartbeat, or excessive swelling of the hands, wrists, ankles, or feet.

You may experience some skin redness, rash, itching, or swelling at the injection site. If this irritation is severe or does not go away, call your doctor. Do not inject this medicine into a skin area that is red, swollen, or itchy.

This medicine may make you dizzy or drowsy. Make sure you know how you react to this medicine before driving, using machines, or doing other tasks that require you to be alert.

Too much Humulin® 70/30 can cause hypoglycemia (low blood sugar). Low blood sugar can also occur if you use Humulin® 70/30 with another antidiabetic medicine, change your insulin regimen (e.g., insulin strength, type of insulin, injection site), delay or miss a meal or snack, exercise more than usual, or drink alcohol. Low blood sugar must be treated before it causes you to pass out (become unconscious). People experience different symptoms of low blood sugar. It is important for you to learn which symptoms of low blood sugar you usually have so that you can treat it quickly.

• Symptoms of low blood sugar include anxiety, behavior changes similar to being drunk, blurred vision, cold sweats, confusion, cool, pale skin, difficulty thinking, drowsiness, excessive hunger, fast heartbeat, a continuing headache, nausea, nervousness, nightmares, restless sleep, shakiness, slurred speech, or unusual tiredness or weakness.
• If symptoms of low blood sugar occur, eat glucose tablets or gel, corn syrup, honey, or sugar cubes, or drink fruit juice, a non-diet soft drink, or sugar dissolved in water to relieve the symptoms. Also, check your blood for low blood sugar. Glucagon is used in emergencies when severe symptoms, including seizures or unconsciousness, occur. Have a glucagon kit available, along with a syringe and needle, and know how to use it. Family members should also know how to use it.

Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your antidiabetic medicine or insulin, change your insulin regimen, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual.

• Symptoms of high blood sugar include blurred vision, drowsiness, dry mouth, flushed, dry skin, a fruit-like breath odor, increased urination (frequency and amount), ketones in the urine, loss of appetite, stomachache, nausea, or vomiting, tiredness, rapid and deep trouble breathing, unconsciousness, or unusual thirst.
• If symptoms of high blood sugar occur, check your blood sugar level and then call your doctor for instructions.

This medicine may cause hypokalemia (low levels of potassium in your blood). Do not use medicines, supplements, or salt substitutes that contain potassium unless you have discussed this with your doctor.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

In deciding to use a medicine, you and your doctor need to consider the risks of taking the medicine against the benefits it may provide. For this medicine, please consider the following:

Allergies

Inform your doctor if you have had any unusual or allergic reactions to this medicine or any other medicines. Also, tell your healthcare professional about any other allergies you may have, including allergies to foods, dyes, preservatives, or animals. For over-the-counter products, read the label or package ingredients carefully.

Pediatric

Studies have not been done to understand how Humulin® 70/30 affects children. Safety and effectiveness have not been established for this age group.

Geriatric

Studies on how Humulin® 70/30 affects older adults have not been conducted, but specific problems related to aging are not expected to limit the use of this medicine in elderly patients. However, older adults are more likely to experience low blood sugar and may have age-related kidney, liver, or heart issues, which could require careful monitoring and possible dose adjustments.

Breast Feeding

There are no adequate studies on the risks to infants when this medication is used during breastfeeding. Consider the potential benefits and risks before using this medication while breastfeeding.

Interactions with Medicines

Some medicines should not be used together, while others can be used together even if an interaction might occur. In these situations, your doctor may need to adjust the dose or take other precautions. It is important for your healthcare professional to know if you are taking any of the following medicines while using this medicine. The following interactions are significant but not an exhaustive list.

Using this medicine with any of the following may increase the risk of certain side effects, but using both may be the best option for you. If both medicines are prescribed, your doctor may adjust the dose or frequency of one or both medicines.

• Acebutolol
• Atenolol
• Betaxolol
• Bisoprolol
• Carteolol
• Carvedilol
• Celiprolol
• Esmolol
• Labetalol
• Levobunolol
• Metipranolol
• Metoprolol
• Nadolol
• Nebivolol
• Oxprenolol
• Penbutolol
• Pindolol
• Practolol
• Propranolol
• Sotalol
• Timolol

Interactions with Food/Tobacco/Alcohol

Some medicines should not be taken at the same time as food or certain types of food due to possible interactions. Using alcohol or tobacco with certain medicines can also lead to interactions. Talk to your healthcare professional about using your medicine with food, alcohol, or tobacco.

Other Medical Problems

Other medical conditions may impact the use of this medicine. Be sure to inform your doctor about any other medical issues, especially:

• Diabetic ketoacidosis (too much acid in the blood) or
• Hypoglycemia (low blood sugar)—This medicine should not be used in these conditions. If you have low blood sugar and take insulin, your blood sugar may drop to dangerously low levels.

• Hypokalemia (low potassium in the blood)—This may worsen this condition and increase the risk of serious side effects.

• Infection or any illness or
• Stress (e.g., physical or emotional)—These conditions can raise blood sugar levels and may require more insulin human isophane and insulin human regular combination.

• Kidney disease or
• Liver disease—Use with caution. The effects of the medicine may be stronger because it is removed from the body more slowly.

Along with its necessary effects, this medicine may also cause some unwanted effects. Not all of these side effects may happen, but if they do, you may need medical attention.

Check with your doctor right away if any of the following side effects happen:

Incidence not known

• Anxiety
• bloating or swelling of the face, arms, hands, lower legs, or feet
• blurred vision
• chest tightness
• chills
• cold sweats
• coma
• confusion
• cool, pale skin
• cough
• decreased urine
• depression
• difficulty swallowing
• dizziness
• dry mouth
• fast heartbeat
• headache
• hives, itching, or rash
• increased hunger
• increased thirst
• irregular heartbeat
• loss of appetite
• mood changes
• muscle pain or cramps
• nausea or vomiting
• nightmares
• numbness or tingling in the hands, feet, or lips
• puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
• rapid weight gain
• seizures
• shakiness
• slurred speech
• tingling of the hands or feet
• unusual tiredness or weakness
• unusual weight gain or loss

Some side effects may happen that typically do not need medical attention. These side effects may go away during treatment as your body gets used to the medicine. Your health care professional may also be able to tell you how to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue, are bothersome, or if you have any questions about them:

Incidence not known

• Weight gain
• redness, swelling, or itching at the injection site

Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

Call your doctor for medical advice about side effects. You can report side effects to the FDA at 1-800-FDA-1088.

In the U.S.

• HumuLIN 50/50
• HumuLIN 70/30
• NovoLIN 70/30

Available Dosage Forms:

• Suspension

Therapeutic Class: Antidiabetic

Pharmacologic Class: Insulin, Isophane (NPH)

When you start using this medicine, it is very important that you check your blood sugar often, especially before and after meals and at bedtime. This will help lower the chance of having very low blood sugar.

A nurse or other trained health professional may give you this medicine. You may also be taught how to give your medicine at home. This medicine is given as a shot under your skin.

Always double-check both the concentration (strength) of your insulin and your dose. Concentration and dose are not the same. The dose is how many units of insulin you will use. The concentration tells how many units of insulin are in each milliliter (mL), such as 100 units/mL (U-100), but this does not mean you will use 100 units at a time.

This medicine comes with a patient information leaflet and patient instructions. Read and follow these instructions carefully. Ask your doctor if you have any questions.

Each package of Humulin® 70/30 contains a patient information sheet. Read this sheet carefully before beginning your treatment and each time you refill for any new information, and make sure you understand:

• How to prepare the medicine.
• How to inject the medicine.
• How to dispose of syringes, needles, and injection devices.

This medicine is given as a shot under the skin of your stomach, thighs, or upper arm. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas.

Check the liquid in the vial or pen. It should look cloudy all the way through after mixing. Do not use Humulin® 70/30 if it has any small particles in it. Do not mix this insulin with any other insulin.

Use a new needle for the prefilled pen each time you give yourself an injection. Always remove and throw the needle after each injection from the pen. Store it without a needle attached.

This medicine should be given at least 30 to 45 minutes before a meal.

Follow carefully the special meal plan your doctor gave you. This is the most important part of controlling your condition, and is necessary if the medicine is to work properly. Also, exercise regularly and test for sugar in your blood or ketones in your urine as directed.

Do not change the brand, type, or dose of your insulin unless your doctor tells you to. When you receive a new supply of insulin, check the label to be sure if it is the correct type of insulin.

Dosing

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

• For injection dosage form:For diabetes mellitus: Adults—Dose is based on your blood sugar and must be determined by your doctor. Children—Use and dose must be determined by your doctor.

Missed Dose

Call your doctor or pharmacist for instructions.

Storage

Keep out of the reach of children.

Do not keep outdated medicine or medicine no longer needed.

Ask your healthcare professional how you should dispose of any medicine you do not use.

Unopened vials: Store in the refrigerator. You may store the medicine at room temperature for 31 days. Protect from light. Do not freeze.

Unopened prefilled pens: Store in the refrigerator. You may store the medicine at room temperature for 10 days. Protect from light. Do not freeze.

Opened vials: Store in the refrigerator or at room temperature in a cool place, away from sunlight and heat. Use within 31 days.

Opened prefilled pens: Store at room temperature, away from direct heat and light. Do not refrigerate. Throw away any opened pen after 10 days.

Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

• How and where should I inject insulin?
• How long does Humulin last?