Diabetes melitus

Hypoglycaemia(hunger, tachycardia, unsteadiness, sweating, pallor, irrational behaviour, Agression, unconsciousness, local neurological deficit and convulsions),

Sensitivity, reactions (porcine insulin is intrinsically less antigenic than bovine insulin), Insulin resistence, lipoatrophy(rare) Insulin oedema (bovine insulin) cross reactivity to human insulins(in patients sensitised to other insulins.

Hypoglycaemia,severe allergic reactions(bovine and procaine insulins)short term administration of bovine insulin.

Special precautions:

Pregnancy.Insulin requirement would tend to fall during first trimester, increase during the 2nd and 3rd. immediately after placental separation, Insulin requirements are markedly reduced and doseof insulin including I.V. infusions should be halved,

Diabetes secondary to pancreatic disease, Addisons disease, hypopitutarism(require small doses of insulin), hypokalaemic myopathy.

Indications:

Diabetes melitus

Dosage:

Individualise dose. Adults and children- 0.5 to 1U/kg/day. Children(below 5 years)- 100 to 200mg/

Storage: Always store in referigerator. Do not freeze.

1.Use same type and brand syringe to avoid dosage errors. Rotate site to prevent lipodystropy. If using a -pen-filled- device,follow information for proper use in insert.

2. Do not change the order of mixing insulins(if applicable) or change the brand, strength, type, species, or dose without your physicians knowledge.

3. Insulin reqiuirements may change in patients who become ill, especially with vomitting or fever. Consult a physician.

4. See your dentist twice yearly; see your opthalmologist regularly.

5.Patients must receive complete instructions about the nature of diabetes. Strict adherance to prescribed diet, excercise program and personal hygiene are essential.

6. Patients should wear diabetic identification, so appropiate treatment can be given if complications occur away from home.

7. Monitor blood glucose and urine for glucose and ketone as prescribed, monitor blood pressure regularly.

8.Allergies- tell your doctor if you have ever had any unusual or allergic reaction to insulin, especially in the skin area where you injected the insulin. Also tell your doctor if you are allergic to any other substances, such as foods, presrvatives or dyes.

9.Pregnancy - theamount of insulin you need changes during pregnancy. Close monitoring of your blood sugar can feduce the cahnce of your baby gaining too much weight having

10.Breast feeding- you will need to test your blood sugar for several months in case your insulin dose needs to be changed

11. Children - children are especially sensitive to the effects of insulin before puberity. Threfore lowe blood sugar may especially likely to occur

12. Elderly- some older people may have vision problems or other medical problems that may it harder for them to measure and inject the medicine. Special training and equipment may be needed

13. Other medicines - Let your doctor know what other medicines you are taking, so that he can advice you accordingly. Alcohol- small amounts of alcohol taken with meals do not usually cause a problem, however more than small amounts of alcohol taken for a longer time or in one sitting with food can increase the effect of insulin to lower blood sugar.

Beta blockers- can cover the symptoms of low blod sugar (such as fast heartbeat) . Because of this a person with diabetes might not recognize that he or she has low blood sugar and might not take immediate steps to treat it. Beta blockers can also cause a low blood sugar level to last longer than normal.

Corticosteroids- higher dosese of insulin may be required during corticosteroid treatment and for a period of time after treatment ends. Pentamidine - your dose of pentamidine or insulin or both may need to be adjusted if your pancreas can still make some insulin, because pentamidine may cause your pancreaes to release insulin too fast

14. Other medical problems - Tell your doctor if you have any other medical problems especially - Changes in female hormones for some woen or High fever or Infection severe or Psychological stress or

Other conditions that cause high blood sugar - these condition increase blood sugar and increase the amount of insulin you need to take Adrenal gland low activity or Pitutiary gland low activity not properly controlled or Other conditions that cause low blood sugar- these conditions lower blood sugar and may lower the amount of insulin you may need to take

Diarrhea or Gastroparesis or Intestinal blockage or Vomiting or Other conditions - these conditions may slow the time it takes to breakdown and absorb your meal from the stomach or intestines Injury or Surgery - efects of insulin may be increased or decreased - the amount and type of insulin you need may change rapidly

Surgery - efects of insulin may be increased or decreased partly because of slower removal of insulin from the body Kidney disesase - efects of insulin may be increased or decreased

Liver disease- effects of insulin may be increased or decreased Overactive thyroid, not properly controlled- effects of insulin may be increased or decreased

Kidney diseasse - may prevent indapamide from working properly

Liver disease - higher blood levels of indapamide may occur which may increase the chance of side effects

15. Missed dose - If you miss a dose of this medicine, take it as soon as possible. however, if it is almost time for the next dose, skip the missed dose. Do not double doses.

16. Storage - Keep out of reach of children. Store away from heat or direct sunlight. Do not store the capsule in bathroom, near the kitchen sink, or in other damp places.

17. Outdated medicines - Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of reach of children.

Pharmacology:

Insulin secreted by the beta cells of the pancreas, is the principal hormone required for proper glucose use in normal metabolic process. It is composed of two amino acid chains, A(acidic) and B(basic), joined together by disulfide linkages.

Human insulin has minor but significant differences from animal insulin with respect to the amino acid sequence on the B-chain. It is derived from a bio-synthetic process with strains of E-coli(recombinant DNA; rDNA) or from a semisynthetic process in which pork insulin is enzymatically converted at B-30 terminal amino acid to human insulin.

Reports not available

Pregnancy

Insulin requirement would tend to fall during first trimester, increase during the 2nd and 3rd. immediately after placental separation,