17 . July , 2018 - Tuesday
Check todays hot topics or new products

Find a Drug: Advanced

Please Sign in or Register

All about: Humulin N

Big Image
Generic Name: insulin human
Dosage Form: Injection

INFORMATION FOR THE PATIENT

WARNINGS

THIS LILLY HUMAN INSULIN PRODUCT DIFFERS FROM ANIMAL-SOURCE INSULINS BECAUSE IT IS STRUCTURALLY IDENTICAL TO THE INSULIN PRODUCED BY YOUR BODY'S PANCREAS AND BECAUSE OF ITS UNIQUE MANUFACTURING PROCESS.

ANY CHANGE OF INSULIN SHOULD BE MADE CAUTIOUSLY AND ONLY UNDER MEDICAL SUPERVISION. CHANGES IN STRENGTH, MANUFACTURER, TYPE (E.G., REGULAR, NPH, LENTE®), SPECIES (BEEF, PORK, BEEF-PORK, HUMAN), OR METHOD OF MANUFACTURE (rDNA VERSUS ANIMAL-SOURCE INSULIN) MAY RESULT IN THE NEED FOR A CHANGE IN DOSAGE.

SOME PATIENTS TAKING HUMULIN® (HUMAN INSULIN, rDNA ORIGIN) MAY REQUIRE A CHANGE IN DOSAGE FROM THAT USED WITH ANIMAL-SOURCE INSULINS. IF AN ADJUSTMENT IS NEEDED, IT MAY OCCUR WITH THE FIRST DOSE OR DURING THE FIRST SEVERAL WEEKS OR MONTHS.

DIABETES

Insulin is a hormone produced by the pancreas, a large gland that lies near the stomach. This hormone is necessary for the body's correct use of food, especially sugar. Diabetes occurs when the pancreas does not make enough insulin to meet your body's needs.

To control your diabetes, your doctor has prescribed injections of insulin products to keep your blood glucose at a near-normal level. You have been instructed to test your blood and/or your urine regularly for glucose. Studies have shown that some chronic complications of diabetes such as eye disease, kidney disease, and nerve disease can be significantly reduced if the blood sugar is maintained as close to normal as possible. The American Diabetes Association recommends that if your premeal glucose levels are consistently above 130 mg/dL or your hemoglobin A1c (HbA1c) is more than 7%, consult your doctor. A change in your diabetes therapy may be needed. If your blood tests consistently show below-normal glucose levels you should also let your doctor know. Proper control of your diabetes requires close and constant cooperation with your doctor. Despite diabetes, you can lead an active and healthy life if you eat a balanced diet, exercise regularly, and take your insulin injections as prescribed.

Always keep an extra supply of insulin as well as a spare syringe and needle on hand. Always wear diabetic identification so that appropriate treatment can be given if complications occur away from home.

NPH HUMAN INSULIN

Description

Humulin is synthesized in a special non-disease-producing laboratory strain of Escherichia coli bacteria that has been genetically altered by the addition of the gene for human insulin production. Humulin N is a crystalline suspension of human insulin with protamine and zinc providing an intermediate-acting insulin with a slower onset of action and a longer duration of activity (up to 24 hours) than that of regular insulin. The time course of action of any insulin may vary considerably in different individuals or at different times in the same individual. As with all insulin preparations, the duration of action of Humulin N is dependent on dose, site of injection, blood supply, temperature, and physical activity. Humulin N is a sterile suspension and is for subcutaneous injection only. It should not be used intravenously or intramuscularly. The concentration of Humulin N is 100 units/mL (U-100).

Identification

Human insulin manufactured by Eli Lilly and Company has the trademark Humulin and is available in 6 formulations — Regular (R), NPH (N), Lente (L), Ultralente® (U), 50% Human Insulin Isophane Suspension [NPH]/50% Human Insulin Injection [buffered regular] (50/50), and 70% Human Insulin Isophane Suspension [NPH]/30% Human Insulin Injection [buffered regular] (70/30). Your doctor has prescribed the type of insulin that he/she believes is best for you. DO NOT USE ANY OTHER INSULIN EXCEPT ON HIS/HER ADVICE AND DIRECTION.

Always check the carton and the bottle label for the name and letter designation of the insulin you receive from your pharmacy to make sure it is the same as that your doctor has prescribed.

Always examine the appearance of your bottle of insulin before withdrawing each dose. A bottle of Humulin N must be carefully shaken or rotated before each injection so that the contents are uniformly mixed. Humulin N should look uniformly cloudy or milky after mixing. Do not use it if the insulin substance (the white material) remains at the bottom of the bottle after mixing. Do not use a bottle of Humulin N if there are clumps in the insulin after mixing. Do not use a bottle of Humulin N if solid white particles stick to the bottom or wall of the bottle, giving it a frosted appearance. Always check the appearance of your bottle of insulin before using, and if you note anything unusual in the appearance of your insulin or notice your insulin requirements changing markedly, consult your doctor.

Storage

Insulin should be stored in a refrigerator but not in the freezer. If refrigeration is not possible, the bottle of insulin that you are currently using can be kept unrefrigerated as long as it is kept as cool as possible (below 86°F [30°C]) and away from heat and light. Do not use insulin if it has been frozen. Do not use a bottle of insulin after the expiration date stamped on the label.

INJECTION PROCEDURES

Correct Syringe

Doses of insulin are measured in units. U-100 insulin contains 100 units/mL (1 mL=1 cc). With Humulin N, it is important to use a syringe that is marked for U-100 insulin preparations. Failure to use the proper syringe can lead to a mistake in dosage, causing serious problems for you, such as a blood glucose level that is too low or too high.

Syringe Use

To help avoid contamination and possible infection, follow these instructions exactly.

Disposable syringes and needles should be used only once and then discarded. NEEDLES AND SYRINGES MUST NOT BE SHARED.

Reusable syringes and needles must be sterilized before each injection. Follow the package directions supplied with your syringe. Described below are 2 methods of sterilizing.

Boiling

  1. Put syringe, plunger, and needle in strainer, place in saucepan, and cover with water. Boil for 5 minutes.
  2. Remove articles from water. When they have cooled, insert plunger into barrel, and fasten needle to syringe with a slight twist.
  3. Push plunger in and out several times until water is completely removed.

Isopropyl Alcohol

If the syringe, plunger, and needle cannot be boiled, as when you are traveling, they may be sterilized by immersion for at least 5 minutes in Isopropyl Alcohol, 91%. Do not use bathing, rubbing, or medicated alcohol for this sterilization. If the syringe is sterilized with alcohol, it must be absolutely dry before use.

Preparing the Dose

  1. Wash your hands.
  2. Carefully shake or rotate the insulin bottle several times to completely mix the insulin.
  3. Inspect the insulin. Humulin N should look uniformly cloudy or milky. Do not use it if you notice anything unusual in the appearance.
  4. If using a new bottle, flip off the plastic protective cap, but do not remove the stopper. When using a new bottle, wipe the top of the bottle with an alcohol swab.
  5. If you are mixing insulins, refer to the instructions for mixing that follow.
  6. Draw air into the syringe equal to your insulin dose. Put the needle through rubber top of the insulin bottle and inject the air into the bottle.
  7. Turn the bottle and syringe upside down. Hold the bottle and syringe firmly in 1 hand and shake gently.
  8. Making sure the tip of the needle is in the insulin, withdraw the correct dose of insulin into the syringe.
  9. Before removing the needle from the bottle, check your syringe for air bubbles which reduce the amount of insulin in it. If bubbles are present, hold the syringe straight up and tap its side until the bubbles float to the top. Push them out with the plunger and withdraw the correct dose.
  10. Remove the needle from the bottle and lay the syringe down so that the needle does not touch anything.

Mixing Humulin N and Regular Human Insulin

  1. NPH human insulin should be mixed only with regular human insulin.
  2. Draw air into your syringe equal to the amount of Humulin N you are taking. Insert the needle into the Humulin N bottle and inject the air. Withdraw the needle.
  3. Now inject air into your regular human insulin bottle in the same manner, but do not withdraw the needle.
  4. Turn the bottle and syringe upside down.
  5. Making sure the tip of the needle is in the insulin, withdraw the correct dose of regular insulin into the syringe.
  6. Before removing the needle from the bottle, check your syringe for air bubbles which reduce the amount of insulin in it. If bubbles are present, hold the syringe straight up and tap its side until the bubbles float to the top. Push them out with the plunger and withdraw the correct dose.
  7. Remove the needle from the bottle of regular insulin and insert it into the bottle of Humulin N. Turn the bottle and syringe upside down. Hold the bottle and syringe firmly in 1 hand and shake gently. Making sure the tip of the needle is in the insulin, withdraw your dose of Humulin N.
  8. Remove the needle and lay the syringe down so that the needle does not touch anything.

Follow your doctor's instructions on whether to mix your insulins ahead of time or just before giving your injection. It is important to be consistent in your method.

Syringes from different manufacturers may vary in the amount of space between the bottom line and the needle. Because of this, do not change:

  • the sequence of mixing, or
  • the model and brand of syringe or needle that the doctor has prescribed.

Injection

Cleanse the skin with alcohol where the injection is to be made. Stabilize the skin by spreading it or pinching up a large area. Insert the needle as instructed by your doctor. Push the plunger in as far as it will go. Pull the needle out and apply gentle pressure over the injection site for several seconds. Do not rub the area. To avoid tissue damage, give the next injection at a site at least 1/2” from the previous site.

DOSAGE

Your doctor has told you which insulin to use, how much, and when and how often to inject it. Because each patient's case of diabetes is different, this schedule has been individualized for you.

Your usual insulin dose may be affected by changes in your food, activity, or work schedule. Carefully follow your doctor's instructions to allow for these changes. Other things that may affect your insulin dose are:

Illness

Illness, especially with nausea and vomiting, may cause your insulin requirements to change. Even if you are not eating, you will still require insulin. You and your doctor should establish a sick day plan for you to use in case of illness. When you are sick, test your blood/urine frequently and call your doctor as instructed.

Pregnancy

Good control of diabetes is especially important for you and your unborn baby. Pregnancy may make managing your diabetes more difficult. If you are planning to have a baby, are pregnant, or are nursing a baby, consult your doctor.

Medication

Insulin requirements may be increased if you are taking other drugs with blood-glucose-raising activity, such as oral contraceptives, corticosteroids, or thyroid replacement therapy. Insulin requirements may be reduced in the presence of drugs with blood-glucose-lowering activity, such as oral antidiabetic agents, salicylates (for example, aspirin), sulfa antibiotics, alcohol, certain antidepressants and some kidney and blood pressure medicines. Your Health Care Professional may be aware of other medications that may affect your diabetes control. Therefore, always discuss any medications you are taking with your doctor.

Exercise

Exercise may lower your body's need for insulin during and for some time after the activity. Exercise may also speed up the effect of an insulin dose, especially if the exercise involves the area of injection site (for example, the leg should not be used for injection just prior to running). Discuss with your doctor how you should adjust your regimen to accommodate exercise.

Travel

Persons traveling across more than 2 time zones should consult their doctor concerning adjustments in their insulin schedule.

COMMON PROBLEMS OF DIABETES

Hypoglycemia (Insulin Reaction)

Hypoglycemia (too little glucose in the blood) is one of the most frequent adverse events experienced by insulin users. It can be brought about by:

  1. Missing or delaying meals
  2. Taking too much insulin
  3. Exercising or working more than usual
  4. An infection or illness (especially with diarrhea or vomiting)
  5. A change in the body's need for insulin
  6. Diseases of the adrenal, pituitary, or thyroid gland, or progression of kidney or liver disease
  7. Interactions with other drugs that lower blood glucose, such as oral antidiabetic agents, salicylates (for example, aspirin), sulfa antibiotics, certain antidepressants and some kidney and blood pressure medicines
  8. Consumption of alcoholic beverages

Symptoms of mild to moderate hypoglycemia may occur suddenly and can include:

  • sweating
  • dizziness
  • palpitation
  • tremor
  • hunger
  • restlessness
  • tingling in the hands, feet, lips, or tongue
  • lightheadedness
  • inability to concentrate
  • headache
  • drowsiness
  • sleep disturbances
  • anxiety
  • blurred vision
  • slurred speech
  • depressed mood
  • irritability
  • abnormal behavior
  • unsteady movement
  • personality changes

Signs of severe hypoglycemia can include:

  • disorientation
  • unconsciousness
  • seizures
  • death

Therefore, it is important that assistance be obtained immediately.

Early warning symptoms of hypoglycemia may be different or less pronounced under certain conditions, such as long duration of diabetes, diabetic nerve disease, medications such as beta-blockers, change in insulin preparations, or intensified control (3 or more insulin injections per day) of diabetes.

A few patients who have experienced hypoglycemic reactions after transfer from animal-source insulin to human insulin have reported that the early warning symptoms of hypoglycemia were less pronounced or different from those experienced with their previous insulin.

Without recognition of early warning symptoms, you may not be able to take steps to avoid more serious hypoglycemia. Be alert for all of the various types of symptoms that may indicate hypoglycemia. Patients who experience hypoglycemia without early warning symptoms should monitor their blood glucose frequently, especially prior to activities such as driving. If the blood glucose is below your normal fasting glucose, you should consider eating or drinking sugar-containing foods to treat your hypoglycemia.

Mild to moderate hypoglycemia may be treated by eating foods or drinks that contain sugar. Patients should always carry a quick source of sugar, such as candy mints or glucose tablets. More severe hypoglycemia may require the assistance of another person. Patients who are unable to take sugar orally or who are unconscious require an injection of glucagon or should be treated with intravenous administration of glucose at a medical facility.

You should learn to recognize your own symptoms of hypoglycemia. If you are uncertain about these symptoms, you should monitor your blood glucose frequently to help you learn to recognize the symptoms that you experience with hypoglycemia.

If you have frequent episodes of hypoglycemia or experience difficulty in recognizing the symptoms, you should consult your doctor to discuss possible changes in therapy, meal plans, and/or exercise programs to help you avoid hypoglycemia.

Hyperglycemia and Diabetic Acidosis

Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin. Hyperglycemia can be brought about by:

  1. Omitting your insulin or taking less than the doctor has prescribed
  2. Eating significantly more than your meal plan suggests
  3. Developing a fever, infection, or other significant stressful situation

In patients with insulin-dependent diabetes, prolonged hyperglycemia can result in diabetic acidosis. The first symptoms of diabetic acidosis usually come on gradually, over a period of hours or days, and include a drowsy feeling, flushed face, thirst, loss of appetite, and fruity odor on the breath. With acidosis, urine tests show large amounts of glucose and acetone. Heavy breathing and a rapid pulse are more severe symptoms. If uncorrected, prolonged hyperglycemia or diabetic acidosis can lead to nausea, vomiting, dehydration, loss of consciousness or death. Therefore, it is important that you obtain medical assistance immediately.

Lipodystrophy

Rarely, administration of insulin subcutaneously can result in lipoatrophy (depression in the skin) or lipohypertrophy (enlargement or thickening of tissue). If you notice either of these conditions, consult your doctor. A change in your injection technique may help alleviate the problem.

Allergy to Insulin

Local Allergy— Patients occasionally experience redness, swelling, and itching at the site of injection of insulin. This condition, called local allergy, usually clears up in a few days to a few weeks. In some instances, this condition may be related to factors other than insulin, such as irritants in the skin cleansing agent or poor injection technique. If you have local reactions, contact your doctor.

Systemic Allergy— Less common, but potentially more serious, is generalized allergy to insulin, which may cause rash over the whole body, shortness of breath, wheezing, reduction in blood pressure, fast pulse, or sweating. Severe cases of generalized allergy may be life threatening. If you think you are having a generalized allergic reaction to insulin, notify a doctor immediately.

ADDITIONAL INFORMATION

Additional information about diabetes may be obtained from your diabetes educator.

DIABETES FORECAST is a national magazine designed especially for patients with diabetes and their families and is available by subscription from the American Diabetes Association, National Service Center, 1660 Duke Street, Alexandria, Virginia 22314, 1-800-DIABETES (1-800-342-2383).

Another publication, DIABETES COUNTDOWN, is available from the Juvenile Diabetes Foundation International (JDF), 120 Wall Street, 19th Floor, New York, New York 10005, 1-800-JDF-CURE (1-800-533-2873).

Additional information about Humulin can be obtained by calling 1-888-88-LILLY (1-888-885-4559).

Patient Information revised April 9, 2007

Eli Lilly and Company, Indianapolis, IN 46285, USA

Copyright © 1997, 2007, Eli Lilly and Company. All rights reserved.

INFORMATION FOR THE PATIENT
3 ML DISPOSABLE INSULIN DELIVERY DEVICE

HUMULIN®N Pen

NPH

HUMAN INSULIN

(rDNA ORIGIN) ISOPHANE SUSPENSION

100 UNITS PER ML (U-100)

WARNINGS

THIS LILLY HUMAN INSULIN PRODUCT DIFFERS FROM ANIMAL-SOURCE INSULINS BECAUSE IT IS STRUCTURALLY IDENTICAL TO THE INSULIN PRODUCED BY YOUR BODY'S PANCREAS AND BECAUSE OF ITS UNIQUE MANUFACTURING PROCESS.

ANY CHANGE OF INSULIN SHOULD BE MADE CAUTIOUSLY AND ONLY UNDER MEDICAL SUPERVISION. CHANGES IN STRENGTH, MANUFACTURER, TYPE (E.G., REGULAR, NPH, LENTE, ETC), SPECIES (BEEF, PORK, BEEF-PORK, HUMAN), OR METHOD OF MANUFACTURE (rDNA VERSUS ANIMAL-SOURCE INSULIN) MAY RESULT IN THE NEED FOR A CHANGE IN DOSAGE.

SOME PATIENTS TAKING HUMULIN®(HUMAN INSULIN, rDNA ORIGIN) MAY REQUIRE A CHANGE IN DOSAGE FROM THAT USED WITH ANIMAL-SOURCE INSULINS. IF AN ADJUSTMENT IS NEEDED, IT MAY OCCUR WITH THE FIRST DOSE OR DURING THE FIRST SEVERAL WEEKS OR MONTHS.

TO OBTAIN AN ACCURATE DOSE, CAREFULLY READ AND FOLLOW THE “DISPOSABLE INSULIN DELIVERY DEVICE USER MANUAL” AND THIS INFORMATION FOR THE PATIENT INSERT BEFORE USING THIS PRODUCT. BEFORE EACH INJECTION, YOU SHOULD PRIME THE PEN, A NECESSARY STEP TO MAKE SURE THE PEN IS READY TO DOSE. PRIMING THE PEN IS IMPORTANT TO CONFIRM THAT INSULIN COMES OUT WHEN YOU PUSH THE INJECTION BUTTON AND TO REMOVE AIR THAT MAY COLLECT IN THE INSULIN CARTRIDGE DURING NORMAL USE. IF YOU DO NOT PRIME, YOU MAY RECEIVE TOO MUCH OR TOO LITTLE INSULIN (see alsoINSTRUCTIONS FOR PEN USE section).

DIABETES

Insulin is a hormone produced by the pancreas, a large gland that lies near the stomach. This hormone is necessary for the body's correct use of food, especially sugar. Diabetes occurs when the pancreas does not make enough insulin to meet your body's needs.

To control your diabetes, your doctor has prescribed injections of insulin products to keep your blood glucose at a near-normal level. You have been instructed to test your blood and/or your urine regularly for glucose. Studies have shown that some chronic complications of diabetes such as eye disease, kidney disease, and nerve disease can be significantly reduced if the blood sugar is maintained as close to normal as possible. The American Diabetes Association recommends that if your premeal glucose levels are consistently above 130 mg/dL or your hemoglobin A1c (HbA1c) is more than 7%, consult your doctor. A change in your diabetes therapy may be needed. If your blood tests consistently show below-normal glucose levels, you should also let your doctor know. Proper control of your diabetes requires close and constant cooperation with your doctor. Despite diabetes, you can lead an active and healthy life if you eat a balanced diet, exercise regularly, and take your insulin injections as prescribed.

Always keep an extra supply of insulin as well as a spare syringe and needle on hand. Always wear diabetic identification so that appropriate treatment can be given if complications occur away from home.

NPH HUMAN INSULIN

Description

Humulin is synthesized in a non-disease-producing special laboratory strain of Escherichia coli bacteria that has been genetically altered by the addition of the human gene for insulin production. Humulin® N (human insulin [rDNA origin] isophane suspension) is a crystalline suspension of human insulin with protamine and zinc providing an intermediate-acting insulin with a slower onset of action and a longer duration of activity (up to 24 hours) than that of regular insulin. The time course of action of any insulin may vary considerably in different individuals or at different times in the same individual. As with all insulin preparations, the duration of action of Humulin N is dependent on dose, site of injection, blood supply, temperature, and physical activity. Humulin N is a sterile suspension and is for subcutaneous injection only. It should not be used intravenously or intramuscularly. The concentration of Humulin N in Humulin N Pen is 100 units/mL (U-100).

Identification

Humulin disposable insulin delivery devices, manufactured by Eli Lilly and Company, are available in 2 formulations — NPH and 70/30.

Your doctor has prescribed the type of insulin that he/she believes is best for you. DO NOT USE ANY OTHER INSULIN EXCEPT ON HIS/HER ADVICE AND DIRECTION.

The Humulin N Pen is available in boxes of 5 disposable insulin delivery devices (“insulin pens”). The Humulin N Pen is not designed to allow any other insulin to be mixed in its cartridge, or for the cartridge to be removed.

Always examine the appearance of Humulin N suspension in the insulin pen before administering a dose. A cartridge of Humulin N contains a small glass bead to assist in mixing. Humulin N Pen must be rolled between the palms 10 times and inverted 180° 10 times before each injection so that the contents are uniformly mixed (see Figures 1 and 2). Inspect the Humulin N suspension for uniform mixing and repeat the above steps as necessary.

Figure 1.

Figure 2.

Humulin N should look uniformly cloudy or milky after mixing. Do not use if the insulin substance (the white material) remains visibly separated from the liquid after mixing. Do not use the Humulin N Pen if there are clumps in the insulin after mixing. Do not use the Humulin N Pen if solid white particles stick to the walls of the cartridge, giving it a frosted appearance.

Always check the appearance of the Humulin N suspension in the insulin Pen before using, and if you note anything unusual in the appearance of Humulin N suspension or notice your insulin requirements changing markedly, consult your doctor.

Never attempt to remove the cartridge from the Humulin N Pen. Inspect the cartridge through the clear cartridge holder.

Storage

Not in-use (unopened): Humulin N Pens not in-use should be stored in a refrigerator but not in the freezer. Do not use Humulin N Pen if it has been frozen.

In-use: Humulin N Pens in-use should NOT be refrigerated but should be kept at room temperature (below 86°F [30°C]) away from direct heat and light. Humulin N Pens in-use must be discarded after 2 weeks, even if they still contain Humulin N.

Do not use Humulin N Pens after the expiration date stamped on the label.

INSTRUCTIONS FOR PEN USE

It is important to read, understand, and follow the instructions in the “Disposable Insulin Delivery Device User Manual” before using. Failure to follow instructions may result in getting too much or too little insulin. The needle must be changed and the Pen must be primed before each injection to make sure the Pen is ready to dose. These steps are important to confirm that insulin comes out when you push the injection button, and to remove air that may collect in the insulin cartridge during normal use.

Every time you inject:

  • Use a new needle
  • Prime to make sure the Pen is ready to dose
  • Make sure you got a full dose

NEVER SHARE INSULIN PENS, CARTRIDGES, OR NEEDLES.

PREPARING THE INSULIN PEN FOR INJECTION

  1. Always check the appearance of the Humulin N suspension in the insulin Pen before using.
  2. Roll the Humulin N Pen between the palms 10 times (see Figure 1 above).
  3. Holding the Humulin N Pen by one end, invert it 180° slowly 10 times to allow the glass bead to travel the full length of the cartridge with each inversion (see Figure 2). The cartridge is contained in the clear cartridge holder of the Humulin N Pen.
  4. Inspect the appearance of the Humulin N suspension to make sure the contents look uniformly cloudy or milky. If not, repeat the above steps until the contents are mixed. Do not use a Humulin N Pen if there are clumps in the insulin or if solid white particles stick to the walls of the cartridge.
  5. Follow the instructions in the “Disposable Insulin Delivery Device User Manual” for these steps:
    • Preparing the Pen
    • Attaching the Needle. Use a new needle for each injection.
    • Priming the Pen. The Pen must be primed before each injection to make sure the Pen is ready to dose. Performing the priming step is important to confirm that insulin comes out when you push the injection button, and to remove air that may collect in the insulin cartridge during normal use.
    • Setting a Dose
    • Injecting a Dose. To make sure you have received your dose, you must push the injection button all the way down until you see a diamond (♦) or an arrow (→) in the center of the dose window.
    • Following an Injection

PREPARING FOR INJECTION

  1. Wash your hands.
  2. To avoid tissue damage, choose a site for each injection that is at least 1/2 inch from the previous injection site. The usual sites of injection are abdomen, thighs, and arms.
  3. Cleanse the skin with alcohol where the injection is to be made.
  4. With one hand, stabilize the skin by spreading it or pinching up a large area.
  5. Inject the dose as instructed by your doctor.
  6. After dispensing a dose, pull the needle out and apply gentle pressure over the injection site for several seconds. Do not rub the area.
  7. Immediately after an injection, remove the needle from the Humulin N Pen. Doing so will guard against contamination, leakage, reentry of air, and needle clogs. Do not reuse needles. Place the used needle in a puncture-resistant disposable container and properly dispose of it as directed by your Health Care Professional.

DOSAGE

Your doctor has told you which insulin to use, how much, and when and how often to inject it. Because each patient's case of diabetes is different, this schedule has been individualized for you.

Your usual insulin dose may be affected by changes in your food, activity, or work schedule. Carefully follow your doctor's instructions to allow for these changes. Other things that may affect your insulin dose are:

Illness

Illness, especially with nausea and vomiting, may cause your insulin requirements to change. Even if you are not eating, you will still require insulin. You and your doctor should establish a sick day plan for you to use in case of illness. When you are sick, test your blood glucose/urine glucose and ketones frequently and call your doctor as instructed.

Pregnancy

Good control of diabetes is especially important for you and your unborn baby. Pregnancy may make managing your diabetes more difficult. If you are planning to have a baby, are pregnant, or are nursing a baby, consult your doctor.

Medication

Insulin requirements may be increased if you are taking other drugs with blood-glucose-raising activity, such as oral contraceptives, corticosteroids, or thyroid replacement therapy. Insulin requirements may be reduced in the presence of drugs with blood-glucose-lowering activity, such as oral antidiabetic agents, salicylates (for example, aspirin), sulfa antibiotics, alcohol, certain antidepressants and some kidney and blood pressure medicines. Your Health Care Professional may be aware of other medications that may affect your diabetes control. Therefore, always discuss any medications you are taking with your doctor.

Exercise

Exercise may lower your body's need for insulin during and for some time after the activity. Exercise may also speed up the effect of an insulin dose, especially if the exercise involves the area of injection site (for example, the leg should not be used for injection just prior to running). Discuss with your doctor how you should adjust your regimen to accommodate exercise.

Travel

Persons traveling across more than 2 time zones should consult their doctor concerning adjustments in their insulin schedule.

COMMON PROBLEMS OF DIABETES

Hypoglycemia (Insulin Reaction)

Hypoglycemia (too little glucose in the blood) is one of the most frequent adverse events experienced by insulin users. It can be brought about by:

  1. Missing or delaying meals
  2. Taking too much insulin
  3. Exercising or working more than usual
  4. An infection or illness (especially with diarrhea or vomiting)
  5. A change in the body's need for insulin
  6. Diseases of the adrenal, pituitary or thyroid gland, or progression of kidney or liver disease
  7. Interactions with other drugs that lower blood glucose, such as oral antidiabetic agents, salicylates (for example, aspirin), sulfa antibiotics, certain antidepressants and some kidney and blood pressure medicines
  8. Consumption of alcoholic beverages

Symptoms of mild to moderate hypoglycemia may occur suddenly and can include:

  • sweating
  • dizziness
  • palpitation
  • tremor
  • hunger
  • restlessness
  • tingling in the hands, feet, lips, or tongue
  • lightheadedness
  • inability to concentrate
  • headache
  • drowsiness
  • sleep disturbances
  • anxiety
  • blurred vision
  • slurred speech
  • depressed mood
  • irritability
  • abnormal behavior
  • unsteady movement
  • personality changes

Signs of severe hypoglycemia can include:

  • disorientation
  • unconsciousness
  • seizures
  • death

Therefore, it is important that assistance be obtained immediately.

Early warning symptoms of hypoglycemia may be different or less pronounced under certain conditions, such as long duration of diabetes, diabetic nerve disease, medications such as beta-blockers, change in insulin preparations, or intensified control (3 or more insulin injections per day) of diabetes.

A few patients who have experienced hypoglycemic reactions after transfer from animal-source insulin to human insulin have reported that the early warning symptoms of hypoglycemia were less pronounced or different from those experienced with their previous insulin.

Without recognition of early warning symptoms, you may not be able to take steps to avoid more serious hypoglycemia. Be alert for all of the various types of symptoms that may indicate hypoglycemia. Patients who experience hypoglycemia without early warning symptoms should monitor their blood glucose frequently, especially prior to activities such as driving. If the blood glucose is below your normal fasting glucose, you should consider eating or drinking sugar-containing foods to treat your hypoglycemia.

Mild to moderate hypoglycemia may be treated by eating foods or drinks that contain sugar. Patients should always carry a quick source of sugar, such as candy mints or glucose tablets. More severe hypoglycemia may require the assistance of another person. Patients who are unable to take sugar orally or who are unconscious require an injection of glucagon or should be treated with intravenous administration of glucose at a medical facility.

You should learn to recognize your own symptoms of hypoglycemia. If you are uncertain about these symptoms, you should monitor your blood glucose frequently to help you learn to recognize the symptoms that you experience with hypoglycemia.

If you have frequent episodes of hypoglycemia or experience difficulty in recognizing the symptoms, you should consult your doctor to discuss possible changes in therapy, meal plans, and/or exercise programs to help you avoid hypoglycemia.

Hyperglycemia and Diabetic Acidosis

Hyperglycemia (too much glucose in the blood) may develop if your body has too little insulin. Hyperglycemia can be brought about by:

  1. Omitting your insulin or taking less than the doctor has prescribed
  2. Eating significantly more than your meal plan suggests
  3. Developing a fever, infection, or other significant stressful situation

In patients with insulin-dependent diabetes, prolonged hyperglycemia can result in diabetic acidosis. The first symptoms of diabetic acidosis usually come on gradually, over a period of hours or days, and include a drowsy feeling, flushed face, thirst, loss of appetite, and fruity odor on the breath. With acidosis, urine tests show large amounts of glucose and acetone. Heavy breathing and a rapid pulse are more severe symptoms. If uncorrected, prolonged hyperglycemia or diabetic acidosis can lead to nausea, vomiting, dehydration, loss of consciousness or death. Therefore, it is important that you obtain medical assistance immediately.

Lipodystrophy

Rarely, administration of insulin subcutaneously can result in lipoatrophy (depression in the skin) or lipohypertrophy (enlargement or thickening of tissue). If you notice either of these conditions, consult your doctor. A change in your injection technique may help alleviate the problem.

Allergy to Insulin

Local Allergy— Patients occasionally experience redness, swelling, and itching at the site of injection of insulin. This condition, called local allergy, usually clears up in a few days to a few weeks. In some instances, this condition may be related to factors other than insulin, such as irritants in the skin cleansing agent or poor injection technique. If you have local reactions, contact your doctor.

Systemic Allergy— Less common, but potentially more serious, is generalized allergy to insulin, which may cause rash over the whole body, shortness of breath, wheezing, reduction in blood pressure, fast pulse, or sweating. Severe cases of generalized allergy may be life threatening. If you think you are having a generalized allergic reaction to insulin, notify a doctor immediately.

ADDITIONAL INFORMATION

Additional information about diabetes may be obtained from your diabetes educator.

DIABETES FORECAST is a national magazine designed especially for patients with diabetes and their families and is available on subscription from the American Diabetes Association, National Service Center, 1660 Duke Street, Alexandria, Virginia 22314, 1-800-DIABETES (1-800-342-2383).

Another publication, DIABETES COUNTDOWN, is available from the Juvenile Diabetes Foundation, 120 Wall Street 19th Floor, New York, New York 10005-4001, 1-800-JDF-CURE (1-800-533-2873).

Additional information about Humulin and Humulin N Pen can be obtained by calling 1-888-88-LILLY (1-888-885-4559).

Patient Information revised April 9, 2007

Eli Lilly and Company, Indianapolis, IN 46285, USA

Copyright © 1998, 2007, Eli Lilly and Company. All rights reserved.


Humulin N (Insulin human)
PRODUCT INFO
Product Code 0002-8315 Dosage Form INJECTION, SUSPENSION
Route Of Administration SUBCUTANEOUS DEA Schedule
INGREDIENTS
Name (Active Moiety) Type Strength
Insulin human (Insulin human) Active 100 UNITS  In 1 MILLILITER
Glycerin Inactive 16 MILLIGRAM  In 1 MILLILITER
Metacresol Inactive 1.6 MILLIGRAM  In 1 MILLILITER
Zinc Inactive .025 MILLIGRAM  In 1 MILLILITER
Phenol Inactive 0.65 MILLIGRAM  In 1 MILLILITER
Protamine sulfate Inactive .35 MILLIGRAM  In 1 MILLILITER
Dibasic sodium phosphate Inactive 3.78 MILLIGRAM  In 1 MILLILITER
IMPRINT INFORMATION
Characteristic Appearance Characteristic Appearance
Color Score
Shape Symbol
Imprint Code Coating
Size
PACKAGING
# NDC Package Description Multilevel Packaging
1 0002-8315-01 10 MILLILITER In 1 VIAL None

Humulin N (Insulin human)
PRODUCT INFO
Product Code 0002-8730 Dosage Form INJECTION, SUSPENSION
Route Of Administration SUBCUTANEOUS DEA Schedule
INGREDIENTS
Name (Active Moiety) Type Strength
Insulin human (Insulin human) Active 100 UNITS  In 1 MILLILITER
Glycerin Inactive 16 MILLIGRAM  In 1 MILLILITER
Metacresol Inactive 1.6 MILLIGRAM  In 1 MILLILITER
Zinc Inactive .025 MILLIGRAM  In 1 MILLILITER
Phenol Inactive 0.65 MILLIGRAM  In 1 MILLILITER
Protamine sulfate Inactive .35 MILLIGRAM  In 1 MILLILITER
Dibasic sodium phosphate Inactive 3.78 MILLIGRAM  In 1 MILLILITER
IMPRINT INFORMATION
Characteristic Appearance Characteristic Appearance
Color Score
Shape Symbol
Imprint Code Coating
Size
PACKAGING
# NDC Package Description Multilevel Packaging
1 0002-8730-59 5 SYRINGE In 1 CARTON contains a SYRINGE (0002-8730-01)
1 0002-8730-01 3 MILLILITER In 1 SYRINGE This package is contained within the CARTON (0002-8730-59)

Revised: 06/2007

Recent Drug Updates at DrugIndexOnline:





Attain Attain
Some commonly used brand names are: In the U.S.— Accupep HPF 9 Advera 2 Alitraq 9 Amin-Aid 2 Attain 10 Carnation Instant Breakfast 7 Carnation Instant Breakfast No Sugar Added 7 Casec 8 CitriSource 10 Compleat Modified 1 Compleat Regular 1 Comply 10 Criticare HN 9 Crucial 2 Deliver 2.0 10 more...

Dyphylline Elixir Dyphylline Elixir
Generic Name: Dyphylline Elixir (DYE-fi-lin) Brand Name: DylixDyphylline Elixir is used for:Relieving breathing problems caused by bronchial asthma, chronic bronchitis, or emphysema. Dyphylline Elixir is a bronchodilator. It works by widening the air passages and making it easier to breathe. Do more...

Hepatic-Aid II Hepatic-Aid II
Some commonly used brand names are: In the U.S.— Accupep HPF 9 Advera 2 Alitraq 9 Amin-Aid 2 Attain 10 Carnation Instant Breakfast 7 Carnation Instant Breakfast No Sugar Added 7 Casec 8 CitriSource 10 Compleat Modified 1 Compleat Regular 1 Comply 10 Criticare HN 9 Crucial 2 Deliver 2.0 10 more...

Ibu-4 Ibu-4
Some commonly used brand names are: In the U.S.— Actron 9 Advil 7 Advil Caplets 7 Advil, Children's 7 Aleve 14 Anaprox 14 Anaprox DS 14 Ansaid 6 Bayer Select Ibuprofen Pain Relief Formula Caplets 7 Cataflam 1 Clinoril 18 Cotylbutazone 16 Cramp End 7 Daypro 15 Dolgesic 7 Dolobid 2 EC-Napro more...

Lanso?l Lanso?l
more...

Levitra Levitra
Generic name: Vardenafil Brand names: Levitra Why is Levitra prescribed? Levitra is an oral drug for male impotence, also known as erectile dysfunction (ED). It works by dilating blood vessels in the penis, allowing the inflow of blood needed for an erection. Most important fact about Levitra more...

Lupron Depot-Ped Lupron Depot-Ped
Some commonly used brand names are: In the U.S.— Eligard Lupron Lupron Depot Lupron Depot-Ped Lupron Depot-3 Month 11.25 mg Lupron Depot-3 Month 22.5 mg Lupron Depot-4 Month 30 mg Viadur In Canada— Eligard Lupron Lupron Depot Lupron-3 Month SR Depot 22.5 mg Another commonly used more...

PEG-Intron PEG-Intron
Generic Name: peginterferon alfa-2b (peg in ter FEAR on AL fa 2 b) Brand Names: PEG-Intron, PEG-Intron Redipen What is peginterferon alfa-2b? Peginterferon alfa-2b is a long acting interferon. Interferons are proteins released in the body in response to viral infections. Interferons are more...