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$Title{INSULIN}
$Subject{Humulin L (Lilly)
Humulin N (Lilly)
Humulin R (Lilly)
Iletin I (Lilly)
Iletin II (Lilly)
Insulatard NPH (Nordisk-USA)
Mixtard (Nordisk-USA)
Novulin (Squibb-Novo)
Velosulin (Nordisk-USA)}
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Copyright (C) 1991 Publications International, Ltd.


INSULIN
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BRAND NAMES (Manufacturers):
     Humulin L (Lilly)
     Humulin N (Lilly)
     Humulin R (Lilly)
     Iletin I (Lilly)
     Iletin II (Lilly)
     Insulatard NPH (Nordisk-USA)
     Mixtard (Nordisk-USA)
     Novulin (Squibb-Novo)
     Velosulin (Nordisk-USA)
TYPE OF DRUG:
     Antidiabetic
INGREDIENT:
     insulin
DOSAGE FORM:
     Injectable (all types) (40 units/ml, 100 units/ml)
     Injectable (regular) (40 units/ml, 100 units/ml, 500 units/ml)
     This drug is available only as an injectable (if insulin is taken orally,
       it is destroyed by stomach acid).  Various types of insulin provide
       different times of onset and different durations of action (see Insulin
       Table).
STORAGE:
     After opening, keep most forms (except 500 units/ml strength) at room
       temperature if used in six months.  Refrigerate unopened vials.  Never
       freeze insulin.

USES

     Insulin is a hormone that is normally produced by the pancreas; it
functions in the regulation of blood sugar levels.  This medication is used to
treat diabetes mellitus (sugar diabetes)--a disorder that results from an
inability of the pancreas to produce enough insulin.  Injectable insulin is
used only to treat those patients whose blood sugar levels cannot be
controlled by diet or by oral antidiabetic medications.

TREATMENT

     Your doctor, nurse, dietitian, or pharmacist will show you how to inject
insulin, using a specially marked hypodermic syringe.  This medication is
packaged with printed instructions that should be carefully followed.
     You may prefer to use presterilized disposable needles and syringes,
which are used once and then discarded.  If you use a glass syringe and metal
needle, you must sterilize them before reuse.
     Make sure that the insulin you are using is exactly the kind your doctor
ordered and that its expiration date has not passed.
     Do not shake the bottle; tip it gently, end to end, to mix.  ALWAYS CHECK
THE DOSE in the syringe at least twice before injecting it.
     Clean the site of the injection thoroughly with an antiseptic, such as
rubbing alcohol.
     Change the site of the injection daily, and avoid injecting cold insulin.
     NEVER use a vial of insulin if there are lumps in it.  Make your insulin
injection a regular part of your schedule, so that you do not miss any doses.
Ask your doctor what to do if you have to take a dose later than the scheduled
time.

SIDE EFFECTS

     Minor.

     Insulin can cause redness and rash at the site of injection.  Try to
rotate injection sites in order to avoid this reaction.

     Major.

     Tell your doctor about any side effects that are persistent or
particularly bothersome.  IT IS ESPECIALLY IMPORTANT TO TELL YOUR DOCTOR about
palpitations, fainting, shortness of breath, skin rash, or sweating.
     Too much insulin can cause hypoglycemia (low blood sugar), which can lead
to anxiety, chills, cold sweats, drowsiness, fast heart rate, headache, loss
of consciousness, nausea, nervousness, tremors, unusual hunger, or unusual
weakness.  If you experience these symptoms, eat a quick source of sugar (such
as table sugar, orange juice, honey, or a nondiet cola).  You should also tell
your doctor that you have had this reaction.
     Too little insulin can cause symptoms of hyperglycemia (high blood
sugar), such as confusion, drowsiness, dry skin, fatigue, flushing, frequent
urination, fruitlike breath odor, loss of appetite, or rapid breathing.  If
you experience any of these symptoms, contact your doctor; he or she may want
to modify your dosing schedule or change your insulin dosage.

INTERACTIONS

     Insulin interacts with several other types of medications:
     1. Insulin can increase digoxin's side effects to the heart.
     2. Oral contraceptives (birth control pills), adrenocorticosteroids
(cortisonelike medicines), danazol, dextrothyroxine, furosemide, ethacrynic
acid, thyroid hormone, thiazide diuretics (water pills), phenytoin, or
nicotine (from smoking) can increase insulin dosing requirements.
     3. Monoamine oxidase (MAO) inhibitors, phenylbutazone, fenfluramine,
guanethidine, disopyramide, sulfinpyrazone, tetracycline, alcohol, anabolic
steroids, or large doses of aspirin can increase the effects of insulin,
leading to hypoglycemia.
     4. Beta blockers (acebutolol, atenolol, betaxolol, carteolol, esmolol,
labetalol, metoprolol, nadolol, penbutolol, pindolol, propranolol, timolol)
may prolong the effects of insulin and mask the signs of hypoglycemia.
     BE SURE TO TELL YOUR DOCTOR about any medications you are currently
taking, especially any of those listed above.

WARNINGS

     * Tell your doctor about unusual or allergic reactions you have had to
any medications, especially to insulin.
     * Before starting to take this medication, be sure to tell your doctor if
you now have or if you have ever had high fevers, infections, kidney disease,
liver disease, thyroid disease, or severe nausea and vomiting.
     * If your doctor prescribes two types of insulin to achieve better
glucose control and recommends mixing the insulin into one syringe, always
draw the regular insulin (clear) into the syringe first.
     * Some insulin mixtures are stable and won't interact with each other for
some time.  Others react quickly and require immediate injection.  Consult
your doctor or pharmacist about this.
     * Make sure that your friends and family are aware of the symptoms of an
insulin reaction and know what to do should they observe any of the symptoms
in you.
     * Carry a card or wear a bracelet that identifies you as a diabetic.
     * Always have insulin and syringes available.
     * When traveling, always carry an ample supply of your diabetic needs
and, if possible, a prescription for insulin and syringes.  Carry insulin and
syringes on your person; baggage can be lost, delayed, or stolen.
     * Do not store insulin in your car's glove compartment.
     * To avoid the possibility of hypoglycemia (low blood sugar levels), you
should eat on a regular schedule and should avoid skipping meals.
     * Before having surgery or other medical or dental treatment, tell your
doctor or dentist you are taking insulin.
     * Check with your doctor or pharmacist before taking any over-the-counter
(nonprescription) cough, cold, diet, allergy, asthma, or sinus medications.
Some of these products affect blood sugar levels.
     * If you become ill--if you catch a cold or the flu or become
nauseated--your insulin requirements may change.  Consult your doctor.
     * Be sure to tell your doctor if you are pregnant.  Insulin dosing
requirements often change during pregnancy.

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The material contained here is "FOR INFORMATION ONLY" and should not replace 
the counsel and advice of your personal physician.  Promptly consulting your 
doctor is the best path to a quick and successful resolution of any medical 
problem.
