NovoLOG

NovoLOG parenteral route is used to treat diabetes mellitus. Insulin is produced naturally in our body. Its main function is to transport glucose (or blood sugar) from the bloodstream to cells where it is burned for energy or turned into needed fats, protein or sugars.

Insulin is usually prescribed to individuals with type-1 diabetes, or childhood-onset diabetes mellitus. However, patients with type-2 diabetes (adult-onset diabetes, the type caused by unhealthy lifestyle) may need insulin injections as well.

Individuals with diabetes have a deficiency in insulin, so they are unable to use glucose in the blood. Doctors prescribe insulin along with diet and lifestyle recommendations to manage diabetes symptoms and prevent complications.

It is essential that the insulin you take must be balanced with your daily diet and amount of exercise you do. Not doing so can result in too high or too low blood sugar levels, which can harm your health.

There are several types of insulin:

• Rapid-acting
• Short-acting
• Intermediate-acting
• Long-acting
• Pre-mixed

Your doctor may prescribe a combination of these insulin types to better control your blood sugar levels. Insulin injections are also used for other conditions, like testing for growth hormone deficiency and treating high blood sugar levels in infants.

You need a prescription in purchasing insulin. Insulin is an injectable drug. Because you may need more than one Insulin injection daily, your doctor will teach you how to properly inject them by yourself at home.

If you are about to start NovoLOG, speak with your doctor about what you need to know.

The doctor will consider the following before treating you with NovoLOG:

Tell your doctor if you have allergies to drugs like insulin. You must tell your doctor all your allergies to food, medications and animal products before treatment.

Insulin injections must be used with caution in children since they tend to be more sensitive to its effects. If your child receives insulin treatments, make sure to give the injections on time and watch out for early signs of abnormal blood sugar levels. Note that insulin needs changes once the child reaches puberty.

Elderly patients can use Insulin. However, it is easier to miss early signs of abnormal blood sugar levels in elderly so they require close monitoring. The elderly may need special equipment and teachings so they can administer insulin by themselves.

Tell your doctor if you are pregnant before and during insulin treatment. Pregnancy may change your insulin requirements, and you require closer monitoring to guard your health and your baby’s. Complications to your baby, like too heavy birth weight and birth defects, can result if your blood levels are not maintained during pregnancy.

Tell your doctor if you will breastfeed while on Insulin treatment. You can breastfeed while taking insulin injections. Insulin is not expressed in breast milk, but breastfeeding may reduce your insulin requirements.

Tell your doctor if you use alcohol or tobacco. Insulin dosage may require adjustments if you smoke or use tobacco. Make sure to tell your doctor all the medications you take before and when having Insulin treatment. Insulin has several drug interactions.

Here are some of the drugs known to interact with NovoLOG:

• Amisulpride
• Aripiprazole
• Asenapine
• Atazanavir
• Balofloxacin
• Besifloxacin
• Ciprofloxacin
• Clozapine
• Darunavir
• Enoxacin
• Ethylestrenol
• Fleroxacin
• Flumequine
• Fosamprenavir
• Gatifloxacin
• Gemifloxacin
• Iloperidone
• Indinavir
• Lanreotide
• Levofloxacin
• Liraglutide
• Lomefloxacin
• Lopinavir
• Lurasidone
• Mesterolone
• Methandriol
• Methandrostenolone
• Methenolone
• Metreleptin
• Mibolerone
• Moxifloxacin
• Nadifloxacin
• Nandrolone
• Nelfinavir
• Norfloxacin
• Octreotide
• Ofloxacin
• Olanzapine
• Oxandrolone
• Oxymetholone
• Paliperidone
• Pasireotide
• Pazufloxacin
• Pefloxacin
• Pioglitazone
• Pramlintide
• Prulifloxacin
• Quetiapine
• Risperidone
• Ritonavir
• Rosiglitazone
• Rufloxacin
• Saquinavir
• Sertindole
• Sparfloxacin
• Stanozolol
• Telaprevir
• Tipranavir
• Tosufloxacin
• Ziprasidone
• Zotepine

You must mention all your health conditions when having Insulin. Certain health problems can change your Insulin needs and may require adjustments.

Here are some health conditions that you should tell your doctor:

• High fever
• Diarrhea
• Slow stomach emptying or gastroparesis
• Vomiting
• Physical injuries
• Severe infection
• Severe stress
• Overactive adrenal gland
• Changes in female hormones caused by pregnancy, menses or puberty
• Surgery
• Blockage in the intestine
• Problems in the kidney, liver or thyroid gland
• Any health problem in the digestive tract that delays food absorption of stomach emptying, like Crohn’s disease, ulcerative colitis
• Health conditions like problems in the endocrine glands (thyroid, adrenal, pancreas or pituitary), sepsis, encephalitis, brain tumors, cerebral hemorrhage, and meningitis.

To use NovoLOG properly, you must follow all instructions given by your doctor. The doctor will determine the types of Insulin you will use and the dose based on your blood sugar levels, body weight, and health.

Since your blood sugar levels and energy needs changes over time, you need to have regular checkups for adjusting your Insulin doses.

Only use the insulin type and strength prescribed by your doctor. To avoid getting confused when buying supplies, always keep the label with you.

Note that concentration (strength) of insulin is measured in USP Insulin Units and USP Insulin Human Units, and usually expressed in terms like U-100 Insulin. Insulin is injected using a specialized insulin syringe, which is available in sizes up to 30 USP Units of Insulin, 50 USP Units of Insulin and 100 USP Units of Insulin.

Follow instructions when injecting Insulin. Your doctor will instruct you how to select and rotate injection sites to avoid skin problems caused by repeated injections.

Here are steps to draw up insulin for injection:

• Wash hands with soap and water
• Inspect the Insulin vial first. Discard if the liquid is unusually thick, looks lumpy or grainy and sticks to the bottle, or has discoloration, crystals or forms frosts on the side of the bottle. Regular insulin (short-acting) must be clear and colorless.
• Mix Insulin by slowly rolling the vial between your hands, or simply tip the bottle over a few times. Make sure to mix Insulin properly, especially if you use the cloudy type. Never shake the bottle vigorously.
• Remove the cap from the bottle. Do not remove the rubber stopper.
• Wipe the rubber with an alcohol swab.
• Remove the needle cover from the syringe

If you will use more than one type of insulin:

• Pull back the plunger on the syringe, up to the level of your insulin dose
• With the Insulin vial standing upright, gently push the needle through the rubber stopper
• Push the plunger, turn the vial upside down with one hand with the syringe and look if the tip of the needle is submerged in insulin. Using the other hand, draw back the plunger to draw the correct dose of insulin into the syringe
• Check the syringe and make sure you have the right dose and there are no air bubbles in it. The presence of air bubbles displaces insulin. If there are air bubbles, gently tap the side of the syringe while pushing back the plunger. Then, withdraw the plunger and draw up the dose again.
• Check the dose in the syringe, and make sure it has so before withdrawing the needle from the vial.
• Put back the needle cover carefully using a one-handed technique.

If you will use more than two types of Insulin:

• If you have to mix regular Insulin with another type of Insulin, withdraw regular Insulin first. This does not matter to other types of Insulin.
• After you learn the method of drawing up Insulin, stick to it each time.
• Note that some types of Insulin must be injected immediately. Ask your doctor to find out which type you have.
• Withdraw the first Insulin dose into the syringe. If you use regular Insulin, always withdraw it first. Remove air bubbles and check your dose.
• With the same syringe, push it into the second vial taking care not to move the plunger. Withdraw a little bit more than needed. Turn the vial with the needle and remove air bubbles. Since you withdrew extra insulin, you can correct the dose this time.
• Check the doses again and withdraw the syringe from the vial. Now you have a syringe containing two types of Insulin.
• Do not squirt extra solution back to the Insulin vials because that can change the Insulin in the bottle. If you find that you withdrew incorrect doses into the syringe or unsure if you did it correctly, remove the Insulin and dispose of it in the sink. Do it again. You can use the same syringe again.
• You can prepare and fill syringes with Insulin ahead of time. When using an Insulin-filled syringe that is stored for a time, remix the liquid by gently rolling the syringe back and forth. Do not shake the syringe.

Now you prepared and filled the syringe with the medication, here are steps in injecting Insulin:

• You can inject Insulin into the fatty area of the body.
• Clean the injection site first with soap and water, or alcohol swab, and let it dry.
• Hold the syringe as you would hold a pencil, pinch the injection site, and push the needle straight into the pinched-up skin at a 90-degree angle (adult) or 45-degree angle for a child. Make sure that the needle is all the way in and push the plunger down.
• Now that the medication is injected let go of the skin. Grab an alcohol swab and place it near the needle, and then pull out the syringe.
• Press the alcohol swab into the injection site. Do not rub.
• The instructions for injection may be different in individuals who are obese or overweight.

If you use special injection devices for administering Insulin, make sure to follow the instructions. You can choose to use an automatic injector, which quickly plunges the needle into your skin with a touch of the button to release the Insulin dose. Use it properly and follow the prescribed dose. If you need help, call your doctor.

If you use a continuous subcutaneous infusion Insulin pump, a portable device that pumps Insulin continuously, here are important things to know:

• Buffered regular human Insulin is recommended for such devices. However, you can use non-buffered regular Insulin in it.
• The device has a button that delivers an extra dose of Insulin. Only press this button if you need an extra dose at times, for example, at mealtime.
• Follow the instructions properly in loading Insulin in the syringe and pump reservoir so you are sure you get the correct dose.
• Make sure to check the infusion site and the tubings at a regular basis to make sure the pump is working properly.

If you use disposable syringes, note that manufacturers recommend using them only once because sterility is not guaranteed when it is reused. However, you can reuse the syringe as long as the needle is not dull and the syringes are handled and stored properly.

Throw away the syringe if the needle has touched surfaces other than the cleaned skin and vial of the medication. Recapping needles can increase the risk of needlestick injuries. You can prevent getting pricked by using a one-handed method of recapping syringes, or using a separate device.

If you use an Insulin pen device, you can change the dose by rotating the head of the pen. Administer Insulin by pressing the pen into your skin and pressing the plunger. Note that injection amounts vary from different devices.

In some devices, you need to press the plunger several times to get the right dose. Note that there are also devices that use special cartridges of Isophane Insulin (NPH), regular Insulin, or a mixture of these two types.

You can use nondisposable syringes, which uses a glass syringe and a metal needle. These syringes can be sterilized for repeated use. Ask your doctor or nurse on how to use and maintain these devices properly.

You can also use a spray injector gun for administering Insulin. This device sprays Insulin into the skin at very high pressures without using a needle.

Note that many laws require proper disposal of used syringes and empty vials. You can dispose used needles and vials in a rigid sealed container, like empty bleach containers, and put on the cap so the contents will not spill out. Follow doctor’s instructions in injecting Insulin to reduce risks of side effects.

The doctor will give you instructions regarding diet, exercise levels and how to test blood sugar levels, which is important when you are injecting Insulin regularly.

Diet – the doctor will give you a meal plan to approximate your total daily calorie intake while making sure you meet your energy needs and maintain a healthy weight. Make sure to follow the meal plan.

Exercise – follow your doctor’s recommendation on how much exercise levels you need daily.

Blood tests – blood tests is the only way to check your blood glucose levels, which determines if treatment is working.

Testing is essential so your health providers can adjust your insulin dose, meal plan, and exercise requirements.

Changes in Insulin dose – note that changing the first Insulin dose can change your blood sugar levels later in the day, or necessitate changing later Insulin doses. Make sure the doctor knows if you change doses, even on a temporary basis.

On sick days – continue taking the prescribed Insulin dose even if you feel sick or too ill to eat. Take your usual dose and try to follow your meal plan if you have nausea, vomiting, diarrhea or have colds.

Infection actually increases your need for insulin. If you cannot take usual solid food items, drink juices, sodas, clear soups, and bland foods. Call your doctor or dietician for help in knowing the foods to eat.

Make sure to call your doctor and tell him or her that you are sick. Test your blood sugar every four hours and check urine for ketones. If ketones are present, or you have severe and prolonged vomiting, call your doctor and head to the nearest hospital.

Here is a simple guide to types of Insulins sold at the market, the brand names, and important information during administration:

Rapid-acting Insulin – Novolog, Apidra, Humalog

• Short-acting Insulin has onset of effect within 15 minutes and peaks for 90 minutes
• Eat a meal in 5 minutes to 10 minutes after administration. May be used with another type of Insulin.
• In children, the dose is determined by the doctor.

Regular Insulin (R) – Humulin R, Novolin R

• Short-acting, peak effect lasts 2 to 4 hours
• For adults and teenagers, it is injected 15 minutes to 30 minutes before meals and/or bedtime snack. Doctors often prescribe another form of Insulin when prescribing regular Insulin.
• For children, the doctor determines the dose by basing it on blood sugar levels and body weight

Human Insulin (NPH) – Humulin N, Novolin N

• Has onset of 1 to 2 hours, peak effect lasts 4 to 12 hours
• In adults and children, it is injected 30 minutes to an hour before a meal or bedtime snack. Doctors may also prescribe another type of Insulin with it.
• In children, the doctor determines the dose by basing it on blood sugar levels and body weight

Premixed Insulin — Humulin 70/30, Novolin 70/30, Humulin 50/50, Humalog Mix 75/25, Humalog Mix 50/50, NovoLog Mix 70/30

• Combination of short- and intermediate-acting Insulins
• In adults and teenagers, is injected 15 minutes to 30 minutes before breakfast, and another dose before a meal or bedtime. It can also be used with other types of Insulin.
• In children, dose is determined by the doctor

Long-acting Insulins (L) – Determined, Glargine

• Long-acting has onset of 1 hour and has effect lasting around 24 hours
• In adults and children, is administered 30 minutes to 60 minutes before breakfast or meals. The doctor may prescribe another dose before each meal or bedtime snack. May be used with another type of Insulin.
• In children, the dose is determined by the doctor.

Storage:

Store Insulin vials in the refrigerator. Do not freeze Insulin. Bring Insulin at room temperature first before injecting it. If you store prefilled needles, store them with needles facing up. This will prevent the formation of crystals in the needles that can block the syringe.

Insulin vials that are in use can be kept at room temperature for up to a month. Bottles kept longer than a month are no longer viable and must be thrown away. Do not expose Insulin to sunlight and hot temperatures.

Before using NovoLOG, there are some precautions you must take. Always follow the doctor’s instructions and the dose in taking Insulin. Call your doctor if you have questions or need help.

Never share Insulin syringes, needles pens or cartridges with others. Doing so can put you at risk of bloodborne infections such as hepatitis B and HIV infection. Make sure you visit your doctor regularly, especially at first few months of treatment.

Discuss with your doctor if you are trying to quit tobacco and alcohol use. Alcohol may cause your blood sugar to drop to dangerously low levels. Your Insulin levels may be reduced if you are quitting tobacco.

If you are having Insulin injections, you must not take other medicines without your doctor’s approval. Note that certain non-prescription medicines like aspirin, appetite enhancers, drugs for asthma, colds, hay fever and sinus problems may cause adverse changes to the effects of Insulin.

When traveling, learn to organize your medications including Insulin so you are sure to have injections on time. Store your Insulin properly, keep a recent prescription and your medical history, and be prepared for emergencies. In case, your travel will cross time zones, make sure to eat your meals as close as possible to usual meal times.

Consider having to counsel. Restrictions on diet and exercise due to diabetes and injections of insulin may have an impact on daily activities. Counseling can help you cope with the condition. Women with diabetes may need counseling on topics like contraception and pregnancy.

Make sure to be prepared in case of emergency.

Here are things you can do:

• Wear a medical ID bracelet, and an ID card in your wallet, stating your diabetic status and your needed medications
• Make sure you have access to extra insulin and syringe (with needles)
• Keep a source of sugar, like hard candy, to eat when your blood sugar becomes too low
• Keep a glucagon kit to address too low blood sugar. Make sure to check and replace if expired.

Note that Insulin can lower your blood sugar to dangerous levels (hypoglycemia), which can cause loss of consciousness and seizures. You must understand the early signs of low blood sugar so you can address it before it becomes worse.

Note that symptoms are different among individuals.

Here are symptoms of low blood sugar levels:

• Feelings of anxiousness and nervousness
• Behavior similar to being drunk, confusion, shakiness, slurred speech and blurring of vision
• Drowsiness, cold, pale skin, cold sweats
• Fast heartbeat
• Excessive hunger, unusual weakness or fatigue
• A headache, nausea, difficulty concentrating
• Restless sleep and nightmares

Your blood sugar levels can drop down due to the following reasons:

• Drinking lots of alcohol
• Taking certain medicines
• Missing a meal or a snack
• Exercising more than usual
• Using too much Insulin
• Getting sick, especially with vomiting or diarrhea

If your blood sugar levels become low, eating simple sugars can prevent it from getting worse.

Here are important things to know:

• Consuming items like glucose tablets or gels, half-cup of non-diet sodas, a tablespoon of honey or corn syrup, sugar cubes (6 cubes) or 6 teaspoons of table sugar dissolved in water can help raise blood sugar levels and relieve symptoms.
• If snack or meals are scheduled for more than an hour, you can eat a light snack like cheese with crackers, half a sandwich, or a glass of milk (8 ounces).
• Do not give chocolate because it has high-fat content that slows down sugar absorption.
• If blood sugar becomes too low and the patient becomes unconscious, you can give Glucagon. You must have a Glucagon kit readily available, and you or family members must know how to use it.

Elevated blood sugar levels (hyperglycemia) are also a problem in diabetics. You can have it when you have diarrhea, fever or active infection, do not exercise or ate too much food and did not follow the meal plan. You can also experience it if you did not take enough Insulin. Symptoms of high blood pressure tend to appear more slowly.

Learn to notice the following symptoms of high blood sugar:

• Blurred vision
• Dry mouth
• Thirst
• Drowsiness
• Flushed and dry skin
• Increased frequency and amount of urination
• Loss of appetite
• Pain in the abdomen
• Nausea or vomiting

Severe hyperglycemia is a serious condition, and the patient must be brought to the hospital right away. It can cause a condition called ketoacidosis (also known as diabetic coma), caused by the formation of ketones in the bloodstream.

Here are symptoms of ketoacidosis:

• Presence of ketones in the urine
• Fruit-like breath odor
• Fainting
• Rapid and deep breathing, or breathing difficulties

You always need to have an open communication with your doctor, especially if you experience hyperglycemia or hypoglycemia. Any abnormalities in blood sugar levels must be addressed to prevent complications. If you have diabetes, you need to visit your doctor often.

During visits, the doctor will discuss the following with you:

• The doctor may increase your insulin dose during holidays. This is to accommodate days when you plan to eat large meals
• On the other hand, your doctor might reduce your dose for a short time like in case you are unable to exercise
• If your blood sugar level is over 200 mg/dL, skipping a meal (and taking Insulin) can make it go down. If it remains too high, you must take extra Insulin.
• Call the doctor right away if your blood sugar rises to 240 mg/dL, or you have symptoms of ketoacidosis

NovoLOG may cause side effects. Call your doctor if you experience the following:

• Loss of consciousness
• Seizures
• Symptoms of low blood sugar
• Weight gain
• Skin changes at injection sites, like depressing or thickening of skin
• Infection at the injection site, like redness and formation of pus
• Swelling of the face, fingers or ankles