patient information leaflet hypurin bovine range of insulin injection

INFORMATION FOR PATIENTS

HYPURIN® BOVINE RANGE OF INSULIN INJECTION

Please read this leaflet carefully before you inject your insulin. It gives a brief outline of the more important things you should know. If you want to know more about this medicine, or if you are not sure about anything, ask your doctor, pharmacist or diabetes nurse. You should keep this leaflet with you throughout your treatment.

THE NAME OF YOUR MEDICINE IS HYPURIN® BOVINE INSULIN

Hypurin® Bovine is the brand name for a range of highly purified bovine (cow) insulin injections.

Hypurin® Bovine Neutral is a sterile clear solution of bovine insulin (100 international units/ml). It also contains m-cresol, phenol, glycerol and sodium phosphate. It is short acting.

Hypurin® Bovine Isophane is a sterile, white suspension of bovine insulin (100 international units/ml) with protamine sulphate and zinc chloride in water. It also contains m-cresol, phenol, glycerol and sodium phosphate. It is longer acting than Hypurin® Bovine Neutral.

Hypurin® Bovine Neutral and Hypurin® Bovine Isophane are available in glass cartridges which contain 1.5ml of solution or suspension for use in pen injectors, and glass vials which contain 10 ml of solution or suspension.

HOW DOES YOUR MEDICINE WORK?

Insulin is a natural hormone made by a gland called the pancreas and plays a key role in the way the body uses carbohydrate, fat and protein.

WHAT IS HYPURIN® BOVINE FOR?

Hypurin® Bovine is used for the treatment of insulin-dependent diabetes mellitus. In this type of diabetes your pancreas does not make enough insulin to control the level of sugar in your blood. It can be treated by controlling your diet and taking insulin. Hypurin® Bovine has been prescribed for you as a substitute for your own insulin.

BEFORE USING YOUR MEDICINE

You should not inject Hypurin® Bovine insulin if

you have symptoms of hypoglycaemia (low blood sugar or 'hypo' - see the section on hypoglycaemia below).
you have ever had an allergic reaction to insulin or any of the other ingredients in Hypurin® Bovine. Check by reading the list of ingredients above.

Before using this medicine you should let your doctor know if you are pregnant or wish to become pregnant or start breast-feeding.

Taking another medicine while you are using insulin can affect how it or the other medicine works. Make sure that your doctor knows what other medicines you are taking. Do not take any other medicines while you are taking insulin unless you have told your doctor or pharmacist and asked their advice. This includes medicines you may have bought yourself.

Examples of medicines that can affect insulin are;

Steroids, used to treat a range of allergic conditions
Thyroxine, used for underactive thyroid glands
Some pain killers and anti-inflammatory drugs such as aspirin and cyclophosphamide
Isoniazid, used to treat tuberculosis
Beta blockers, used for high blood pressure and angina
Some drugs such as adrenaline, which are used to treat shock
Some drugs used to treat mental illness such as chlorpromazine or phenylzine
Thiazide diuretics, used to get rid of excess water
Oral contraceptives (birth control pills)
ACE inhibitors, used for high blood pressure
Octreotide, an anti-hormone preparation
Nifedipine, used for angina and high blood pressure

If you have any doubts about injecting insulin then discuss things more fully with your doctor, pharmacist or diabetes nurse.

ADVICE WHEN USING HYPURIN® BOVINE INSULIN

The concentration of glucose in your blood or urine should be checked and your urine tested for ketones at regular intervals.
If your doctor has asked you to increase the frequency or dose of your insulin treatment in order to improve your sugar levels, you may at some point lose some of the warning symptoms that usually occur when your blood sugar is falling too low (hypoglycaemia). These symptoms include shakiness, pounding heartbeat, sweating and feeling anxious. Your ability to concentrate or react may be reduced if you have hypoglycaemia. Please keep this possible problem in mind in all situations where you might put yourself and others at risk (e.g. driving a car or operating machinery). You should contact your doctor about the advisability of driving if you have:
- Frequent episodes of hypoglycaemia
- Reduced or absent warning signs of hypoglycaemia
Hypurin® Bovine Isophane should not be injected into a vein. Hypurin® Bovine Neutral may be injected into a vein, but only by a doctor in an emergency.
During pregnancy, insulin requirements should be assessed frequently by a diabetic physician.

USING THIS MEDICINE

There is no 'standard' dose of insulin. Each person with diabetes has their own dose calculated according to their needs. Patients with disease of the liver, kidneys, adrenal, pituitary or thyroid glands, or coeliac disease may need lower doses. This dose may alter during illness (including infection and surgery), injury, emotional stress and during puberty or pregnancy. It may also change with your diet and lifestyle, particularly if you are exercising more. You must keep a close watch on your blood sugar by testing your glucose levels regularly.

Patients transferred to Hypurin® Bovine insulins from other types of insulin may require dosage adjustments.

Your doctor will decide which dose is best for you and which insulin to use. Always follow your doctor's instructions exactly and also follow any special instructions or warnings that appear on the label that the pharmacist has put on the package. If you do not understand or are in any doubt ask your doctor, pharmacist or diabetes nurse.

Injecting your insulin

Your doctor or diabetes nurse will advise you on how to inject your insulin.

Recommended injection sites include the upper arms, thighs, buttocks and lower abdomen. It may be preferable to use those areas that are less visible. Each time you inject your insulin you should use a different spot in the same general area.Change to a different injection area each week.

Check that the cartridge in the carton has the same label as on the carton and that different types of Hypurin® Bovine have not been mixed up.
Wash and dry your hands.
If you are using a new cartridge of Hypurin® Bovine Isophane shake the cartridge up and down vigorously (with a "bell ringing action") at least ten times until the insulin appears white and cloudy. The cartridge contains a glass bead to help mix the suspension.
Hypurin® Bovine Neutral doe not need to be mixed. It should be a clear, colourless solution and not contain any particles.
Do not use Hypurin® Bovine that has been frozen or contains lumps that do not disappear on mixing.
Put the cartridge into the pen following the pen manufacturer's written instructions.
Before using the pen to inject Hypurin® Bovine Isophane, the insulin must be mixed again by turning the pen up and down at least ten times on each occasion.
Always check that your pen is working before each injection by performing an 'air shot'. Hold the pen vertically, needle up. Dial two units, press the release button and check for a drop of insulin at the end of the needle (repeat until insulin is seen).
Dial your dose to the number of units required. You are now ready to inject your insulin.
Pinch up the skin at the injection site. Inject the Hypurin® Bovine insulin under the skin as you have been taught, keeping the pen in place for a count of five seconds. Release the pinched up skin and remove the pen. Remove the needle from the pen. There is no need to massage the area.
Your doctor may prescribe more than one type of Hypurin® Bovine cartridge injection for you. A separate pen must be used for each type. To identify the pen used with a particular type a self-adhesive strip is included on the cartridge pack. The colour of the strip is identical to the coloured band on the cartridge. The strip should be stuck on the pen. Before injecting your insulin, you must always check that the correct preparation is being used.

ARE THERE ANY SIDE-EFFECTS?

Like many medicines, insulin may cause side-effects in some patients when treatment is first started or there is a change in the type of insulin used. The side-effects that some other patients have had with insulin include hypoglycaemia, generalised swelling (oedema), allergic reactions (which are rare), and thickening or pitting of the skin in the areas used for injection (lipodystrophy). It is quite common to have redness, itching or swelling around the area of injection. This may continue for a day or two.

If you experience any other side-effects or feel that your insulin is affecting you badly please contact your doctor, pharmacist or diabetes nurse.

HYPOGLYCAEMIA ("HYPO") OR INSULIN REACTION

Hypoglycaemia means low blood sugar and may occur for the following reasons (and occasionally for no apparent reason):

1. Missing or postponing a meal or eating less than the correct dietary allowance.
2. Taking more exercise than usual.
3. Injecting the wrong dose of insulin.

Untreated "hypos" can have serious consequences.

The symptoms of a "hypo" are:

Weakness
Tingling of lips, tongue or fingers
Sweating
Palpitations
Trembling
Pale face
Nervousness
Hunger
Excitement
Confusion
Irritability
Blurring of vision

It is important to recognise the symptoms and treat hypoglycaemia early.

Always carry glucose tablets or sugar lumps with you wherever you go. At the first warning sign of hypoglycaemia, stop what you are doing and take five glucose tablets or three sugar lumps, preferably with water. You should begin to feel better almost immediately. If you do not feel better in ten minutes repeat the glucose tablets or sugar lumps. If the "hypo" happens shortly before a meal or snack, treat the "hypo" and have your meal as soon as you can. If a meal is not due, take the quick-acting glucose tablets or sugar lumps and follow them with some longer-acting carbohydrate food like a sandwich or biscuits.

Because of the risk of a "hypo" you should carry an identification card or wear an identity bracelet or necklace carrying details of your name, address, doctor and insulin treatment. It is also important that relatives and close workmates know that you have diabetes and are on insulin so that they can recognise symptoms of a "hypo" and help if necessary.

SAFE KEEPING FOR YOUR MEDICINE

Do not use this medicine if the expiry date on the label has passed or if the insulin has been frozen.
Before use Hypurin® Bovine insulin cartridges should be stored at 2°C - 8°C in a refrigerator. Once in use, the cartridges must not be kept in the refrigerator, but at room temperature. When in use or carried as a spare, Hypurin® Bovine insulin cartridges may be kept at room temperature (up to 25°C) for 28 days after which they should be discarded.
The cartridges should not be emptied beyond the coloured band, the width of which corresponds to approximately six units of insulin. Once the cartridge is empty it must not be used to mix any other insulins. Once you have injected the insulin take the needle off the pen. This will keep the insulin sterile, prevent leakage, re-entry of air and potential clogging of the needle. Do not share your needles.
Keep all cartridges, needles and pens in a secure place where children cannot get at them.
Remember this medicine is for you only. Never give it to anyone else. It may harm them even if their symptoms are the same as yours.

Medicine: hypurin bovine range of insulin injection