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<DOCUMENT author="perl program" datec=020199 title="leaflet" book="ABPI" edition="1996-97" section="company">
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What you should know about Humulin in bottles (vials)
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Please read this leaflet carefully before you start to use your insulin. It does not contain all the information about your insulin that you may need to know, so please ask your doctor, pharmacist or diabetes nurse specialist if you have any questions. This leaflet only applies to Humulin vials.
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What is in your insulin
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Your medicine is called Humulin. It is a brand of human insulin. Its strength is 100 units per ml (U-100), and each bottle contains 10ml (1000 units).
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There are 9 types of Humulin which you can get in bottles. They have different ingredients as follows:
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Humulin S (Soluble):
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 A sterile,, clear, colourless liquid of human insulin dissolved in water - with a pH of between 7.0 and 7.8. Humulin S contains m-cresol as a preservative and glycerol.
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Humulin I (Isophane):
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 A sterile suspension of white crystals of isophane human insulin in an isotonic phosphate liquid with a pH of 6.9-7.5.
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Humulin Lente (Zinc suspension):
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 A sterile suspension of human insulin zinc in liquid with a pH of 7.0-7.8. The insulin is 70% crystals.
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Humulin Zn (Zinc suspension):
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 A sterile, white suspension of human insulin zinc crystals in a liquid with a pH of 7.0-7.8.
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Humulin M1:
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 A sterile suspension of human insulin. The mixture is 10% soluble insulin and 90% isophane insulin.
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Humulin M2:
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 A sterile suspension of human insulin. The mixture is 20% soluble and 80% isophane.
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Humulin M3:
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 A sterile suspension of human insulin. The mixture is 30% soluble and 70% isophane.
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Humulin M4:
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 A sterile suspension of human insulin. The mixture is 40% soluble and 60% isophane.
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Humulin M5:
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 A sterile suspension of human insulin. The mixture is 50% soluble and 50% isophane.
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Humulin I and the M mixtures contain m-cresol, phenol, protamine, glycerol, zinc oxide and dibasic sodium phosphate. Humulin Lente and Humulin Zn contain methyl parahydroxybenzoate, zinc oxide, sodium chloride and sodium acetate.
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Use the type of Humulin that your doctor has told you to. Do not change your insulin unless you are told to by your doctor or nurse, and then only cautiously. Each type of insulin has a different colour and symbol on the pack and the bottle so that you can easily tell the difference.
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Humulin S (Soluble) <PB n=14> <CB n=1> <CB n=2> <FIGURE></FIGURE> <CB n=1> Humulin I (Isophane) <PB n=15> <CB n=2> <CB n=1> <FIGURE></FIGURE> <CB n=2> Humulin Lente (Zinc suspension) <PB n=16> <CB n=1> <CB n=2> <FIGURE></FIGURE> <CB n=1> Humulin Zn (Zinc suspension) <PB n=17> <CB n=2> <CB n=1> <FIGURE></FIGURE> <CB n=2> Humulin M1 (10% Soluble and 90% Isophane) <PB n=18> <CB n=1> <CB n=2> <FIGURE></FIGURE> <CB n=1> Humulin M2 (20% Soluble and 80% Isophane) <PB n=19> <CB n=2> <CB n=1> <FIGURE></FIGURE> <CB n=2> Humulin M3 (30% Soluble and 70% Isophane) <CB n=1> <CB n=2> <FIGURE></FIGURE> <CB n=1> Humulin M4 (40% Soluble and 60% Isophane) <PB n=21> <CB n=2> <CB n=1> <FIGURE></FIGURE> <CB n=2> Humulin M5 (50% Soluble and 50% Isophane) <PB n=22> <CB n=1> <FIGURE></FIGURE> <CB n=2> This is the Humulin S pack. For other Humulin S - see colours and symbols above
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Always check the pack and the bottle label for the name and type of the insulin when you get it from your pharmacy. Make sure it is the type of Humulin that your doctor has told you to use.
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Human insulin is a natural hormone and is made by the human body's pancreas. Humulin is made in the laboratory by a 'recombinant DNA technology' process and has the same structure as the natural hormone. It is therefore different from animal source insulins.
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Humulin is made by Lilly France SA, Rue du Colonel Lilly, 67640 Fegersheim, France. The product licence is held by Lilly Industries Limited, Dextra Court, Chapel Hill, Basingstoke, Hampshire RG21 2SY <PB n=23> <CB n=1>
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Why Humulin?
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You get diabetes if your pancreas does not make enough insulin to control the level of glucose in your blood. Humulin is a substitute for your own Insulin.
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Before injecting your insulin
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Make sure it is safe for you to use Humulin.
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IF YOU THINK A 'HYPO' (LOW BLOOD SUGAR) IS STARTING, DO NOT INJECT YOUR INSULIN
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IF YOU THINK A 'HYPO' (LOW BLOOD SUGAR) IS STARTING, DO NOT INJECT YOUR 
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If you have ever had an allergic reaction to Humulin (see section D on the back of this leaflet), tell your doctor, pharmacist or diabetes nurse specialist.
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If you have increased your insulin injections because your doctor has told you to, you may not experience the warning symptoms (see the back of the leaflet) when your blood sugar is falling too low. You must think carefully about the timing of your meals, how often to exercise, and how much to do. You must also keep a close watch on your blood sugar levels by frequently testing your blood glucose.
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A few patients who have had 'hypos' after switching from animal insulin to human insulin have reported that the early warning symptoms were less obvious or different. If you have frequent 'hypos' or have difficulty recognising them, please discuss this with your doctor.
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If you answer YES to any of the following questions, tell your doctor, pharmacist or diabetes nurse specialist.
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Have you recently become ill?
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Are you taking any other medicines? Your insulin needs may change if you are taking the contraceptive pill, steroids, thyroid hormone replacement therapy, oral hypoglycaemics, aspirin, antibiotics, some antidepressants or some medicines for high blood pressure or angina.
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Do you have trouble with your kidneys or liver, or with your adrenal, pituitary or thyroid glands?
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Are you exercising more than usual?
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Are you pregnant or breast-feeding?
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You should also tell your doctor, pharmacist or diabetes nurse specialist if you are planning to go abroad because the time differences between countries may mean that the timing of your injections and meals will have to be different from when you are at home.
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Please read the back of this leaflet  
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What you should know about Humulin in bottles - continued
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Dosage
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Your doctor has told you which insulin to use, how much, when, and how often to inject. This is only for you. Follow your doctor's instructions exactly and visit your diabetes clinic regularly.
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If you change your insulin type (for example from animal to human), you may have to take more or less than before. This might just be the first dose or a gradual change over several weeks.
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Inject under the skin. You should only inject into a muscle if your doctor has told you to. You can inject Humulin S several times a day. You will usually inject Humulin I, Humulin Lente or Humulin Zn once or twice a day. The Humulin M mixtures should normally be injected twice a day. Many people take two-thirds of their day's dose in the morning and one third in the evening.
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Preparing your insulin
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Humulin S is dissolved in water, so it does not need to be mixed. But you must 
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only
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 use it if it looks like water. It must be clear, have no colour and no solid particles in it.
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Humulin I, Humulin Lente, Humulin Zn and Humulin M should be rolled gently between the palms of your hands just before you use them. Do not shake the bottle vigorously as bubbles and froth will make it difficult to measure the dose. All of these Humulins should look evenly cloudy or milky when you use them.
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Do not use the insulin if the white material stays at the bottom of the bottle after mixing. 
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Do not use the insulin if the mixture is lumpy, or if solid white particles stick to the bottom or sides of the bottle, giving it a frosted look
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Injecting the insulin
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First wash your hands.
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Thoroughly clean the skin where you are going to inject. Clean the rubber stopper on the bottle, but do not remove the stopper.
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Use a clean, sterile syringe and needle to pierce the rubber stopper and draw in the quantity of insulin you want. Your doctor or clinic will tell you how to do this.
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 Do not share your needles and syringes.
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Inject under the skin, as you were taught. Do not inject directly into a vein. Do not rub the area you have just injected.
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Make sure you inject at least half an inch (1cm) from the previous injection and that you 'rotate' the places you inject, as you have been taught.
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Your doctor will tell you if you have to mix Humulins. If you do need to inject a mixture, draw the Humulin S into the syringe before the Humulin I, Humulin Lente, or Humulin Zn. Inject as soon as you have mixed them. Do the same thing every time. Humulin M will not usually be mixed with other insulins.
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Emergencies and Overdoses:
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 Eat glucose tablets or sugar and rest. This will often get you over a mild 'hypo' or minor insulin overdose. If you get worse and your breathing is shallow and your skin gets pale, tell your doctor at once. A glucagon injection can treat moderately severe hypoglycaemia. Eat glucose or sugar after the glucagon injection. If you do not respond to glucagon, you will have to be treated in hospital. Ask your doctor to tell you about glucagon.
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If 'hypos' or 'hypers' (see A and B) are not treated they can be very serious and cause nausea, vomiting, dehydration, unconsciousness, coma or even death.
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Always keep spare syringes and a spare bottle of Humulin.
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Always carry something to show you are diabetic.
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Always carry sugar with you.
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