Talk about your insulin dose with your doctor and nurse. Make sure you get Levemir Penfill as your doctor and nurse have told you to use and follow their advice carefully .
If your doctor has switched youfrom one type or brand of insulin to another, your dose may have to be adjusted by your doctor. Do not change your insulin unless your doctor tells you to.
Use in children
Levemir can be used in children and adolescents 6 years and above.
There is no experience with the use of Levemir in children below the age of 6 years. Therefore, only use Levemir in children below this age, if your doctor has specifically told you to.
Use in special populations
If you have reduced kidney or liver function, or if you are above 65 years of age, you need to check your blood glucose more regularly and discuss changes in your insulin dose with your doctor.
Frequency of administration
When Levemir is used in combination with an oral antidiabetic medicine, Levemir should be administered once a day. When Levemir is used as part of a basal-bolus insulin regimen Levemirshould be administered once or twicedaily depending on patients? needs. Dose of Levemirshould be adjusted individually. The injection can be given at any time during the day, but at the same time each day. For patients who require twice daily dosing to optimise blood glucose control, the evening dose can be administered in the evening or at bedtime.
Method of administration
Levemiris for injection under the skin (subcutaneously). Never inject your insulin directly into a vein (intravenously) or muscle (intramuscular). Always vary the sites you inject within the same region, to avoid lumps (see 4 Possible side effects). The best places to give yourself an injection are: the front of your thighs, the front of your waist (abdomen), or the upper arm. You should always measure your blood glucose regularly.
- Inject the insulin under the skin. Use the injection technique advised by your doctor or nurse and as described in your delivery system manual.
- Keep the needle under your skin for at least 6 seconds to make sure that the full dose has been delivered.
- After each injectionbe sure to remove and discard the needleand store Levemir without the needle attached. Otherwise the liquid may leak out, which can cause inaccurate dosing.
Do not refill the cartridge.Levemir Penfill cartridges are designed to be used with Novo Nordisk insulin delivery systems and NovoFine or NovoTwist needles. Be sure you are not using any counterfeit needles. Ask your pharmacist.
If you are treated with LevemirPenfill and another insulin Penfill cartridge, you should use two insulin delivery systems, one for each type of insulin.
If you take more Levemir than you should
If you take too much insulin your blood sugar gets too low (this is called hypoglycaemia or hypo). This may also happen:
- If you eat too little or miss a meal.
- If you exercise more than usual.
The warning signs of a hypo may come on suddenly and can include: cold sweat; cool pale skin; headache; rapid heart beat; feeling sick; feeling very hungry; temporary changes in vision; drowsiness; unusual tiredness and weakness; nervousness or tremor; feeling anxious; feeling confused; difficulty in concentrating.
If you feel a hypo coming on: take a high sugar snack and then measure your blood sugar. If your blood sugar is too low: eat glucose tablets or another high sugar snack (sweets, biscuits, fruit juice), then rest.
Always carry glucose tablets, sweets, biscuits or fruit juice with you, just in case.
When the symptoms of hypoglycaemia have disappeared or when your blood glucose level is stabilised continue insulin treatment.
Tell relevant people you have diabetes and what the consequences may be, including the risk of passing out (becoming unconscious) due to a hypo.
Tell relevant people that if you pass out, they must turn you on your side and get medical help straight away. They must not give you any food or drink. It could choke you.
You may recover more quickly from unconsciousness with an injection of the hormone glucagon by someone who knows how to use it. If you are given glucagon you will need glucose or a sugary snack as soon as you are conscious. If you do not respond to glucagon treatment, you will have to be treated in a hospital. Contact your doctor or an emergency ward after an injection of glucagon: you need to find the reason for your hypo to avoid getting more.
- If prolonged severe hypoglycaemia is not treated, it can cause brain damage (temporary or permanent) and even death.
- If you have a hypo that makes you pass out, or a lot of hypos, talk to your doctor. The amount or timing of insulin, food or exercise may need to be adjusted.
If you forget to take Levemir
If you forget to take your insulinyour blood sugar may get too high (this is called hyperglycaemia). This may also happen:
- If you repeatedly take less insulin than you need.
- If you get an infection or a fever.
- If you eat more than usual.
- If you exercise less than usual.
The warning signs appear gradually. They include: increased urination; feeling thirsty; losing your appetite; feeling sick (nausea or vomiting); feeling drowsy or tired; flushed, dry skin; dry mouth and a fruity (acetone) smell of the breath.
If you get any of these signs:test your blood sugar level, test your urine for ketones if you can, then seek medical advice immediately.
These may be signs of a very serious condition called diabetic ketoacidosis. If you do not treat it, this could lead to diabetic coma and eventually death.
If you stop taking Levemir
This could lead to severe hyperglycaemia (very high blood sugar) and ketoacidosis (build-up of acid in the blood because the body is breaking down fat instead of sugar). Do not stop taking your insulin without speaking to a doctor, who will tell you what needs to be done.
If you have any further questions on the use of this medicine, ask your doctor or pharmacist.