Talk about your insulin dose with your doctor and nurse. Make sure you get the NovoMix 50 Penfill that your doctor and nurse have told you to use and follow their advice carefully .
When NovoMix 50 is used in combination with metformin the dose should be adjusted. 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. Eat a meal or snack containing carbohydrates within 10 minutes of the injection to avoid hypoglycaemia. NovoMix 50 is generally given immediately before the meal. When necessary, NovoMix 50 can be given soon after the meal.
Use in children
No clinical studies with NovoMix 50 have been carried out in children and adolescents under the age of 18 years. Therefore only use NovoMix 50 in children and adolescents below this age, if your doctor has specifically told you to.
Use in special populations
As with all insulin medicines, in elderly patients and patients with renal or hepatic impairment, glucose monitoring should be intensified and insulin aspart dose adjusted on an individual basis.
Method of administration
NovoMix 50 is for injection under the skin (subcutaneously). Never inject your insulin directly into a vein (intravenously) or muscle (intramuscularly).
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 waist (abdomen); your buttocks; the front of your thighs or upper arms. The insulin will work more quickly if you inject around the waist. You should always measure your blood glucose regularly.
Do not refill the cartridge.
NovoMix 50 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 NovoMix 50 Penfill and another insulin Penfill cartridge, you should use two insulin delivery systems, one for each type of insulin.
As a precautionary measure, always carry a spare Penfill cartridge in case your Penfill cartridge is lost or damaged.
Resuspension of NovoMix 50
Before you put the cartridge into the insulin delivery system:
- The first time you use NovoMix 50 Penfill, roll the cartridge between your palms 10 times ? it is important that the cartridge is kept horizontal (see picture A). Move the cartridge up and down between positions a and b (see picture B) 10 times so that the glass ball moves from one end of the cartridge to the other. Repeat the rolling and moving procedures (see pictures A and
B) until the liquid does appear uniformly white and cloudy. Resuspension is easier when the insulin has reached room temperature. Complete the other stages of injection without delay - For every following injection move the delivery system with the cartridge inside up and down between a and b (see picture B) at least 10 times until the liquid appears uniformly white and cloudy. If the moving procedure alone is not enough to give a uniformly white and cloudy liquid, repeat the rolling and moving procedures described above until the liquid does appear uniformly white and cloudy. Complete the other stages of injection without delay.
Check there are at least 12 units of insulin left in the cartridge to allow even resuspension. If there are less than 12units left, use a new one.
How to inject NovoMix 50
Inject the insulin under the skin. Use the injection technique advised by your doctor or nurse and described in your delivery system manual Keep the needle under your skin for at least 6 seconds. Keep the push button fully depressed until the needle has been withdrawn. This will ensure correct delivery and limit possible flow of blood into the needle or insulin reservoir After each injection be sure to remove and discard the needle and store NovoMix 50 without the needle attached. Otherwise, the liquid may leak out which can cause inaccurate dosing.
If you take more NovoMix 50 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 symptoms of hypoglycaemia have disappeared or when blood glucose level is stabilised continue insulin treatment.
Tell relevant people you have diabetes and what may be the consequences, including the risk of passing out due to a hypo.
Tell relevant people that if you pass out (become unconscious), 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 NovoMix 50
If you forget to take your insulin your 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 NovoMix 50
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.