The most commonly seen adverse reaction with Biphasic Isophane Insulin are: Hypoglycemia:
Hypoglycemia is one of the most common adverse effects seen with the use of any type of insulin including human insulin. This can occur because of the following: Use of too much insulin; Missed meal/delayed meal; Intercurrent infection or illness;
Disease of the adrenal, pituitary, or thyroid gland, or progression of kidney or liver disease may also lead to hypoglycemia.
Concomitant administration with other drugs that lower blood glucose such as oral hypoglycemics, salicylates (i.e. Aspirin), sulfa antibiotics, and certain antidepressants may lead to hypoglycemia.
Symptoms of mild to moderate hypoglycemia may occur suddenly and can include: sweating, dizziness, palpitation, tremor, hunger, restlessness, tingling of the hands, feet, lips or tongue, lightheadedness, inability to concentrate, headache, drowsiness, sleep disturbances, anxiety, blurred vision, slurred speech, depressive mood, irritability, abnormal behavior, unsteady movement, personality changes.
Signs of severe hypoglycemia can include: disorientation. unconsciousness, seizure, death.
Therefore it is important that assistance be obtained immediately. Early warning symptoms of hypoglycemia may be different or less pronounced under certain conditions, such as long duration of diabetes, diabetic nerve disease, co-administration of medications such as beta-blockers, change in insulin preparations, or intensified control (3 or more insulin injections per day) of diabetes. The use of preparations of (Glysolin 30/70) should minimize the incidence of adverse effects associated with the use of animal insulins.
Oedema and refraction anomalies may occur upon initiation of insulin therapy. These symptoms are usually of transitory nature.
Allergy to insulin:
Systemic Allergy: Less common, but potentially more serious, is generalized allergy to insulin, which may cause rash over the whole body, shortness of breath, wheezing, reduction in blood pressure, fast pulse, or sweating. Severe cases of generalized allergy may be life threatening.
Local Allergy: Patients occasionally experience redness, swelling and itching at the site of injection of insulin. This condition called local allergy, usually clears up in a few days to a few weeks. In some instances, this condition may be related to factors other than insulin, such as irritants in the skin cleansing agent.
Lipoatrophy and lipodystrophy:
Lipodystrophy occurs at the site of injection after long usage. However, this is less common with the newer preparations of insulin.
When insulin requirement is increased (>200 IU/day), insulin resistance is said to have developed. The following are the different grades of insulin resistance: Acute: Acute insulin resistance develops rapidly and is usually a short term problem. It usually occurs due to an underlying infection, trauma, surgery and emotional stress. Treatment is to overcome the precipitating factor and to give high doses of regular insulin.
Chronic: This type of insulin resistance is generally seen in patients treated for years with conventional preparations of beef or pork insulin and it is more common in patients with type 2 diabetes. Development of such type of insulin resistance is an indication for switching patients to the newer preparations of insulin. After instituting the newer preparations, insulin requirement gradually declines over weeks and months, Majority of patients stabilize at approximately 60 IU/day.