Follow carefully the advice of the doctor and diabetes nurse on insulin needs. If the doctor has switched the patient from one type or brand of insulin to another, the dose may have to be adjusted by the doctor. Eat a meal or snack containing carbohydrates within 30 min of the injection. It is recommended to measure the blood glucose regularly.
Before use: Check the label to ensure the right type of insulin. Disinfect the rubber membrane with a medicinal swab.
Actrapid is for SC injection. Always vary the sites of injection to avoid lumps (see Side Effects). The best places to inject are: The front of the abdomen; the buttocks; the front of the thighs or upper arms. The insulin will work more quickly if injected around the abdomen. Actrapid may also be administered IV in special situations by medical professionals.
Vial: Actrapid vials are for use with insulin syringes with the corresponding unit scale.
To inject Actrapid on its own: Draw air into the syringe, in the same amount as the dose of insulin needed. Inject the air into the vial. Push the needle through the rubber stopper and press the plunger. Turn the vial and syringe upside down. Draw the right dose of insulin into the syringe. Pull the needle out of the vial. Make sure there is no air left in the syringe. Point the needle upwards and push the air out. Check for the right dose. Inject straight away.
To mix Actrapid with long-acting insulin: Roll the vial of long-acting insulin between the hands until the liquid is uniformly white and cloudy. Draw as much air into the syringe as the dose of long-acting insulin needed. Inject the air into the long-acting insulin vial, then pull out the needle. Draw as much air into the syringe as the dose of Actrapid needed. Inject the air into the Actrapid vial. Then turn the vial and syringe upside down. Draw the right dose of Actrapid into the syringe. Pull the needle out of the vial. Make sure there is no air left in the syringe. Point the needle upwards and push the air out. Check the dose. Now push the needle into the vial of long-acting insulin. Then turn the vial and syringe upside down. Draw the right dose of long-acting insulin into the syringe. Pull the needle out of the vial. Make sure there is no air left in the syringe, and check the dose. Inject the mixture straight away. Always mix fast-acting and long-acting insulin in this order.
Injecting the insulin: Inject the insulin SC. Keep the needle under the skin for at least 6 sec to make sure the full dose has been delivered.
Penfill: Penfill cartridges are designed to be used with Novo Nordisk insulin delivery systems and NovoFine needles. If treated with Actrapid Penfill and another insulin Penfill cartridge, use 2 insulin delivery systems, 1 for each type of insulin.
How to Inject: Inject the insulin SC. Use injection technique described in the delivery system manual. Keep the needle under the skin for at least 6 sec to make sure the full dose has been delivered. Remove the needle after each injection, otherwise the liquid may leak out when the temperature changes.
NovoLet: NovoLet is a simple, compact pre-filled pen with dial doses from 2-78 units in increments of 2 units. NovoLet is designed to be used with NovoFine needles. As a precautionary measure, always carry a spare insulin delivery device in case if NovoLet is lost or damaged.
1. Getting started: Check the label to make sure that the NovoLet contains the correct type of insulin. Take off the pen cap. Disinfect the rubber membrane with a medicinal swab. Remove the protective tab from a NovoFine needle. Screw the needle straight and tightly onto NovoLet. Pull off the big outer needle cap and the inner needle cap. Do not discard the big outer needle cap.
2. Priming to expel air: Small amounts of air may collect in the needle and cartridge during normal use. To avoid injection of air and ensure proper dosing: Hold NovoLet with the needle pointing upwards. Tap the cartridge gently with the finger a few times. Any air bubbles will collect at the top of the cartridge.
Keeping the needle upwards, turn the cartridge one click. Still with the needle upwards, press the push-button fully down. A drop of insulin must appear at the needle tip. If not, change the needle and repeat the procedure no more than 6 times. If a drop of insulin still does not appear, the device is defective and must not be used.
3. Setting the dose: Put the cap back on the pen, with 0 next to the dosage indicator. Check that the push-button is fully down. If not, turn the cap until the push-button is fully depressed. Hold NovoLet horizontally. Turn the cap to set the right dose. Cap clicking can be felt, and the push-button will rise up. Do not put hand over the push-button when setting the dose. If the push-button cannot rise freely, some of the insulin will be pushed out of the needle. The scale on the cap shows 0, 2, 4, 6, 8, 10, 12, 14, 16 and 18 units. For every click felt when turning the cap, 2 units more is set. The push-button also rises as the cap is turned. The scale under the push-button shows 20, 40 and 60 units. For every full turn of the cap, 20 units is set.
Dosage examples: To set 8 units: Turn the cap until 8 is opposite the dosage indicator; 4 clicks.
To select 26 units: Turn the cap round 1 full turn, so 0 is opposite the dosage indicator again. Now, 20 units have been set. Keep turning the cap until 6 is opposite the dosage indicator. The 20-line will show on the push-button scale. Add the 6 from the dosage indicator to the 20 on the push-button scale and 26 units have been set.
To check a dose set: Note the figure on the cap next to the dosage indicator. Note the highest figure seen on the push-button scale. Add the 2 together to show the set dose. If the wrong dose was set, simply turn the cap forwards or backwards until the right number of units is set.
The maximum dose is 78 units. Do not try to set a dose >78 units. Otherwise, insulin will leak out of the needle and the dose will be incorrect. If by mistake, a dose over 78 units was set, follow these steps: Turn the cap back as far as possible. Turn it till the push-button is fully down and resistance is felt. Then take the cap off and put it back on again, lining up the 0 next to the dosage indicator. Now set the dose again. Remember that 78 units is the maximum dose. After the dose is set, remove the cap to inject the insulin.
4. Injecting the insulin: Insert the needle into the skin. Deliver the dose by pressing the push-button fully down. Be careful only to push the push-button when injecting. Keep the push-button fully depressed after the injection until the needle has been withdrawn from the skin. The needle must remain under the skin for at least 6 seconds. This will ensure that the full dose has been delivered.
Subsequent injections: Always check that the push-button is completely down. If not, turn the cap until the push-button is fully depressed, then proceed as described in “Getting Started”. When the push-button is pressed, a clicking sound may be heard. Do not use this to set or check the dose; it may not be accurate. A dose higher than the number of units left in the cartridge cannot be set. Use the insulin level indicator to estimate how much is left but it cannot be used to set or select the dose.
5. Removing the needle: Replace the big outer needle cap and unscrew the needle. Dispose of it carefully. Use a new needle for each injection. Remove the needle after each injection, otherwise the liquid may leak out when the temperature changes. Close the NovoLet fully with 0 next to the dosage indicator. Dispose of used NovoLet carefully without the needle attached.
6. Maintenance: NovoLet is designed to work accurately and safely. It must be handled with care. Clean the exterior of NovoLet by wiping it with a medicinal swab. Do not soak, wash or lubricate it. This may damage the mechanism.