Only a physician can change an insulin dose or recommend to mix insulin preparations or to exchange one preparation for another.
Patients should inform a physician if they developed any earlier manifestations of allergy to any insulin preparations, as well as other drugs, food, preservatives or dyes.
In patients who developed generalised reaction to insulin skin tests should be conducted before the commencement of treatment with a new preparation.
During the insulin treatment glucose concentration in serum and urine, glycated haemoglobulin (HbA1) and fructosamine concentrations in blood should be monitored.
Patients should learn how to check themselves their glucose concentration in urine and blood by using simple tests (e.g. stripe tests). In case it is not accurate they should promptly notify their physician.
In different patients symptoms of a drop of glucose concentration in blood (hypoglycaemia) may occur at different times with different strength. Patients then should learn how lo recognise the characteristic for them hypoglycaemia symptoms. If such symptoms occur frequently, even with mild intensity, they should contact their physician in order to change the insulin dose or diet.
Patients who change the animal insulin for human insulin may require a smaller dose of insulin (possibility of hypoglycaemia). Some patients may not feel the early hypoglycaemia symptoms after the human insulin administration as intensely as after animal insulin.
Also in patients with long-lasting diabetes or diabetic neuropathy, or ones who parallely apply β-adrenolytical drugs and reached to balance their glucose level in blood, the early signs of hypoglycaemia may also be weaker. Both hyperglycaemia and hypoglycaemia when not treated may lead to loss of consciousness, coma or death.
Patients should regularly visit their physicians, mostly at the commencement of insulin treatment.
It is very important to keep to regular and dietetic meals.
The need of insulin lowers with a bigger physical effort; a more intense exercise of the muscle that insulin has been injected in accelerates the hypoglycaemia development (e.g. insulin injection into a thigh before a run).
Patients who intend to change at least two time zones should consult a physician to change the timing of insulin administration. During a flight insulin should be storaged in a hand-baggage not in a baggage hatch (insulin can't get frozen).
The need of insulin may be altered by: High fever, severe infection (it may considerably increase the insulin need), emotional stress, sicknesses and disturbances of digestive tract with nausea, vomit, diarrhoea, low stomach discharge, absorption disturbances. Such conditions always require a consultation with a physician. Glucose concentration in blood and urine should be then frequently controlled, and if the results are not correct, it is absolutely obligatory to consult a physician. The recommended doses of insulin and regular meals should be observed. Even medicines available over-the-counter (cold, fever, pain relief, appetite-reducing medicines) may alter the insulin need, therefore each time their application should be consulted with a physician.
With kidneys failure the insulin elimination is reduced and its action lime is longer.
Patients with diabetes due to pancreas diseases or diabetes that co-exists with Addison's disease require very small doses of insulin.
In pituitary, adrenal or thyroid gland disturbances the organism requirements of insulin may alter. Long-term insulin taking may generate an insulin resistance effect (see Adverse Reactions); in case insulin resistance effect occurs bigger doses of insulin should be administered.
Effect on the Ability of Driving and Operating Machinery: The influence of correct insulin doses administration on the ability of driving vehicles has not been examined. It may be handicapped by hyperglycaemia that causes disturbances of the central nervous system with the following symptoms: Headaches, anxiety, double seeing, disorders of association and distance evaluation. At the commencement of insulin treatment, change of insulin preparation, during the stress or excessive physical effort-when considerable differences of glucose concentration in blood occur, disorders in ability of driving and operating machinery may happen.
It is recommended to control the glucose concentration in blood during long journeys.