Insulin Rapid: time of action and instructions for use. From the side of the skin

Symptoms

Insulin overdose, for example, administering an excess amount of insulin compared to food intake or energy expenditure, can lead to severe and sometimes prolonged and life-threatening hypoglycemia

Treatment

Mild episodes of hypoglycemia (the patient is conscious) can be stopped by ingestion of carbohydrates. Adjustment of insulin dose, food intake and physical activity may be required.

More severe episodes of hypoglycemia with coma, seizures, or neurologic deficits may be treated with intramuscular or subcutaneous glucagon or intravenous administration of concentrated dextrose. In children, the amount of dextrose administered is set in proportion to the child's body weight. After an increase in blood glucose concentration, maintenance carbohydrate intake and observation may be required, since after the apparent clinical resolution of the symptoms of hypoglycemia, its re-development is possible. In cases of severe or prolonged hypoglycemia following glucagon injection or dextrose administration, it is recommended to infuse with a less concentrated dextrose solution in order to prevent the recurrence of hypoglycemia. In young children, it is necessary to carefully monitor the concentration of glucose in the blood, due to the possible development of severe hyperglycemia.

Combined use with oral hypoglycemic agents, angiotensin-converting enzyme inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, pentoxifylline, propoxyphene, salicylates, amphetamine, anabolic steroids and male sex hormones, cibenzoline, cyclophosphamide; fenfluramine, guanethidine, ifosfamide, phenoxybenzamine, phentolamine, somatostatin and its analogues; sulfonamides, tetracyclines, tritoqualin or trophosfamidemay enhance the hypoglycemic effect of insulin and increase the susceptibility to the development of hypoglycemia.

Co-administration with corticotropin, glucocorticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, estrogens and progestogens (eg, those present in combined contraceptives), phenothiazine derivatives, somatotropin, sympathomimetic agents (eg, epinephrine, salbutamol, terbutaline), thyroid hormones, barbiturates, nicotinic acid, phenolphthalein, phenytoin derivatives, doxazosinmay weaken the hypoglycemic effect of insulin.

Beta-blockers, lithium salts can either potentiate or weaken the hypoglycemic action of insulin.

With ethanol

Ethanol can either potentiate or weaken the hypoglycemic action of insulin. Drinking ethanol can cause hypoglycemia or lower an already low blood glucose to dangerous levels. Ethanol tolerance in patients receiving insulin is reduced. Permissible amounts of alcohol to be consumed must be determined by a doctor.

With pentamidine

With simultaneous administration, hypoglycemia may develop, which can sometimes turn into hyperglycemia.

When used together with sympatholytic agents, such as beta-blockers, guanethidine and, possible weakening or complete absence of symptoms of reflex (in response to hypoglycemia) activation of the sympathetic nervous system.

In case of insufficient glycemic control or a tendency to episodes of hyper- or hypoglycemia, before making a decision to adjust the dose of insulin, it is imperative to check the prescribed regimen of insulin administration, make sure that insulin is injected into the recommended area, check the correct injection technique and all other factors. , which may interfere with the effect of insulin.

Since the simultaneous administration of a number of drugs (see the section "Interaction with other drugs") can weaken or enhance the hypoglycemic effect of the drug Insuman® Rapid GT, when using it, no other drugs should be taken without the special permission of the doctor.

hypoglycemia

Hypoglycemia occurs when the dose of insulin exceeds the need for it.

The risk of hypoglycemia is high at the beginning of insulin treatment, when switching to another insulin preparation, in patients with a low maintenance blood glucose concentration.

As with all insulins, special care should be taken and intensive monitoring of blood glucose concentrations is recommended in patients for whom hypoglycemic episodes may be of particular clinical significance, such as patients with severe stenosis of the coronary or cerebral arteries (risk of cardiac or cerebral complications of hypoglycemia) , as well as in patients with proliferative retinopathy, especially if they have not undergone photocoagulation (laser therapy), since they have a risk of transient amaurosis (total blindness) with the development of hypoglycemia.

There are certain clinical symptoms and signs that should indicate to the patient or others that hypoglycemia is developing. These include: increased sweating, skin moisture, tachycardia, heart rhythm disturbances, increased blood pressure, retrosternal pain, tremor, anxiety, hunger, drowsiness, sleep disturbances, fear, depression, irritability, unusual behavior, anxiety, paresthesia in the mouth and around the mouth, pallor of the skin, headache, impaired coordination of movements, as well as transient neurological disorders (disturbances in speech and vision, paralytic symptoms) and unusual sensations. With an increasing decrease in: the concentration of glucose, the patient may lose self-control and even consciousness. In such cases, cooling and moisture of the skin may occur, and convulsions may also occur.

Therefore, every diabetic patient receiving insulin must learn to recognize the symptoms that are a sign of developing hypoglycemia. Patients who regularly monitor their blood glucose levels are less likely to develop hypoglycemia. The patient himself can correct the decrease in the concentration of glucose in the blood he noticed by eating sugar or foods high in carbohydrates. For this purpose, the patient should always have 20 g of glucose with him. In more severe conditions of hypoglycemia, a subcutaneous injection of glucagon is indicated (which can be done by a doctor or nursing staff). After a sufficient improvement in the condition, the patient should eat. If hypoglycemia cannot be immediately eliminated, then you should immediately call a doctor. It is necessary to immediately inform the doctor about the development of hypoglycemia in order for him to decide on the need to adjust the dose of insulin. Poor diet, missed insulin injections, increased need for insulin due to infectious or other diseases, reduced physical activity can lead to an increase in blood glucose (hyperglycemia), possibly with an increase in the level of ketone bodies in the blood (ketoacidosis). Ketoacidosis can develop over hours or days. At the first symptoms of metabolic acidosis (thirst, frequent urination, loss of appetite, fatigue, dry skin, deep and rapid breathing, high concentrations of acetone and glucose in the urine), urgent medical intervention is necessary.

When changing doctors (for example, hospitalization due to an accident, sickness while on vacation), the patient must tell the doctor that he has diabetes.

Patients should be warned about conditions that may change, be less pronounced, or completely absent symptoms that warn of the development of hypoglycemia, for example:

With a significant improvement in glycemic control;

With the gradual development of hypoglycemia;

In elderly patients;

In patients with autonomic neuropathy;

In patients with a long history of diabetes mellitus;

In patients simultaneously receiving treatment with certain drugs (see section "Interaction with other drugs").

Such situations can lead to the development of severe hypoglycemia (and possibly loss of consciousness) before the patient realizes that he is developing hypoglycemia.

In the case of detection of normal or reduced values ​​of glycated hemoglobin, one should think about the possibility of developing recurring, unrecognized (especially nocturnal) episodes of hypoglycemia.

To reduce the risk of hypoglycemia, it is required that the patient strictly follow the prescribed dosing regimen and diet, correctly administer insulin injections, and be warned about the symptoms of developing hypoglycemia.

Factors that increase the susceptibility to the development of hypoglycemia require careful monitoring and may require dose adjustment.

These factors include:

Changing the area of ​​insulin injection;

Increased insulin sensitivity (for example, elimination of stress factors);

Unaccustomed (increased or prolonged physical activity);

Intercurrent pathology (vomiting, diarrhea);

Insufficient food intake;

skipping meals;

Alcohol consumption;

Certain uncompensated endocrine diseases (such as hypothyroidism and anterior pituitary insufficiency or adrenal insufficiency);

Simultaneous reception of certain drugs (see section "Interaction with other drugs").

Intercurrent diseases

Intercurrent diseases require intensive metabolic control. Urinalysis for the presence of ketone bodies is indicated in many cases, and insulin dose adjustment is often necessary. The need for insulin often increases. Patients with type 1 diabetes should continue to consume at least a small amount of carbohydrate regularly, even if they can only take small amounts of food or if they vomit, and they should never completely stop insulin administration.

Cross immunological reactions

In a fairly large number of patients with hypersensitivity to animal insulin, the transition to human insulin is difficult due to the immunological cross-reaction of human insulin and animal insulin. With increased sensitivity of the patient to insulin of animal origin, as well as to m-cresol, the tolerability of the drug Insuman® Rapid GT should be evaluated in the clinic using intradermal tests. If an intradermal test reveals hypersensitivity to human insulin (immediate reaction, Arthus type), then further treatment should be carried out under clinical supervision.

Instructions for use and handling filled syringe pen SoloStar®

Before the first use, the syringe pen must be kept at room temperature for 1-2 hours.

Before use, inspect the cartridge inside the syringe pen. It should only be used if the insulin solution is completely clear, colorless, with no visible foreign particles.

Empty SoloStar® syringe pens should not be reused and must be destroyed.

To prevent infection, the pre-filled pen should only be used by one patient and not shared with another person.

Handling the SoloStar® pen

Before using the SoloStar® syringe pen, carefully read the information for use.

Important information on using the SoloStar® syringe pen

Before each use, carefully connect a new needle to the pen and carry out a safety test.

Only SoloStar® compatible needles should be used.

Special precautions must be taken to avoid needle accidents and the possibility of transmission of infection.

Never use the SoloStar® pen if it is damaged or if you are not sure that it will work properly.

Always have a spare SoloStar® pen available in case your copy of the SoloStar® pen is lost or damaged.

Storage instructions

Please read the "Storage Conditions" section regarding the rules for storing the SoloStar® syringe pen.

If the SoloStar® syringe pen is stored in the refrigerator, remove it from there 1-2 hours before the intended injection so that the solution reaches room temperature. The introduction of chilled insulin is more painful.

The used syringe pen SoloStar® must be destroyed.

Exploitation

The SoloStar® syringe pen must be protected from dust and dirt.

The outside of the SoloStar® pen can be cleaned by wiping it with a damp cloth.

Do not immerse in liquid, do not rinse and do not lubricate the SoloStar® pen, as this may damage it.

The SoloStar® pen syringe accurately doses insulin and is safe to use. It also requires careful handling. Avoid situations in which damage to the SoloStar® syringe pen may occur. If you suspect that your copy of the SoloStar® pen may have been damaged, use a new pen.

Stage 1. Insulin control

The label on the SoloStar® pen should be checked to make sure it contains the correct insulin. For Insuman® Rapid GT, the SoloStar® syringe pen is white with a yellow injection button with a relief ring on it. After removing the cap of the syringe pen, the appearance of the insulin contained in it is controlled: the insulin solution must be absolutely transparent, colorless, without visible foreign particles.

Stage 2. Connecting the needle

It is necessary to use only needles compatible with the SoloStar® syringe pen.

For each subsequent injection, always use a new sterile needle. After removing the cap, the needle must be carefully installed on the syringe pen.

Stage 3: Performing a safety test

Before each injection, a safety test should be performed to ensure that the pen and needle are working well and that air bubbles have been removed.

Measure the dose equal to 2 units.

The outer and inner needle caps must be removed.

Positioning the syringe pen with the needle up, gently tap the insulin cartridge with your finger so that all air bubbles are directed towards the needle.

Fully press the injection button.

If insulin appears at the needle tip, the pen and needle are working properly.

If no insulin appears at the needle tip, then step 3 can be repeated until insulin appears at the needle tip.

Stage 4. Dose selection

The dose can be set with an accuracy of 1 unit from a minimum dose of 1 unit to a maximum dose of 80 units. If it is necessary to administer a dose greater than 80 units, 2 or more injections should be given.

The dosing window should show “O” after completion of the safety test. After that, the required dose can be set.

Stage 5. Dosing

The patient should be informed about the injection technique by a healthcare professional.

The needle must be inserted under the skin.

The injection button must be fully depressed. It is held in this position for another 10 seconds until the needle is withdrawn. Thus, the introduction of the selected dose of insulin is ensured completely.

Stage 6. Removal and ejection of the needle

In all cases, the needle must be removed and discarded after each injection. This ensures that contamination and/or infection is prevented, air enters the insulin container, and insulin leaks.

Special precautions must be taken when removing and discarding the needle. Follow recommended safety precautions for removing and discarding needles (e.g., one-handed capping technique) to reduce the risk of needle-related accidents, and preventing infection.

After removing the needle, close the SoloStar® pen with a cap.

The patient's ability to concentrate and the speed of psychomotor reactions may be impaired as a result of hypoglycemia or hyperglycemia, as well as as a result of visual disturbances. This may present a certain risk in situations where these abilities are important (driving motor vehicles or other mechanisms).

Patients should be advised to exercise caution and avoid hypoglycemia while driving. This is especially important in patients who have reduced or no awareness of symptoms that indicate the development of hypoglycemia, or who have frequent episodes of hypoglycemia. In such patients, the question of the possibility of driving motor vehicles or other mechanisms should be individually decided.

5 ml of the drug in a bottle of transparent and colorless glass (type 1). The bottle is stoppered, crimped with an aluminum cap and covered with a protective plastic cap. 5 bottles with instructions for use in a cardboard box.

3 ml of the drug in a transparent and colorless glass cartridge (type I). The cartridge is sealed on one side with a stopper and crimped with an aluminum cap, on the other side with a plunger. 5 cartridges in a blister pack of PVC film and aluminum foil. 1 blister pack along with instructions for use in a cardboard box.

3 ml of the drug in a transparent and colorless glass cartridge (type I). The cartridge is sealed on one side with a stopper and crimped with an aluminum cap, on the other side with a plunger. The cartridge is mounted in a SoloStar® disposable syringe pen.

5 syringe pens SoloStar® together with instructions for use in a cardboard box.

To store in the place protected from light at a temperature from 2 to 8 °C. Do not freeze.

Keep out of the reach of children.

Do not use after the expiry date stated on the packaging.

Active substance: human insulin (100% soluble human insulin) - 3.571 mg (100 IU);
excipients: metacresol (m-cresol), sodium dihydrogen phosphate dihydrate, glycerol (85%), sodium hydroxide (used to adjust pH), hydrochloric acid (used to adjust pH), water for injection.
Description: clear colorless liquid.

Pharmacodynamics. Insuman® Rapid GT contains insulin identical in structure to human insulin and obtained by genetic engineering using the K12 strain of E. Coli. Mechanism of action of insulin:
- reduces the concentration of glucose in the blood, promotes anabolic effects and reduces catabolic effects;
- increases the transfer of glucose into cells and the formation of glycogen in the muscles and liver and improves the utilization of pyruvate, inhibits glycogenolysis and gluconeogenesis;
- increases lipogenesis in the liver and adipose tissue and inhibits lipolysis;
- promotes the entry of amino acids into cells and protein synthesis;
- increases the flow of potassium into cells.
Insuman® Rapid GT is an insulin with a rapid onset of action and a short duration of action. After subcutaneous administration, the hypoglycemic effect occurs within 30 minutes and reaches a maximum within 1-4 hours. The effect persists for 7-9 hours.

Diabetes mellitus requiring insulin treatment.
- Treatment of diabetic coma and.
- Achievement of metabolic compensation in patients with diabetes mellitus during surgical interventions (before surgery, during surgery and in the postoperative period).

The selection of the dose of insulin in the patient is carried out by the doctor individually, depending on the diet, level of physical activity and lifestyle. The dose of insulin is determined based on the level of sugar in the blood, as well as on the basis of the planned level of physical activity and the state of carbohydrate metabolism. Read more about calculating dosages for type 1 and type 2 diabetes. Treatment with insulin requires appropriate self-preparation of the patient. The doctor should give the necessary instructions on how often to check the level of sugar in the blood and, possibly, in the urine, as well as give appropriate recommendations in case of any changes in the diet or in the regimen of insulin therapy.
The average daily dose of insulin is from 0.5 to 1.0 IU per kg of body weight of the patient, with 40-60% of the dose accounted for by long-acting human insulin.
When switching from animal-derived insulins to human insulin, it may be necessary to reduce the dose of insulin. Switching from other types of insulin to this drug can only be done under medical supervision. Particularly frequent monitoring of the state of carbohydrate metabolism is necessary in the first weeks after such a transition.
Insuman Rapid GT is usually injected deep subcutaneously 15-20 minutes before a meal. Intramuscular administration of the drug is allowed. The injection site must be changed each time. Changing the injection site (for example, from the abdomen to the thigh) should be done only after consulting a doctor.
Insuman Rapid GT can be administered intravenously in the treatment of hyperglycemic coma and ketoacidosis, as well as to achieve metabolic compensation in the pre-, intra- and postoperative periods in patients with diabetes mellitus.
Insuman Rapid GT is not used in various types of insulin pumps (including implanted ones), where a silicone coating is used.
Do not mix Insuman Rapid GT with insulins of other concentrations (for example, 40 IU / ml and 100 IU / ml), with insulins of animal origin or other drugs. Only clear, colorless solutions of Insuman Rapid GT without visible mechanical inclusions should be used.
It must be remembered that the concentration of insulin in the vial is 100 IU / ml, so only plastic syringes designed for this concentration of insulin should be used. The syringe must not contain any other drug or its residual amounts.
Before the first set of insulin from the vial, you must remove the plastic cap (the presence of a cap is evidence of an unopened vial). The injection solution must be absolutely transparent and colorless.
Before taking insulin from the vial, a volume of air equal to the prescribed dose of insulin is sucked into the syringe and injected into the vial (not into a liquid). Then the vial, together with the syringe, is turned upside down with the syringe and the required amount of insulin is drawn up. Before injection, air bubbles must be removed from the syringe.
A fold of skin is taken at the injection site, a needle is inserted under the skin and insulin is slowly injected. After the injection, the needle is slowly removed and the injection site is pressed with a cotton swab for a few seconds. The date of the first set of insulin from the vial should be recorded on the vial label.
After opening, the vials can be stored at a temperature not exceeding +25°C for 4 weeks in a place protected from light and heat.

In case of insufficient glycemic control or a tendency to episodes of hyper- or hypoglycemia, before making a decision to adjust the dose of insulin, it is imperative to check the prescribed regimen of insulin administration, make sure that insulin is injected into the recommended area, check the correct injection technique and all other factors. , which may interfere with the effect of insulin.
Since the simultaneous use of a number of drugs (see section "Interaction with other drugs") can weaken or enhance the hypoglycemic effect of the drug Insuman® Rapid GT, when using it, no other drugs should be taken without the special permission of the doctor.
Hypoglycemia occurs when the dose of insulin exceeds the need for it. The risk of hypoglycemia is high at the beginning of insulin treatment, when switching to another insulin preparation, in patients with a low maintenance blood glucose concentration.
As with all insulins, special care should be taken and intensive monitoring of blood glucose concentrations is recommended in patients for whom hypoglycemic episodes may be of particular clinical significance, such as patients with severe stenosis of the coronary or cerebral arteries (risk of cardiac or cerebral complications of hypoglycemia) , as well as in patients with proliferative retinopathy, especially if they have not undergone photocoagulation (laser therapy), since they have a risk of transient amaurosis (total blindness) with the development of hypoglycemia.
There are certain clinical symptoms and signs that should indicate to the patient or others that hypoglycemia is developing. These include: increased sweating, skin moisture, heart rhythm disturbances, increased blood pressure, retrosternal pain, anxiety, hunger, drowsiness, fear, irritability, unusual behavior, anxiety, paresthesia in and around the mouth, pallor of the skin , impaired coordination of movements, as well as transient neurological disorders (disturbances in speech and vision, paralytic symptoms) and unusual sensations. With an increasing decrease in the concentration of glucose, the patient may lose self-control and even consciousness. In such cases, cooling and moisture of the skin may occur, and may also appear.
Therefore, every diabetic patient receiving insulin must learn to recognize the symptoms that are a sign of developing hypoglycemia. Patients who regularly monitor their blood glucose levels are less likely to develop hypoglycemia. The patient himself can correct the decrease in the concentration of glucose in the blood he noticed by eating sugar or foods high in carbohydrates. For this purpose, the patient should always have 20 g of glucose with him. In more severe conditions of hypoglycemia, a subcutaneous injection of glucagon is indicated (which can be done by a doctor or nursing staff). After a sufficient improvement in the condition, the patient should eat. If hypoglycemia cannot be immediately eliminated, then you should immediately call a doctor. It is necessary to immediately inform the doctor about the development of hypoglycemia in order for him to decide on the need to adjust the dose of insulin. Poor diet, missed insulin injections, increased need for insulin due to infectious or other diseases, reduced physical activity can lead to an increase in blood glucose (hyperglycemia), possibly with an increase in the level of ketone bodies in the blood (ketoacidosis). Ketoacidosis can develop over hours or days. At the first symptoms (thirst, frequent urination, loss of appetite, fatigue, dry skin, deep and rapid breathing, high concentrations of acetone and glucose in the urine), urgent medical intervention is necessary.
When changing doctors (for example, when hospitalized due to an accident, illness during vacation), the patient must inform the doctor that he has.
Patients should be warned about conditions that may change, be less pronounced, or completely absent symptoms that warn of the development of hypoglycemia, for example:
- with a significant improvement in glycemic control;
- with the gradual development of hypoglycemia;
- in elderly patients;
- in patients with autonomic neuropathy;
- in patients with a long history of diabetes mellitus;
- in patients simultaneously receiving treatment with certain drugs (see section "Interaction with other drugs"). Such situations can lead to the development of severe hypoglycemia (and possibly loss of consciousness) before the patient realizes that he is developing hypoglycemia.
In the case of detection of normal or reduced values ​​of glycated hemoglobin, one should think about the possibility of developing recurring, unrecognized (especially nocturnal) episodes of hypoglycemia.
To reduce the risk of hypoglycemia, it is required that the patient strictly follow the prescribed dosing regimen and diet, correctly administer insulin injections, and be warned about the symptoms of developing hypoglycemia.
Factors that increase the susceptibility to the development of hypoglycemia require careful monitoring and may require dose adjustment. These factors include:
- changing the area of ​​insulin injection;
- increased sensitivity to insulin (for example, elimination of stress factors);
- unusual (increased or prolonged physical activity);
- intercurrent pathology (vomiting,);
- insufficient food intake;
- skipping meals
- alcohol consumption;
- some uncompensated endocrine diseases (such as insufficiency of the anterior pituitary gland or insufficiency of the adrenal cortex);
- concomitant use of certain drugs (see section "Interaction with other drugs"). Intercurrent diseases
Intercurrent diseases require intensive metabolic control. Urinalysis for the presence of ketone bodies is indicated in many cases, and insulin dose adjustment is often necessary. The need for insulin often increases. Patients with type 1 diabetes should continue to consume at least a small amount of carbohydrates regularly, even if they can only take small amounts of food or if they have, and they should never completely stop insulin administration. Cross immunological reactions
In a fairly large number of patients with hypersensitivity to animal insulin, the transition to human insulin is difficult due to the immunological cross-reaction of human insulin and animal insulin. With increased sensitivity of the patient to insulin of animal origin, as well as to m-cresol, the tolerability of the drug Insuman® Rapid GT should be evaluated in the clinic using intradermal tests. If an intradermal test reveals hypersensitivity to human insulin (immediate reaction, Arthus type), then further treatment should be carried out under clinical supervision.
Influence on the ability to drive vehicles or other mechanisms
The patient's ability to concentrate and the speed of psychomotor reactions may be impaired as a result of hypoglycemia or, as well as as a result of visual disorders. This may present a certain risk in situations where these abilities are important (driving motor vehicles or other mechanisms).
Patients should be advised to exercise caution and avoid hypoglycemia while driving. This is especially important in patients who have reduced or no awareness of symptoms that indicate the development of hypoglycemia, or who have frequent episodes of hypoglycemia. In such patients, the question of the possibility of driving motor vehicles or other mechanisms should be individually decided.

Hypoglycemia, the most common side effect, may develop if the dose of insulin administered exceeds the need for it (see "Precautions and special instructions").
Significant fluctuations in blood sugar levels can cause short-term visual disturbances. Also, especially with intensive insulin therapy, a short-term worsening of the course is possible. In patients with proliferative retinopathy, without the use of a course of laser therapy, severe hypoglycemic conditions can lead to blindness.
Sometimes at the injection site, or hypertrophy of adipose tissue may occur, which can be avoided by constantly changing the injection site. In rare cases, there may be slight redness at the injection site, which disappears with continued therapy. If a significant erythema is formed, accompanied by itching and swelling, and its rapid spread beyond the boundaries of the injection site, as well as other severe adverse reactions to the components of the drug (insulin, m-cresol), it is necessary to immediately inform the doctor about this, since in some cases such reactions can pose a threat to the life of the patient. Severe hypersensitivity reactions are quite rare. They may also be accompanied by the development of angioedema, bronchospasm, a drop in blood pressure, and, very rarely, anaphylactic shock. Hypersensitivity reactions require immediate correction in ongoing insulin therapy and the adoption of appropriate emergency measures.
The formation of antibodies to insulin is possible, which may require adjustment of the dose of insulin administered. Sodium retention with subsequent tissue swelling is also possible, especially after an intensive course of insulin treatment.
With a sharp decrease in blood sugar levels, development (complications from the cardiovascular system) or development of cerebral edema is possible.
Since some side effects can be, under certain conditions, life-threatening, it is necessary to inform the attending physician when they occur.
If you notice any side effects, please see your doctor!

Combined use with oral hypoglycemic agents, angiotensin-converting enzyme inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors,
pentoxifylline, propoxyphene, salicylates, amphetamine, anabolic steroids and male sex hormones, cibenzoline, cyclophosphamide, fenfluramine, guanethidine, ifosfamide, phenoxybenzamine, phentolamine, somatostatin and its analogs, sulfonamides, tetracyclines, tritoqualin, or trophosfamide may increase the predisposition to insulin development of hypoglycemia.
Co-administration with corticotropin, glucocorticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, estrogens and progestogens (eg, those present in combined contraceptives), phenothiazine derivatives, somatotropin, sympathomimetic agents (eg, epinephrine, salbutamol, terbutaline), thyroid hormones, barbiturates, nicotinic acid, phenolphthalein, phenytoin derivatives, doxazosin can weaken the hypoglycemic effect of insulin.
Beta-blockers, clonidine, lithium salts can either potentiate or weaken the hypoglycemic effect of insulin.
With ethanol
Ethanol can either potentiate or weaken the hypoglycemic action of insulin. Drinking ethanol can cause hypoglycemia or lower an already low blood glucose to dangerous levels. Ethanol tolerance in patients receiving insulin is reduced. Permissible amounts of alcohol to be consumed must be determined by a doctor. With pentamidine
With simultaneous administration, hypoglycemia may develop, which can sometimes turn into hyperglycemia.
When used together with sympatholytic agents, such as beta-blockers, clonidine, guanethidine and reserpine, it is possible to weaken or completely lack symptoms of reflex (in response to hypoglycemia) activation of the sympathetic nervous system.

Hypoglycemia.
- Hypersensitivity reaction to insulin or to any of the auxiliary components of the drug.
If you have one of these diseases or conditions, before using the drug, be sure to consult your doctor. Carefully
- With (possible decrease in insulin requirements due to a decrease in insulin metabolism).
- In elderly patients (gradual decline in kidney function may
lead to an ever-increasing decrease in insulin requirements).
- In patients with hepatic insufficiency (the need for insulin may decrease due to a decrease in the ability to gluconeogenesis and a decrease in insulin metabolism).
- In patients with severe stenosis of the coronary and cerebral arteries (hypoglycemic episodes may be of particular clinical importance, since there is an increased risk of cardiac or cerebral complications of hypoglycemia).
- In patients with proliferative retinopathy, especially those who have not received photocoagulation (laser therapy) treatment, since they have a risk of transient amaurosis - total blindness with hypoglycemia.
- In patients with intercurrent diseases (because intercurrent diseases often increase the need for insulin).
If you have one of these diseases or conditions, before using the drug, be sure to consult your doctor. Pregnancy and lactation
Treatment with Insuman® Rapid HT should be continued when pregnancy occurs. Insulin does not cross the placental barrier. Effective maintenance of metabolic control throughout pregnancy is mandatory for women who had diabetes before pregnancy or women who develop gestational diabetes.
Insulin requirements during pregnancy may decrease during the first trimester of pregnancy and usually increase during the second and third trimesters of pregnancy. Immediately after delivery, the need for insulin decreases rapidly (increased risk of hypoglycemia). During pregnancy and especially after childbirth, careful monitoring of blood glucose concentrations is mandatory.
When pregnancy occurs or when planning a pregnancy, it is imperative to inform the doctor.
There are no restrictions on insulin therapy during breastfeeding.
available, but insulin dose and dietary adjustments may be required.

Symptoms
Insulin overdose, for example, administering an excess amount of insulin compared to food intake or energy expenditure, can lead to severe and sometimes prolonged and life-threatening hypoglycemia Treatment
Mild episodes of hypoglycemia (the patient is conscious) can be stopped by ingestion of carbohydrates. Adjustment of insulin dose, food intake and physical activity may be required.
More severe episodes of hypoglycemia with coma, seizures, or neurologic deficits may be treated with intramuscular or subcutaneous glucagon or intravenous administration of concentrated dextrose. In children, the amount of dextrose administered is set in proportion to the child's body weight. After an increase in blood glucose concentration, maintenance carbohydrate intake and observation may be required, since after the apparent clinical resolution of the symptoms of hypoglycemia, its re-development is possible. In cases of severe or prolonged hypoglycemia following glucagon injection or dextrose administration, it is recommended to infuse with a less concentrated dextrose solution in order to prevent the recurrence of hypoglycemia. In young children, it is necessary to carefully monitor the concentration of glucose in the blood, due to the possible development of severe hyperglycemia.
Under certain conditions, hospitalization of patients in intensive care units is recommended for more careful monitoring of their condition and control over ongoing therapy.