⚠️ Warnings
Before travelling between time zones, the patient should consult their physician. Travelling between time zones may mean that the patient will need to use insulin and take meals at different times. Hyperglycaemia
Inadequate dosing or discontinuation of treatment, especially in type 1 diabetics, may lead to hyperglycaemia and diabetic ketoacidosis. The first symptoms of hyperglycaemia usually develop gradually over a period of hours or days. They include thirst, increased frequency of urination, nausea, vomiting, drowsiness, flushed dry skin, dry mouth, loss of appetite, and acetone odour on the breath. In type 1 diabetes, untreated hyperglycaemic events may lead to diabetic ketoacidosis, which is potentially fatal.
Hypoglycaemia
Omission of a meal or unplanned strenuous physical exercise may lead to hypoglycaemia.
Hypoglycaemia may occur if the insulin dose is too high relative to the insulin requirement. In the event of hypoglycaemia or suspected hypoglycaemia, Actraphane must not be administered. After the patient's blood glucose level has been stabilised, dose adjustment must be considered (see sections 4.8 and 4.9).
Patients whose glycaemic control is greatly improved, e.g. by intensified insulin therapy, may experience a change in the usual warning symptoms of hypoglycaemia. Patients should be informed accordingly. In patients who have had diabetes for a long time, the usual warning symptoms may disappear.
Concomitant illness, particularly infections and febrile conditions, usually increases the patient's insulin requirement. Concomitant disease of the kidneys, liver, or conditions affecting the adrenal glands, pituitary gland, or thyroid gland may require changes in insulin dose.
If the patient is transferred to another type of insulin medicinal product, the early warning signs of hypoglycaemia may change or be attenuated compared with those experienced with the previous insulin.
Transfer from other insulin medicinal products
Transfer of a patient to another type or brand of insulin must be carried out under strict medical supervision. Changes in strength, brand (manufacturer), type, origin (animal insulin, human insulin, or insulin analogue) and/or method of manufacture (recombinant DNA versus animal-source insulin) may result in the need for a change in dose. Patients transferred to Actraphane from another type of insulin may require an increased number of daily injections or a change in dose compared with those used with previous insulin medicinal products. If dose adjustment is necessary, it may be made at the first dose or during the first several weeks or months.
Injection site reactions
As with any insulin therapy, injection site reactions may occur, manifesting as pain, redness, urticaria, inflammation, bruising, swelling, and itching. Regular rotation of the injection site within one area reduces the risk of developing these reactions. Reactions usually resolve within a few days to weeks. In rare cases, injection site reactions may require discontinuation of Actraphane.
Skin and subcutaneous tissue disorders
Patients must be instructed to continuously rotate the injection site to reduce the risk of lipodystrophy and cutaneous amyloidosis. There is a potential risk of delayed insulin absorption and worsening of glycaemic control following injection of insulin into sites with these reactions. A sudden change in injection site to an unaffected area has been reported to result in hypoglycaemia. Blood glucose monitoring is recommended after changing the injection site from an affected to an unaffected area, and dose adjustment of antidiabetic medication may be considered.
Combination of Actraphane with pioglitazone
Cases of cardiac failure have been reported when pioglitazone was used in combination with insulin, particularly in patients with risk factors for developing cardiac failure. This must be taken into account if treatment with pioglitazone in combination with Actraphane is considered. If the combination is used, patients must be monitored for signs and symptoms of heart failure, weight gain, and oedema. Pioglitazone must be discontinued if any deterioration in cardiac symptoms occurs.
Prevention of accidental mix-ups/medication errors
Patients must be instructed to check the insulin label before each injection to avoid accidental mix-up of Mixtard with other insulin preparations.
Traceability
In order to improve the traceability of biological medicinal products, the name of the administered product and the batch number should be clearly recorded.
