Seek physician's advice when travelling between different time zones. Inadequate dosage or discontinuation of treatment, especially in type 1 diabetes, may lead to hyperglycemia & diabetic ketoacidosis. Insulin dose that is too high, omission of meal or unplanned strenuous physical exercise may lead to hypoglycemia. Intensified insulin therapy may change the usual warning symptoms of hypoglycemia. The warning symptoms of hypoglycemia may disappear in long-standing diabetes. Hypoglycemia may occur earlier after an inj due to rapid onset of action. Transferring from other types of insulin may reduce the early warning symptoms of hypoglycemia, & should be done under strict medical supervision. Concomitant illness, especially infections & feverish conditions, usually increases the patient's insulin requirement. Concomitant diseases in the kidney, liver or affecting the adrenal, pituitary or thyroid gland can require changes in the insulin dose. Rotate inj site continuously. Cases of CHF were reported when thiazolidinediones were used in combination w/ insulin, especially in patients w/ risk factors for development of CHF. Insulin antibodies may form & require dose adjustment. In elderly patients & patients w/ renal or hepatic impairment, glucose monitoring should be intensified & the dosage should be adjusted on an individual basis. Hypoglycemia may impair ability to drive or operate machinery. May be used in pregnancy & lactation, but dose adjustments may be needed.
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