Not to be administered IV. Not to be used w/ any other reusable pen except for ClikStar, OptiPen, TactiPen, Autopen 24 & AllStar. Potential risk of delayed insulin absorption & worsened glycemic control following insulin inj. Instruct patient in skills for diabetes self-management eg, blood sugar monitoring, proper inj technique, measures for recognizing & managing hypo-/hyperglycaemia; handling special situations eg, skipped, inadequate or increased insulin doses, inadequate food intake or missed meals. Perform continuous rotation of inj site to reduce risk of developing lipodystrophy & localized amyloidosis. Consider blood glucose monitoring after change in inj site & dose adjustment of antidiabetic medications. May affect ability to operate vehicle or perform hazardous tasks. Liver function impairment. Moderate to severe renal impairment. Maintain good metabolic control during pregnancy in women w/ preexisting or gestational diabetes. Decrease insulin requirements & generally increase during 2nd & 3rd trimesters. Childn <2 yr. Elderly. Hypoglycemia: Occur at start of insulin treatment, following transfer to different insulin prep, where metabolic control is unstable, or in severe kidney or liver diseases. Patients w/ significant narrowing of coronary arteries or of blood vessels supplying brain, or those w/ certain eye disease related to diabetes (proliferative retinopathy), particularly when not treated w/ photocoagulation (risk of transient blindness). Close monitoring & adjust dose to factors increasing risk eg, change in inj area (eg, from thigh to upper arm); improved insulin sensitivity by, eg, removal of stress factors; unaccustomed or increased physical activity; concomitant illness (eg, vomiting, diarrhoea); inadequate food intake eg, missed or delayed meals, smaller than usual meals or w/ less carbohydrate content than normal (sweet & starchy food), changes in diet; alcohol consumption; certain uncompensated endocrine disorders eg, reduced thyroid function or anterior pituitary or adrenocortical insufficiency; concurrent use of other medicines. Intensified blood sugar monitoring. Patient should comply w/ dosage & dietary regimen, correct insulin administration & symptoms awareness. Correct hypoglycemic attack by immediately taking sugar eg, glucose, sugar cubes or sweetened beverages (except food & drinks containing artificial sweeteners). Immediately test blood sugar after taking glucose. May delay recovery from hypoglycemia due to prolonged effect of SC treatment. Hyperglycemia: Omission or reduction of inj or decrease in insulin effectiveness (eg, due to incorrect storage); pen malfunction; decreased physical activity, stress situations (emotional distress, excitement), injuries, operations; feverish illnesses or certain other diseases; concurrent use of other medicines. Carry out tests for blood sugar or ketones in urine as soon as symptoms occur. Intensified metabolic monitoring & further dose adjustment, urine tests for ketones in patients w/ concomitant illness.
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