PACKAGE LEAFLET: INFORMATION FOR THE USER

HUMULIN® I (Isophane) 100 lU/ml suspension for injection in vial

(insulin, human)

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Read all of this leaflet carefully before you start using this medicine.

-    Keep this leaflet. You may need to read it again.

-    If you have any further questions, ask your diabetes specialist nurse, doctor or pharmacist.

-    This medicine has been prescribed for you. Do not pass it on to others. It may harm them, even if their symptoms are the same as yours.

-    If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your diabetes specialist nurse, doctor or pharmacist.

In this leaflet:

1.    What Humulin I is and what it is used for

2.    Before you use Humulin I

3.    How to use Humulin I

4.    Possible side effects

5.    How to store Humulin I

6.    Further information

1.    WHAT HUMULIN I IS AND WHAT IT IS USED FOR

Humulin I contains the active substance human insulin, which is used to treat diabetes. You get diabetes if your pancreas does not make enough insulin to control the level of glucose in your blood (blood sugar). Humulin I is used to control glucose in the long term. Its action is prolonged by the inclusion of protamine sulphate in the suspension.

Your doctor may tell you to use Humulin I as well as a fast-acting insulin. Each kind of insulin comes with its own patient information leaflet to tell you about it.

Do not change your insulin unless your doctor tells you to. Be very careful if you do change insulin. Each type of insulin has a different colour and symbol on the pack and the vial so that you can easily tell the difference.

2.    BEFORE YOU USE HUMULIN I Do not use Humulin I if you:

-    think hypoglycaemia (low blood sugar) is starting. Further in this leaflet it tells you how to deal with mild hypoglycaemia (see A in Section 4).

-    are allergic (hypersensitive) to human insulin or any of the other ingredients of Humulin I (see Section 6).

Take special care with Humulin I

•    If your blood sugar levels are well controlled by your current insulin therapy, you may not feel the warning symptoms when your blood sugar is falling too low. Warning signs are listed later in this leaflet. You must think carefully about when to have your meals, how often to exercise and how much to do.

oo You must also keep a close watch on your blood sugar levels by testing your 2 blood glucose often.

•    A few people who have had hypoglycaemia (low blood sugar) after switching from animal insulin to human insulin have reported that the early warning symptoms were less obvious or different. If you often have hypoglycaemia or have difficulty recognising the symptoms, please discuss this with your doctor.

•    I f you answer YES to any of the following questions, tell your diabetes specialist nurse, doctor or pharmacist.

-    Have you recently become ill?

-    Do you have trouble with your kidneys or liver?

-    Are you exercising more than usual?

•    The amount of insulin you need may also change if you drink alcohol.

•    You should also tell your diabetes specialist nurse, doctor or pharmacist if you are planning to go abroad. The time difference between countries may mean that you have to have your injections and meals at different times to when you are at home.

•    Some patients with long-standing type 2 diabetes mellitus and heart disease or previous stroke who were treated with pioglitazone and insulin experienced the development of heart failure. Inform your doctor as soon as possible, if you experience signs of heart failure such as unusual shortness of breath or rapid increase in weight or localised swelling (oedema).

Using other medicines

Please tell your doctor or diabetes specialist nurse, if you are taking or have recently taken any other medicines, including medicines obtained without a prescription.

Your insulin needs may change if you are taking any of the following:

•    steroids,

•    thyroid hormone replacement therapy,

•    oral hypoglycaemics (antidiabetic medication),

•    acetylsalicylic acid (aspirin),

•    growth hormone,

•    octreotide, lanreotide,

•    beta₂ stimulants (for example ritodrine, salbutamol or terbutaline),

•    beta-blockers,

•    thiazides or some antidepressants (monoamine oxidase inhibitors),

•    danazol,

•    some angiotensin converting (ACE) inhibitors (for example captopril, enalapril) or angiotensin II receptor blockers.

Pregnancy and breast-feeding

Ask your doctor or diabetes specialist nurse for advice before taking any medicine.

The amount of insulin you need usually falls during the first three months of pregnancy and increases for the remaining six months. If you are breastfeeding, you may need to alter your insulin intake or diet.

Driving and using machines

Your ability to concentrate and react may be reduced if you have hypoglycaemia (low blood sugar). Please remember this in all situations where you might put yourself and others at risk (e.g. driving a car or operating machinery). You should contact your diabetes specialist nurse or doctor about the advisability of driving if you have:

•    frequent episodes of hypoglycaemia

J • reduced or absent warning signs of hypoglycaemia.    g

3.    HOW TO USE HUMULIN I

Always check the pack and the vial label for the name and type of the insulin when you get it from your pharmacy. Make sure you get the Humulin that your doctor has told you to use.

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Always use Humulin I exactly as your doctor has told you. You should check with your doctor if you are not sure.

Dosage

•    You should normally inject Humulin I as your basal insulin. Your doctor has told you which insulin to use, how much, when and how often to inject.

These instructions are only for you. Follow them exactly and visit your diabetes clinic regularly.

•    If you change your insulin type (for example from animal to human), you may have to take more or less than before. This might just be for the first injection or it may be a gradual change over several weeks or months.

•    Inject Humulin I under the skin. You should not administer it using a different administration route. Under no circumstances should Humulin I be given into a vein.

Preparing Humulin I

•    Vials containing Humulin I should be rotated several times in the palms of the hands before use to resuspend insulin until it appears uniformly cloudy or milky. If not, repeat the above procedure until contents are mixed.

Do not shake vigorously as this may cause frothing which may interfere with the correct measurement of the dose. The vials should be examined frequently and should not be used if clumps of material are present or if solid white particles stick to the bottom or sides of the vial, giving it a frosted appearance. Check each time you inject yourself.

Injecting Humulin I

•    First wash your hands.

•    Before you make an injection, clean your skin as you have been instructed.

Clean the rubber stopper on the vial, but do not remove the stopper.

•    Use a clean, sterile syringe and needle to pierce the rubber stopper and draw in the amount of Humulin I you want. Your doctor or clinic will tell you how to do this. Do not share your needles and syringes.

•    Inject under the skin, as you were taught. Do not inject directly into a vein.

After your injection, leave the needle in the skin for 5 seconds to make sure you have taken the whole dose. Do not rub the area you have just injected.

Make sure you inject at least half an inch (1 cm) from where you last injected and that you ‘rotate’ the places you inject, as you have been taught.

•    Your doctor will tell you if you have to mix Humulin S with Humulin I. For example if you do need to inject a mixture, draw the Humulin S into the syringe before the long acting insulin. Inject the liquid as soon as you have mixed it. Do the same thing every time. You should not normally mix Humulin I with a mixture of human insulins. You should never mix Humulin I with insulins produced by other manufacturers or animal insulins.

•    You must not inject Humulin I into a vein. Inject Humulin I as your diabetes specialist nurse or doctor has taught you.

If you take more Humulin I than you need

If you take more Humulin I than you need, your blood sugar may become low. Check your blood sugar (see A in Section 4).

If you forget to use Humulin I

If you take less Humulin I than you need, your blood sugar levels may increase. Check your blood sugar.

If you stop using Humulin I

If you take less Humulin I than you need, your blood sugar levels may become too high. Do not change your insulin unless your doctor tells you to.

If you have any further questions on the use of this product, ask your diabetes specialist nurse, doctor or pharmacist.

4.    POSSIBLE SIDE EFFECTS

Like all medicines, Humulin I can cause side effects, although not everybody gets them.

Human insulin may cause hypoglycaemia (low blood sugar). See more information on hypoglycaemia below in the subsection “Common problems of diabetes”.

Possible side effects

Systemic allergy is very rare (affects less than 1 person in 10,000). The symptoms are as follows:

•    fall in blood pressure    •    rash over the whole    body

•    difficulty in breathing    •    wheezing

•    fast heart beat    •    sweating

If you think you are having this sort of insulin allergy with Humulin I, tell your doctor at once.

Local allergy is common (affects less than 1 person in 10). Some people get redness, swelling or itching around the area of the insulin injection. This usually clears up in anything from a few days to a few weeks. If this happens to you, tell your doctor.

Lipodystrophy (thickening or pitting of the skin) is uncommon (affects less than 1 person in 100). If you notice your skin thickening or pitting at the injection site, change your injection site and tell your doctor.

Oedema (e.g. swelling in arms, ankles; fluid retention) has been reported, particularly at the start of insulin therapy or during a change in therapy to improve control of your blood glucose.

If any of the side effects gets serious, or if you notice any side effects not listed in this leaflet, please tell your doctor or pharmacist.

Common problems of diabetes

A.    Hypoglycaemia

Hypoglycaemia (low blood sugar) means there is not enough sugar in the blood. This can be caused if you:

•    take too much Humulin I or other insulin;

•    miss or delay meals or change your diet;

•    exercise or work too hard just before or after a meal;

•    have an infection or illness (especially diarrhoea or vomiting);

•    have a change in your need for insulin; or

•    have trouble with your kidneys or liver which gets worse.

Alcohol and some medicines can affect your blood sugar levels.

The first symptoms of low blood sugar usually come on quickly and include the following:

•    tiredness    •    rapid heartbeat

•    nervousness or shakiness    •    feeling sick

•    headache    •    cold sweat

Until you become confident in recognising your warning symptoms, avoid situations such as driving a car, in which you or others would be put at risk by hypoglycaemia.

Do not use Humulin I if you think hypoglycaemia (low blood sugar) is starting.

If your blood sugar is low, eat glucose tablets, sugar or drink a sugary drink. Then eat fruit, biscuits, or a sandwich, as your doctor has advised you and have some rest. This will often get you over mild hypoglycaemia or a minor insulin overdose. If you get worse and your breathing is shallow and your skin gets pale, tell your doctor at once. A glucagon injection can treat quite severe hypoglycaemia. Eat glucose or sugar after the glucagon injection. If you do not respond to glucagon, you will have to go to hospital. Ask your doctor to tell you about glucagon.

B.    Hyperglycaemia and diabetic ketoacidosis

Hyperglycaemia (too much sugar in the blood) means that your body does not have enough insulin. Hyperglycaemia can be brought about by:

•    not taking your Humulin I or other insulin;

•    taking less insulin than your doctor tells you to;

•    eating a lot more than your diet allows; or

•    fever, infection or emotional stress.

Hyperglycaemia can lead to diabetic ketoacidosis. The first symptoms come on slowly over many hours or days. The symptoms include the following:

•    feeling sleepy    •    no appetite

•    flushed face    •    fruity smell on the breath

•    thirst    •    feeling or being sick

Severe symptoms are heavy breathing and a rapid pulse. Get medical help immediately.

If hypoglycaemia (low blood sugar) or hyperglycaemia (high blood sugar) are not treated they can be very serious and cause headaches, nausea, vomiting, dehydration, unconsciousness, coma or even death.

Three simple steps to avoid hypoglycaemia or hyperglycaemia are:

•    Always keep spare syringes and a spare vial of Humulin I.

•    Always carry something to show you are diabetic.

•    Always carry sugar with you.

C.    Illness

If you are ill, especially if you feel sick or are sick, the amount of insulin you need may change. Even when you are not eating normally, you still need insulin. Test your urine or blood, follow your ‘sick rules’, and tell your diabetes specialist nurse or doctor.

5.    HOW TO STORE HUMULIN I

Keep out of the reach and sight of children.

Before the first use, store your Humulin I in a refrigerator (2°C - 8°C). Do not freeze. You can keep your ‘in-use’ vial at room temperature (below 30°C) for up to 28 days. Do not put it near heat or in the sun.

Do not use Humulin I after the expiry date which is stated on the label and the carton. The expiry date refers to the last day of that month.

Do not use Humulin I, if clumps of material are present or if solid white particles stick to the bottom or sides of the vial, giving it a frosted appearance. Check this each time you inject yourself.

Medicines should not be disposed of via wastewater or household waste. Ask your pharmacist how to dispose of medicines no longer required. These measures will help to protect the environment.

6.    FURTHER INFORMATION What Humulin I contains

The active substance is human insulin. Human insulin is made in the laboratory by a ‘recombinant DNA technology’ process. It has the same structure as the natural hormone made by the pancreas. It is therefore different from animal insulins. The human insulin in Humulin I is available in a suspension together with protamine sulphate.

The other ingredients are protamine sulphate, metacresol, phenol, glycerol, dibasic sodium phosphate 7H₂O, zinc oxide and water for injection. Sodium hydroxide or hydrochloric acid may have been used during manufacture to adjust the acidity.

What Humulin I looks like and contents of the pack Humulin I (Isophane) 100 IU/ml suspension for injection is a white, sterile suspension and contains 100 units of insulin in each millilitre (100 IU/ml). Each vial contains 1000 units (10 millilitres).

Humulin I 100 IU/ml comes in a pack of 1 vial.

Marketing Authorisation Holder and Manufacturer

Humulin I in vial is made by:

Lilly S.A., Avda. Industria 30, 28108 Alcobendas, Madrid, Spain.

The marketing authorisation is held by: Eli Lilly and Company Limited, Lilly House, Priestley Road, Basingstoke, Hampshire, RG24 9NL, U.K.

It is distributed in the Republic of Ireland by Eli Lilly and Company (Ireland) Limited, Hyde House, 65 Adelaide Road, Dublin 2, Ireland.

This medicinal product is authorised in the Member States of the EEA under the following names:

Huminsulin „Lilly“ Basal 100 I.E./ml (Austria)

Humuline NPH (Belgium, Luxembourg)

Humulin N (Czech Republic, Hungary, Romania, Slovakia)

Huminsulin Basal (NPH) 100 (Germany)

Humulin NPH (Denmark, Finland, Greece, Norway, Sweden)

Humulina NPH 100 (Spain)

Humulin I (Ireland, Italy, uK)

Umuline NPH (France)

This leaflet was last approved in September 2014.

If you would like a large-print version of this leaflet, please phone 01256 315000 (UK) or 01 6614377 (Ireland)

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