insulins-Actrapid

• The treatment of insulin-requiring diabetes.

For the latest PBS indications for Actrapid please see
https://www.pbs.gov.au/medicine/item/1531N-1762R

• Actrapid is a short-acting insulin and is often used in combination with intermediate or long-acting insulins. An injection should be followed by a meal or snack containing carbohydrates within 30 minutes. In an emergency, Actrapid is suitable for intramuscular administration under medical guidance. In an emergency, Actrapid is also suitable for intravenous administration but only if administered by a physician. For emergency use with Penfill, insulin must first be withdrawn into a syringe. Discard Penfill cartridge after emergency use.
• Actrapid may also be administered when insulin is required in the following situations:

• Initial stabilisation of diabetes.
• Treatment of ketoacidosis and hyperosmolar non ketotic syndrome.
• Insulin given as a continuous intravenous infusion or intramuscular injection regime is part of the overall management of both ketoacidosis and hyperosmolar non ketotic syndrome.
• During stress situations such as severe infection.
• Clinical management of severe infections may require higher doses of insulin than normal, intravenous insulin or short-term insulin treatment in individuals normally taking oral hypoglycaemic agents.
• Major trauma and/or surgery in people with diabetes. Management is determined by the nature and severity of the trauma and/or surgery, the duration of peri-operative fasting and the person’s ability to produce insulin. People normally treated with insulin will generally require insulin administration during surgery. People whose HbA1c is not at target or those undergoing major surgery will generally require insulin. Frequent blood glucose monitoring is required during and after surgery. When the person can eat normally, their usual therapy can be re-instated.

• Due to the risk of precipitation in pump catheters, Actrapid should not be used in insulin pumps for continuous subcutaneous insulin infusion.
• Actrapid comes in a vial to be used with insulin syringes with the corresponding unit scale (U100 or 100 U/mL).
• Actrapid comes in a cartridge (Penfill) designed to be used with Novo Nordisk insulin delivery systems NovoPen®. The cartridge must not be refilled.
• Actrapid which has been frozen must not be used.
• Needles should be discarded after each injection.
• Insulin is usually administered subcutaneously by injection in the abdominal wall, the thigh, the gluteal region, or the deltoid region. Injection sites should always be rotated within the same region to reduce the risk of lipodystrophy and cutaneous amyloidosis. Subcutaneous injection into the abdominal wall ensures a faster absorption than from other injection sites. Injection into a lifted skin fold minimises the risk of intramuscular injection. The needle should be kept under the skin for at least 6 seconds to make sure the entire dose is injected.

• Use in renal impairment: Actrapid can be used in renal impairment. As with all insulins, glucose monitoring should be intensified, and dosage adjustment should occur on an individual basis.
• Use in liver impairment: Actrapid can be used in hepatic impairment. As with all insulins, glucose monitoring should be intensified, and dosage adjustment should occur on an individual basis.

• Hypoglycaemia: Hypoglycaemia is the most common adverse effect of insulins. As with all insulins, particular caution (including intensified blood glucose monitoring) should be exercised in individuals who are at greater risk of clinically significant sequelae from hypoglycaemic episodes.

• Travelling with insulin: Before travelling between different time zones, an individual should be advised to consult their doctor or CDE, since this may mean that extra education may be needed due to different time zones. Diabetes Medscheck referral to relevant HCP
• Hyperglycaemia – Inadequate dosing or discontinuation of treatment, especially in type 1 diabetes, may lead to hyperglycaemia and ketoacidosis. The first symptoms of hyperglycaemia usually develop gradually, over a period of hours or days. They include nausea, vomiting, drowsiness, flushed dry skin, dry mouth, increased frequency of urination, thirst, and loss of appetite as well as acetone breath. Untreated hyperglycaemic events maybe life threatening.

• • Hypoglycaemia: Hypoglycaemia is the most common adverse effect of insulins. As with all insulins, particular caution (including intensified blood glucose monitoring) should be exercised in individuals who are at greater risk of clinically significant sequelae from hypoglycaemic episodes.

• • Injection site and allergic reactions: As with any insulin therapy, lipodystrophy may occur at the injection site and delay insulin absorption. Other injection site reactions with insulin therapy include redness, pain, itching, hives, swelling and inflammation.

• • Skin and subcutaneous tissue disorders: Individuals must be instructed to perform continuous rotation of the injection site to reduce the risk of developing lipodystrophy and cutaneous amyloidosis. There is a potential risk of delayed insulin absorption and deterioration of glycaemic management following insulin injections at sites with these reactions. A sudden change in the injection site to an unaffected area has been reported to result in hypoglycaemia. Generalised hypersensitivity reactions may rarely occur. Generalised hypersensitivity reactions are potentially life threatening.

• • A marked change in glycaemic management can cause temporary visual impairment, due to temporary alteration in the turgidity and refractive index of the lens. As with all insulin regimens, intensification of insulin therapy with abrupt improvement in glycaemic management maybe associated with temporary visual impairment or worsening of retinopathy. However, long-term improved glycaemic management decreases the risk of progression of diabetic retinopathy.

• The safety and efficacy of Actrapid has been established in the elderly.

• Hypersensitivity to the active substance or any of the excipients