How this medication works?
Insulin is a hormone that is naturally produced in our body. The pancreas which is organ located behind our stomach is the main source of insulin. Islets, which are clusters of cells in the pancreas, produce the insulin hormone based on glucose levels in our body.
For those with diabetes, their body does not produce the required amount of insulin or use it efficiently. As a result, glucose isn’t store properly and builds up in the bloodstream. Diabetics are typically required to inject insulin under the skin (subcutaneously) to help manage or lower blood sugar levels.
There are several types of insulin medication which produce different results when taken. The absorption rate and duration may vary.
Novolin GE 40/60 is a premixed insulin that contains a combination of intermediate-acting insulin (insulin NPH) and fast-acting insulin (insulin regular).
This premixed insulin is often used by those who have their blood glucose levels under control and have found this ratio of intermediate-acting and short-acting insulin works best for them.
Novolin GE 40/60 premixed insulin starts working between 30-60 minutes after injection, has its maximum effect between 2-8 hours and stops working after 18-24 hours.
Your doctor may have prescribed this medication for reasons included in this article. Speak to your doctor if you are unsure why you have been prescribed this medication. Do not stop taking prescription medication without consulting with your doctor first.
Your prescription medication should not be shared with others even though they may share the same symptoms. Your medication is prescribed based on your individual needs. Sharing it with others may be harmful.
What form does this medication come in?
Each dose of insulin is measure din international units (IU). Each mL of insulin contains 100 IU. The premix contains (40 units of regular insulin and 60 units of insulin isophane, human biosynthetic insulin – NPH).
Non-medical ingredients contained in Novolin GE 40/60 include: metacresol, phenol, disodium phosphate dihydrate, glycerol, protamine sulphate, hydrochloric acid and/or sodium hydroxide, zinc chloride and water for injection.
How is Novolin GE 40/60 used?
Your doctor will base your insulin dosage on several factors including how much insulin your body produces, lifestyle, other medications you are currently taking and glucose levels. Your glucose levels should be monitored regularly and results should be shared with your doctor.
Your doctor or diabetes instructor will show you how to administer your insulin dosage which should be injected under the skin.
Do not inject premixed insulin into a muscle or vein; and do not use insulin with infusion pump.
Insulin dosing schedules may vary however premixed insulin is typically injected 30 minutes before breakfast or dinner.
For application, mix Novolin GE 40/60 premixed insulin by slowly rolling the bottle between your hands. Premixed insulin suspension should appear white and cloudy.
Many factors can affect your insulin dosage such as body weight, existing medical conditions and other medications. Your dosage should be taken according to your doctors instructions even though information may differ online. Do not change the way you take your insulin unless you’ve consulted with your doctor first.
Your insulin timing should be relative to your meals in order to keep your glucose levels under control and to avoid unwanted side effects. It is important to follow your doctors instructions and take medication exactly as prescribed.
A side effect is an unwanted response resulting from taking a medication in normal doses. As with taking any insulin medication, side effects may occur. Side effects can range from mild to severe; temporary or permanent.
Side effects are not experienced by everyone and quite rare. Speak to your doctor if you are concerned about any side effects or experiencing any. Also speak to your doctor about the benefits and risks.
The side effects listed below have been reported in at least 1% of patients taking this medication. Many of the side effects go away over time and can be managed.
Consult your doctor if you experience any of the side effects below:
- low blood glucose levels
- blurred vision
- fast heartbeat
- difficulty concentrating
- numbness or tingling of fingers, lips or tongue
Let your doctor know if you experience any of the side effects or they become bothersome. Your doctor will be able to advise you on how to properly manage side effects such as redness, itching or swelling at the site of injection.
If side effects are left unchecked they may lead to more serious complications if they are not tended to or you seek medical attention.
Stop taking this medication if you experience any of the following:
- blisters or rash all over your body
- symptoms of serious allergic reaction (ie swelling of the throat or face, wheezing, difficulty breathing or itchy or rashy skin)
Some patients may experience side effects other than those listed above. Speak to you doctor if you experience any symptoms not listed or side effects that worry you while taking this medication.
Unopened Novolin GE 40/60 insulin should be kept in the refrigerator until needed.
Do not use insulin past expiry date on label.
Keep medication away from children and pets.
Insulin currently in use can be kept at room temperature for no longer than 28 days and then should be discarded.
Keep away from extreme heat or direct sunlight.
Medication should not be disposed in trash or in wastewater (ie down the toilet or sink). Speak to your pharmacist about how to properly dispose of medication if it is no longer needed or expired.
Warnings & Precaution
Do not use insulin if it appears unusually thick, sticks to the bottle, looks grainy or lumpy or appears discolored.
Do not use premixed insulin if it appears to contain crystals, looks frosted or if the suspension remains clear after rolling between your hands.
Who should not Insulin premixed 40/60?
- This insulin should not be taken by anyone who is allergic to any of the ingredients contained in this medication.
- Is currently experiencing a diabetic coma.
- Has low blood glucose levels (hypoglycemia)
Before taking this medication be sure to inform your doctor of any allergies or existing medical conditions you may have, if you are pregnant, breastfeeding, planning on getting pregnant or important facts about your health. These factors may affect dosage and how it should be taken.
If you experience any allergy symptoms or severe allergic reactions such as swelling of throat or face, difficulty breathing, wheezing, developing rashes or itchy skin, stop taking this medication and seek medical attention.
Appearance of Insulin
Do not take this insulin if it remains clear after rolling it in your hands. Insulin should appear white and cloudy. Do not use if insulin appears frosted or looks like it contains crystals, grainy or lumpy, unusually thick, sticks to the bottle or appears discolored.
Blood Glucose Monitoring
As with taking any insulin, it’s important to monitor your blood glucose levels regularly or as recommended by a doctor or diabetes expert. It is especially important to test glucose levels if there are significant changes to your diet, are experiencing stress, are ill, travelling across other time zones or your meal schedule changes. If blood glucose levels are showing as too high or too low, consult with your doctor.
Changes at injection site
Fatty tissue under the skin may thicken or shrink if you are injecting repeatedly at the same site. To avoid this from happening, it is important to rotate injection sites. Speak to your doctor if you notice skin thickening or pitting at the injection site.
Certain medical conditions or lifestyle changes can affect blood glucose levels and insulin requirements. These can include:
- certain medical conditions (ie thyroid conditions, kidney or liver disease, infections)
- certain medications that may impact blood glucose levels
- change of time zones (change of dosage schedule)
Your doctor should be aware of any changes in your lifestyle and your current health sitation that impact your blood glucose levels and dosage. It’s important to monitor your blood glucose regularly as instructed by your doctor or diabetes educator.
It is important and beneficial to carry identification such as a card, wear a bracelet or necklace that indicates you are diabetic and taking insulin.
Educate Family & Friends
Family and friends should be educated on your condition and what to do if you experience hypoglycemia (low blood glucose). Keep a glucagon emergency kit available and instruct them on how to use it in case you lose consciousness.
Low blood glucose (hypoglycemia) may occur if you take too much insulin, skip meals or exercise more than usual. Mild to moderate symptoms may occur that may include nervousness or shakiness, fast heartbeat, cold sweats, hunger, headache, confusion, lightheadedness, confusion, weakness, numbness or tingling (fingers, tongue and lips). Mile to moderate hypoglycemia may be treated by consuming sugary foods or beverages (non diet) or taking a glucose tablet.
Signs of hypoglycemia may include:
- loss of consciousness
If you are unable to consume a sugary snack due to loss of consciousness you may require an injectable glucagon treatment or receive glucose intravenously (into the vein).
Pregnant or Breast-feeding
It is important to maintain blood glucose control during pregnancy. Insulin requirements may decrease during the first trimester and increase during the second and third trimester. If you are planning on pregnancy, consult with your doctor.
Breast feeding mothers may require modifications to their diet or insulin dosage.
What other medications can interact with insulin premixed 40/60?
- ACE inhibitors (e.g., ramipril, enalapril, lisinopril)
- anabolic steroids (e.g., testosterone)
- beta-blockers (e.g., atenolol, metoprolol, pindolol, propranolol, sotalol)
- birth control pills
- corticosteroids (e.g., prednisone, prednisolone)
- decongestants (e.g., pseudoephedrine)
- certain diuretics (e.g., hydrochlorothiazide)
- growth hormone
- MAO inhibitors (e.g., phenelzine, tranylcypromine)
- oral medications for diabetes (e.g., gliclazide, glyburide, pioglitazone, rosiglitazone)
- salicylates (e.g., ASA)
- sulfa antibiotics (e.g., sulfamethoxazole, sulfadiazine)
- thyroid replacement therapy (if beginning or changing dose)
Let your doctor know if you are taking any of the medications listed above as it may require your doctor to:
- stop taking one of the medications
- replace on dosage to another
- adjust dosage or medication schedule
- leave everything as is
Advise your doctor on any existing medications, over-the-counter drugs, natural supplements and vitamins, herbal medications you are taking. Let your doctor know if you are also consuming alcohol, caffeine or street drugs which can affect the action of one or more medications. Your doctor should provide instructions on how to manage your drug regimen.