Follow carefully the special meal plan your doctor gave you. This is the most important part of controlling your condition, and is necessary if the medicine is to work properly.
Also, exercise regularly and test for sugar in your blood or urine as directed. Do not change the brand, type, or dose of your insulin unless your doctor tells you to. When you receive a new supply of insulin, check the label to be sure if it is the correct type of insulin.
The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.
The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine. Store unused vials, pens, or cartridges in the refrigerator. Do not freeze. This medicine may be refrigerated for only 28 days.
Throw the medicine away after the expiration date has passed. The vial that you are currently using may be kept in the refrigerator or at room temperature in a cool place, away from direct heat and light, for up to 28 days.
The cartridge or pen that you are currently using should not be refrigerated. You should store the cartridge or pen at room temperature in a cool place, away from direct heat and light, for up to 28 days. Throw away used syringes and needles in a hard, closed container that the needles cannot poke through.
Beta-blockers: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents. Betamethasone: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Betaxolol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents.
Bexarotene: Moderate Systemic bexarotene may enhance the action of insulin, resulting in hypoglycemia. Patients should be closely monitored while receiving bexarotene capsules in combination with insulin therapy; monitor for hypoglycemia and need for diabetic therapy adjustments. Hypoglycemia has not been associated with bexarotene monotherapy. Bismuth Subsalicylate: Moderate Use large doses of aspirin cautiously in patients receiving insulin.
Bismuth Subsalicylate; Metronidazole; Tetracycline: Moderate Use large doses of aspirin cautiously in patients receiving insulin. Bisoprolol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents. Bisoprolol; Hydrochlorothiazide, HCTZ: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents. Bortezomib: Moderate During clinical trials of bortezomib, hypoglycemia and hyperglycemia were reported in diabetic patients receiving antidiabetic agents.
Patients taking antidiabetic agents and receiving bortezomib treatment may require close monitoring of their blood glucose levels and dosage adjustment of their medication. Brexpiprazole: Moderate Atypical antipsychotic therapy may aggravate diabetes mellitus and cause metabolic changes such as hyperglycemia. Brimonidine; Timolol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents.
Brompheniramine; Carbetapentane; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Brompheniramine; Dextromethorphan; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Brompheniramine; Hydrocodone; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Brompheniramine; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Brompheniramine; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Brompheniramine; Pseudoephedrine; Dextromethorphan: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Budesonide: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Budesonide; Formoterol: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Budesonide; Glycopyrrolate; Formoterol: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Bumetanide: Minor Monitor patients receiving insulin closely for worsening glycemic control when bumetanide, furosemide, and torsemide are instituted.
Bumetanide, furosemide, and torsemide may cause hyperglycemia and glycosuria in patients with diabetes mellitus, probably due to diuretic-induced hypokalemia. Because of this, a potential pharmacodynamic interaction exists between these drugs and all antidiabetic agents.
Canagliflozin; Metformin: Moderate Coadministration of metformin with an insulin may increase the risk of hypoglycemia. Candesartan: Moderate Monitor patients receiving angiotensin II receptor antagonists concomitantly with insulin for changes in glycemic control. Candesartan; Hydrochlorothiazide, HCTZ: Moderate Monitor patients receiving angiotensin II receptor antagonists concomitantly with insulin for changes in glycemic control.
Captopril: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control. Captopril; Hydrochlorothiazide, HCTZ: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control. Carbetapentane; Chlorpheniramine; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Carbetapentane; Diphenhydramine; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Carbetapentane; Guaifenesin; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Carbetapentane; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Carbetapentane; Phenylephrine; Pyrilamine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Carbetapentane; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Carbinoxamine; Dextromethorphan; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Carbinoxamine; Hydrocodone; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Carbinoxamine; Hydrocodone; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Carbinoxamine; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Carbinoxamine; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Carbonic anhydrase inhibitors: Minor Carbonic anhydrase inhibitors may alter blood sugar. Cariprazine: Moderate Atypical antipsychotic therapy may aggravate diabetes mellitus and cause metabolic changes such as hyperglycemia. Carteolol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents.
Carvedilol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents. Cetirizine; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Chlophedianol; Dexchlorpheniramine; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Chlophedianol; Guaifenesin; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Chloroquine: Major Careful monitoring of blood glucose is recommended when chloroquine and antidiabetic agents, including insulin, are coadministered. A decreased dose of the antidiabetic agent may be necessary as severe hypoglycemia has been reported in patients treated concomitantly with chloroquine and an antidiabetic agent.
Chlorothiazide: Moderate Monitor patients receiving insulin closely for changes in diabetic control when thiazide diuretics are instituted or discontinued; dosage adjustments may be required.
Chlorpheniramine; Dextromethorphan; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Chlorpheniramine; Dextromethorphan; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Chlorpheniramine; Dihydrocodeine; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Chlorpheniramine; Dihydrocodeine; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Chlorpheniramine; Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Chlorpheniramine; Hydrocodone; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Chlorpheniramine; Hydrocodone; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Chlorpheniramine; Ibuprofen; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Chlorpheniramine; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Chlorpheniramine; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Chlorpromazine: Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Hyperglycemia and glycosuria have been reported.
Patients who are taking antidiabetic agents should monitor for worsening glycemic control when a phenothiazine is instituted. Chlorthalidone: Moderate Monitor patients receiving insulin closely for changes in diabetic control when thiazide diuretics are instituted or discontinued; dosage adjustments may be required. Chlorthalidone; Clonidine: Moderate Monitor patients receiving insulin closely for changes in diabetic control when thiazide diuretics are instituted or discontinued; dosage adjustments may be required.
Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents. Since clonidine inhibits the release of catecholamines, clonidine may hide symptoms of hypoglycemia such as tremor, tachycardia, and blood pressure changes. Clonidine does not appear to impair recovery from hypoglycemia, and has not been found to impair glucose tolerance in diabetic patients.
Choline Salicylate; Magnesium Salicylate: Moderate Use large doses of aspirin cautiously in patients receiving insulin. Chromium: Moderate Chromium dietary supplements may lower blood glucose. As part of the glucose tolerance factor molecule, chromium appears to facilitate the binding of insulin to insulin receptors in tissues and to aid in glucose metabolism. Because blood glucose may be lowered by the use of chromium, patients who are on antidiabetic agents may need dose adjustments.
Close monitoring of blood glucose is recommended. Ciclesonide: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Cisapride: Moderate Because cisapride can enhance gastric emptying in patients with diabetes, blood glucose can be affected, which, in turn, may affect the clinical response to insulin and other antidiabetic agents. Monitor blood sugar regularly.
The dosing of antidiabetic agents may require adjustment in patients who receive cisapride concomitantly. Clarithromycin: Moderate The concomitant use of clarithromycin and insulin or other antidiabetic agents can result in significant hypoglycemia. Clonidine: Minor Increased frequency of blood glucose monitoring may be required when clonidine is given with antidiabetic agents.
Clozapine: Moderate Atypical antipsychotic therapy may aggravate diabetes mellitus and cause metabolic changes such as hyperglycemia. Codeine; Guaifenesin; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Codeine; Phenylephrine; Promethazine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Codeine; Promethazine: Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Monitor patients for increase in triglyceride concentrations.
Conjugated Estrogens: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Estrogens can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. Changes in glucose tolerance occur more commonly in patients receiving 50 mcg or more of ethinyl estradiol or equivalent per day in combined oral contraceptives COCs , which are not commonly used in practice since the marketing of lower dose COCs, patches, injections and rings.
The presence or absence of a concomitant progestin may influence the significance of any hormonal effect on glucose homeostasis. Conjugated Estrogens; Bazedoxifene: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Conjugated Estrogens; Medroxyprogesterone: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. Patients receiving antidiabetic agents should be closely monitored for changes in diabetic control when hormone therapy is instituted or discontinued. Corticosteroids: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Cortisone: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Cyclosporine: Moderate Cyclosporine may cause hyperglycemia. Patients should be monitored for worsening of glycemic control if therapy with cyclosporine is initiated in patients receiving insulin. Daclatasvir: Moderate Closely monitor blood glucose levels if daclatasvir is administered with antidiabetic agents.
Dose adjustments of the antidiabetic agents may be needed. Altered blood glucose control, resulting in serious symptomatic hypoglycemia, has been reported in diabetic patients receiving antidiabetic agents in combination with direct acting antivirals, such as daclatasvir. Danazol: Moderate Changes in insulin sensitivity or glycemic control may occur in patients treated with androgens.
Dapagliflozin; Metformin: Moderate Coadministration of metformin with an insulin may increase the risk of hypoglycemia. Darunavir: Moderate Monitor patients receiving insulin closely for changes in diabetic control, specifically hyperglycemia, when anti-retroviral protease inhibitors are instituted.
Darunavir; Cobicistat: Moderate Monitor patients receiving insulin closely for changes in diabetic control, specifically hyperglycemia, when anti-retroviral protease inhibitors are instituted. Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: Moderate Monitor patients receiving insulin closely for changes in diabetic control, specifically hyperglycemia, when anti-retroviral protease inhibitors are instituted.
Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir : Moderate Closely monitor blood glucose levels if dasabuvir; ombitasvir; paritaprevir; ritonavir is administered with antidiabetic agents. Altered blood glucose control, resulting in serious symptomatic hypoglycemia, has been reported in diabetic patients receiving antidiabetic agents in combination with direct acting antivirals, such as dasabuvir; ombitasvir; paritaprevir; ritonavir. Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: Moderate Monitor patients receiving insulin closely for changes in diabetic control, specifically hyperglycemia, when anti-retroviral protease inhibitors are instituted.
Dasiglucagon: Minor Caution should be exercised when glucagon is used as a diagnostic aid for radiologic examination in patients taking insulin. Insulin reacts antagonistically towards glucagon. Monitor the patient receiving glucagon for a diagnostic procedure for the desired clinical effects. There is no concern when glucagon is used to treat severe hypoglycemia. If a patient receives glucagon due to severe hypoglycemia by a family member or caregiver, they should alert their health care provider so that insulin treatment may be adjusted, if needed.
Deflazacort: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Desloratadine; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Desogestrel; Ethinyl Estradiol: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Dexamethasone: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Dexbrompheniramine; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Dexchlorpheniramine; Dextromethorphan; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Dexmethylphenidate: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Dextroamphetamine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Dextromethorphan; Diphenhydramine; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Dextromethorphan; Guaifenesin; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Dextromethorphan; Guaifenesin; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Diazoxide: Minor Diazoxide, when administered intravenously or orally, produces a prompt dose-related increase in blood glucose level, due primarily to an inhibition of insulin release from the pancreas, and also to an extrapancreatic effect. The hyperglycemic effect begins within an hour and generally lasts no more than 8 hours in the presence of normal renal function.
The hyperglycemic effect of diazoxide is expected to be antagonized by certain antidiabetic agents e. Blood glucose should be closely monitored.
Dienogest; Estradiol valerate: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Diethylpropion: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Diethylstilbestrol, DES: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Dihydrocodeine; Guaifenesin; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Diphenhydramine; Hydrocodone; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Diphenhydramine; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Disopyramide: Moderate Monitor patients receiving disopyramide concomitantly with insulin for changes in glycemic control.
Disopyramide may enhance the hypoglycemic effects of insulin. Dobutamine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Dopamine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Dorzolamide; Timolol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents.
Doxapram: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Drospirenone: Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. Drospirenone; Estetrol: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Drospirenone; Estradiol: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Drospirenone; Ethinyl Estradiol: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Drospirenone; Ethinyl Estradiol; Levomefolate: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Dulaglutide: Moderate The risk of hypoglycemia, including severe hypoglycemia, is increased when dulaglutide is used in combination with insulin.
Although specific dose recommendations are not available, a lower dose of the insulin may be required to reduce the risk of hypoglycemia in this setting. Severe hypoglycemia occurred in 2. Adequate blood glucose monitoring should be continued and followed. Calcium EDTA chelates the zinc in selected exogenous insulins, thereby increasing the amount of insulin available to the body and decreasing the duration of the insulin dose. Alterations in blood glucose control may result.
Diabetic patients receiving calcium EDTA may require adjustments in their insulin dosage. Elagolix; Estradiol; Norethindrone acetate: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Elbasvir; Grazoprevir: Moderate Closely monitor blood glucose levels if elbasvir is administered with antidiabetic agents. Altered blood glucose control, resulting in serious symptomatic hypoglycemia, has been reported in diabetic patients receiving antidiabetic agents in combination with direct acting antivirals, such as elbasvir.
Empagliflozin; Linagliptin; Metformin: Moderate Coadministration of metformin with an insulin may increase the risk of hypoglycemia. Empagliflozin; Metformin: Moderate Coadministration of metformin with an insulin may increase the risk of hypoglycemia. Enalapril, Enalaprilat: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control.
Enalapril; Felodipine: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control. Enalapril; Hydrochlorothiazide, HCTZ: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control. Ephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.
Ephedrine; Guaifenesin: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Epinephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Eprosartan: Moderate Monitor patients receiving angiotensin II receptor antagonists concomitantly with insulin for changes in glycemic control.
Eprosartan; Hydrochlorothiazide, HCTZ: Moderate Monitor patients receiving angiotensin II receptor antagonists concomitantly with insulin for changes in glycemic control. Ertugliflozin; Metformin: Moderate Coadministration of metformin with an insulin may increase the risk of hypoglycemia.
Erythromycin; Sulfisoxazole: Moderate Sulfonamides may enhance the hypoglycemic action of antidiabetic agents; patients with diabetes mellitus should be closely monitored during sulfonamide treatment. Sulfonamides may induce hypoglycemia in some patients by increasing the secretion of insulin from the pancreas.
Patients at risk include those with compromised renal function, those fasting for prolonged periods, those that are malnourished, and those receiving high or excessive doses of sulfonamides. Esmolol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents. Esterified Estrogens: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Esterified Estrogens; Methyltestosterone: Moderate Changes in insulin sensitivity or glycemic control may occur in patients treated with androgens. Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Estradiol Cypionate; Medroxyprogesterone: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Estradiol: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Estradiol; Levonorgestrel: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Estradiol; Norethindrone: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Estradiol; Norgestimate: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Estradiol; Progesterone: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Estramustine: Minor Estramustine is an estrogen-containing medication and may decrease glucose tolerance. Patients receiving antidiabetic agents should monitor their blood glucose levels frequently due to this potential pharmacodynamic interaction. Estrogens: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Estropipate: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Ethanol: Moderate Patients should be advised to limit alcohol ingestion when treated with insulin. Alcohol inhibits gluconeogenesis, which can contribute to or increase the risk for hypoglycemia. In some patients, hypoglycemia can be prolonged. If a patient with diabetes ingests alcohol, they should be counselled to avoid ingestion of alcohol on an empty stomach, which increases risk for low blood sugar.
Patients should also be aware of the carbohydrate intake provided by certain types of alcohol in the diet, which can contribute to poor glycemic control. If a patient chooses to ingest alcohol, they should monitor their blood glucose frequently. Many non-prescription drug products may be formulated with alcohol; instruct patients to scrutinize product labels prior to consumption. Ethinyl Estradiol: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Ethinyl Estradiol; Norelgestromin: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Ethinyl Estradiol; Norethindrone Acetate: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Ethinyl Estradiol; Norgestrel: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Ethotoin: Minor Ethotoin and other hydantoins have the potential to increase blood glucose and thus interact with antidiabetic agents pharmacodynamically.
Monitor blood glucose for changes in glycemic control. Dosage adjustments may be necessary in some patients. Ethynodiol Diacetate; Ethinyl Estradiol: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Etonogestrel: Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. Etonogestrel; Ethinyl Estradiol: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.
Exenatide: Moderate The risk of hypoglycemia is increased when exenatide is used in combination with insulins. The concurrent use of exenatide with prandial insulin has not been studied. Exenatide may be used with basal insulin regimens. Fenofibrate: Moderate Dose reductions and increased frequency of glucose monitoring may be required when antidiabetic agents are administered with fibric acid derivatives e. Fibric acid derivatives may enhance the hypoglycemic effects of antidiabetic agents through increased insulin sensitivity and decreased glucagon secretion.
Fenofibric Acid: Moderate Dose reductions and increased frequency of glucose monitoring may be required when antidiabetic agents are administered with fibric acid derivatives e. Fexofenadine; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Fibric acid derivatives: Moderate Dose reductions and increased frequency of glucose monitoring may be required when antidiabetic agents are administered with fibric acid derivatives e.
Fludrocortisone: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Flunisolide: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Fluoxetine: Moderate In patients with diabetes mellitus, fluoxetine may alter glycemic control.
Hypoglycemia has occurred during fluoxetine therapy. Hyperglycemia has developed in patients with diabetes mellitus following discontinuation of the drug. Fluoxymesterone: Moderate Changes in insulin sensitivity or glycemic control may occur in patients treated with androgens.
Fluphenazine: Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Fluticasone: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Fluticasone; Salmeterol: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Fluticasone; Umeclidinium; Vilanterol: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Fluticasone; Vilanterol: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Formoterol; Mometasone: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.
Fosamprenavir: Moderate Monitor patients receiving insulin closely for changes in diabetic control, specifically hyperglycemia, when anti-retroviral protease inhibitors are instituted.
Fosinopril: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control. Fosinopril; Hydrochlorothiazide, HCTZ: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control. Fosphenytoin: Minor Fosphenytoin and other hydantoins have the potential to increase blood glucose and thus interact with antidiabetic agents pharmacodynamically.
Furosemide: Minor Monitor patients receiving insulin closely for worsening glycemic control when bumetanide, furosemide, and torsemide are instituted. Garlic, Allium sativum: Moderate Patients receiving antidiabetic agents should use dietary supplements of Garlic, Allium sativum with caution.
Constituents in garlic might have some antidiabetic activity, and may increase serum insulin levels and increase glycogen storage in the liver. Monitor blood glucose and glycemic control. Patients with diabetes should inform their health care professionals of their intent to ingest garlic dietary supplements.
Some patients may require adjustment to their hypoglycemic medications over time. One study stated that additional garlic supplementation 0. Using a 10 mL syringe, she drew the insulin lispro into the syringe up to the first gradation mark, believing this represented 0.
But the first syringe marking was actually 0. The nurse manager did not verify the dose in the syringe prior to administration. The error was quickly discovered when a clinical nurse specialist asked the nurse, who had just completed orientation, to demonstrate how she had measured the insulin dose in a 10 mL syringe. Another event appeared in recent literature involving a medical resident working in interventional radiology IR who gave the wrong dose of insulin to a hemodialysis patient with hyperkalemia.
On the day of the procedure, her potassium level was 5. A repeat potassium level was drawn, and the result, 6. Because the patient was stable without EKG abnormalities, treatment was delayed until after the procedure. When the procedure had been completed, a resident went to the pharmacy to request the medications needed for hyperkalemia treatment, including 10 units of regular insulin. The pharmacy dispensed a 3 mL vial of U regular insulin without clarification that only 0. The resident mistakenly administered the entire vial of insulin units instead of 10 units.
He had little prior experience measuring and preparing insulin doses since medication administration of this type was not within his scope of practice. When the dosing error was identified, a rapid response team was called. The patient was transferred to an intensive care unit ICU and able to tolerate meals with carbohydrates to provide a more physiological delivery of glucose.
Glucose and potassium levels stabilized, and the patient was transferred out of the ICU within 2 days. Treatment protocols. Establish standard hyperkalemia protocols that specify the threshold for treatment based on severity e. Ensure adequate monitoring of glucose levels and signs and symptoms of hypoglycemia during treatment, even if dextrose is being administered, and for several hours after insulin administration. Hypoglycemia may occur up to 6 hours after dextrose and insulin administration, especially if the patient has renal dysfunction.
In the protocols, also specify the insulin type, dose, and route of administration, and how to flush the IV line or access site, if necessary, to ensure the small volume of insulin has been fully administered; the concomitant dextrose concentration, volume, and route of administration; and specific doses and administration for all other pharmacological interventions e. Standard order sets.
Create standard order sets for hyperkalemia treatment and require their use. Treatment should only be prescribed using a standard order set that is automatically populated with the correct dose and route of administration for the required medications, including insulin. If the insulin dose is to be administered IV push via a syringe, include on the order set a reminder to use a luer-compatible insulin syringe without a needle, and to flush the line or access site if necessary to ensure the small volume of insulin has been fully administered.
These reminders should also appear on the medication administration record.
0コメント