Indications: diabetes mellitus

Hepatic impairment: Insulin requirements may be decreased in patients with hepatic impairment.

Renal impairment: Insulin requirements may decrease in patients with renal impairment and therefore dose reduction may be necessary. The compensatory response to hypoglycaemia is impaired in renal impairment.

Pregnancy and Breast-feeding: During Pregnancy and breast-feeding, insulin requirements may alter and doses should be assessed frequently by an experienced diabetes physician. The dose of insulin generally needs to be increased in the second and third trimesters of pregnancy. The short-acting insulin analogues, insulin aspart and insulin lispro, are not known to be harmful, and may be used during Pregnancy and breast-feeding. Evidence of the safety of long-acting insulin analogues in Pregnancy is limited, therefore isophane insulin is recommended where longer-acting insulins are needed; insulin detemir may also be considered.

Side Effects: transient oedema; local reactions and fat hypertrophy at injection site; rarely hypersensitivity reactions including urticaria, rash; overdose causes hypoglycaemia.

Dose: By subcutaneous injection, adult and child over 2 years, according to requirements.