By B. Elber. State University of New York College of Agriculture and Technology, Cobleskill.

Adverse events commonly associated with human insulin therapy include the following:Skin and Appendages ? injection site reaction 25 mg precose, lipodystrophy order precose 25 mg with mastercard, pruritus discount 50mg precose fast delivery, rash buy cheap precose 25 mg line. Hypoglycemia may occur as a result of an excess of insulin relative to food intake cheap 50 mg precose overnight delivery, energy expenditure, or both. Mild episodes of hypoglycemia usually can be treated with oral glucose. Adjustments in drug dosage, meal patterns, or exercise, may be needed. More severe episodes with coma, seizure, or neurologic impairment may be treated with intramuscular/subcutaneous glucagon or concentrated intravenous glucose. Sustained carbohydrate intake and observation may be necessary because hypoglycemia may recur after apparent clinical recoveryTable 1*: Summary of Pharmacodynamic Properties of Insulin Products (Pooled Cross-Study Comparison)The information supplied in Table 1 indicates when peak insulin activity can be expected and the percent of the total insulin activity occurring during the first 4 hours. The information was derived from 3 separate glucose clamp studies in nondiabetic subjects. Values represent means, with ranges provided in parentheses. Time of Peak Activity, Hours After DosingPercent of Total Activity Occurring in the First 4 HoursHumalog Mix75/25 is intended only for subcutaneous administration. Humalog Mix75/25 should not be administered intravenously. Humalog has been shown to be equipotent to Regular human insulin on a molar basis. One unit of Humalog has the same glucose-lowering effect as one unit of Regular human insulin, but its effect is more rapid and of shorter duration. Humalog Mix75/25 has a similar glucose-lowering effect as compared with Humulin 70/30 on a unit for unit basis. The quicker glucose-lowering effect of Humalog is related to the more rapid absorption rate of insulin lispro from subcutaneous tissue. Humalog Mix75/25 starts lowering blood glucose more quickly than Regular human insulin, allowing for convenient dosing immediately before a meal (within 15 minutes). In contrast, mixtures containing Regular human insulin should be given 30 to 60 minutes before a meal. The rate of insulin absorption and consequently the onset of activity are known to be affected by the site of injection, exercise, and other variables. As with all insulin preparations, the time course of action of Humalog Mix75/25 may vary considerably in different individuals or within the same individual. Patients must be educated to use proper injection techniques. Humalog Mix75/25 should be inspected visually before use. Humalog Mix75/25 should be used only if it appears uniformly cloudy after mixing. Humalog Mix75/25 should not be used after its expiration date. Humalog Mix75/25 [75% insulin lispro protamine suspension and 25% insulin lispro injection, (rDNA origin)] is available in the following package sizes: each presentation containing 100 units insulin lispro per mL (U-100). Unrefrigerated [below 30?C (86?F)] vials must be used within 28 days or be discarded, even if they still contain Humalog Mix75/25. Unrefrigerated [below 30?C (86?F)] Pens, and KwikPens must be used within 10 days or be discarded, even if they still contain Humalog Mix75/25. See table below:Not In-Use (Unopened) Room Temperature [Below 30?C (86?F)]Not In-Use (Unopened) RefrigeratedIn-Use (Opened) Room Temperature [Below 30?C (86?F)]28 days, refrigerated/room temperature. KwikPens manufactured by Eli Lilly and Company, Indianapolis, IN 46285, USAPens manufactured by Eli Lilly and Company, Indianapolis, IN 46285, USA or Lilly France, F-67640 Fegersheim, FranceVials manufactured byEli Lilly and Company, Indianapolis, IN 46285, USA or Lilly France, F-67640 Fegersheim, Francefor Eli Lilly and Company, Indianapolis, IN 46285, USAHTTP/1. NovoLog is an insulin analog with an earlier onset of action than regular human insulin. NovoLog given by subcutaneous injection should generally be used in regimens with an intermediate or long-acting insulin [see Warnings and Precautions, How Supplied/Storage and Handling ]. The total daily insulin requirement may vary and is usually between 0. When used in a meal-related subcutaneous injection treatment regimen, 50 to 70% of total insulin requirements may be provided by NovoLog and the remainder provided by an intermediate-acting or long-acting insulin.

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Luckily generic 25mg precose, support groups are available for family members and friends of a person with bipolar disorder precose 25 mg sale. Your doctor or mental health professional can give you some information about support groups in your area 25 mg precose sale. Never forget that the person with bipolar disorder does not have control of his or her mood state order precose 25mg on line. Those of us who do not suffer from a mood disorder sometimes expect mood-disorder patients to be able to exert the same control over their emotions and behavior that we ourselves are able to order precose 50mg mastercard. When we sense that we are letting our emotions get the better of us and we want to exert some control over them, we tell ourselves things like "Snap out of it," "Get a hold of yourself," "Try and pull yourself out of it. But you can only exert self-control if the control mechanisms are working properly, and in people with mood disorders, they are not. Telling a depressed person things like "pull yourself out of it" is cruel and may in fact reinforce the feelings of worthlessness, guilt, and failure already present as symptoms of the illness. Telling a manic person to "slow down and get a hold of yourself" is simply wishful thinking; that person is like a tractor trailer careening down a mountain highway with no brakes. So the first challenge facing family and friends is to change the way they look at behaviors that might be symptoms of bipolar disorder - behaviors like not wanting to get out of bed, being irritable and short-tempered, being "hyper" and reckless or overly critical and pessimistic. Our first reaction to these sorts of behaviors and attitudes is to regard them as laziness, meanness, or immaturity and be critical of them. Now a warning against the other extreme: interpreting every strong emotion in a person with a mood disorder as a symptom. The other extreme is just as important to guard against. A vicious cycle can get going wherein some bold idea or enthusiasm, or even plain old foolishness or stubbornness, is labeled as "getting manic," leading to feelings of anger and resentment in the person with the diagnosis. Communication is the key: honest and open communication. Ask the person with the illness about his or her moods, make observations about behaviors, express concerns in a caring, supportive way. Remember that your goal is to have your family member trust you when he or she feels most vulnerable and fragile. He or she is already dealing with feelings of deep shame, failure, and loss of control related to having a psychiatric illness. Be supportive, and yes, be constructively critical when criticism is warranted. Never forget that bipolar disorder can occassionally precipitate truly dangerous behavior. Kay Jamison writes of the "dark, fierce and damaging energy" of mania, and the even darker specter of suicidal violence haunts those with serious depression. Violence is often a difficult subject to deal with because the idea is deeply imbedded in us from an early age that violence is primitive and uncivilized and represents a kind of failure or breakdown in character. Of course, we recognize that the person in the grip of psychiatric illness is not violent because of some personal failing, and perhaps because of this there is sometimes a hesitation to admit the need for a proper response to a situation that is getting out of control; when there is some threat of violence, toward either self or others. People with bipolar disorder are at much higher risk for suicidal behavior than the general population. Although family members cannot and should not be expected to take the place of psychiatric professionals in evaluating suicide risk, it is important to have some familiarity with the issue. Patients who are starting to have suicidal thoughts are often intensely ashamed of them. They will often hint about "feeling desperate," about "not being able to go on," but may not verbalize actual self-destructive thoughts. But they may need permission and support in order to do so. Remember that the period of recovery from a depressive episode can be one of especially high risk for suicidal behavior. People who have been immobilized by depression sometimes develop a higher risk for hurting themselves as they begin to get better and their energy level and ability to act improve. Patients having mixed symptoms - depressed mood and agitated, restless, hyperactive behavior - may also be at higher risk for self-harm. Another factor that increases risk of suicide is substance abuse, especially alcohol abuse.

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