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A number of substances affect glucose metabolism and may require insulin dose adjustment. Substances that may enhance the Creon 20 (Pancrelipase Delayed-Released Capsules)- FDA glucose lowering effect and susceptibility to hypoglycaemia include: oral antidiabetic agents, ACE inhibitors, pentoxifylline (oxpentifylline), perhexiline, disopyramide, fibrates, fluoxetine, MAO inhibitors, dextropropoxyphene, salicylates, sulfonamide antibiotics.

Substances that may reduce the blood glucose lowering effect include: corticosteroids, danazol, diazoxide, diuretics, glucagon, isoniazid, estrogens, progestogens, oral contraceptives, phenothiazine derivatives, somatotrophin, sympathomimetic agents (e. Beta-blockers, clonidine, lithium salts or alcohol biotin bayer either potentiate or weaken the blood glucose lowering effect of insulin.

Pentamidine may cause hypoglycaemia, which may be sometimes followed by hyperglycaemia. In addition, under the influence of sympatholytic medicinal products such as beta-blockers, clonidine, guanethidine and reserpine, the signs of adrenergic counter regulation induced by hypoglycaemia may be reduced or absent. The rates (per 100 patient years) of confirmed all Onmel (Itraconazole Oral Administration)- Multum events, severe hypoglycaemia events and nonsevere symptomatic hypoglycaemia are shown in Table 12.

Hypoglycaemia, in general the most frequent adverse reaction of insulin therapy, may occur if the insulin dose is too high in relation to the insulin requirement. As with all insulins, severe hypoglycaemic attacks, especially if recurrent, may lead to neurological damage. Prolonged or severe hypoglycaemic episodes may be life threatening.

In many patients, the signs and symptoms of Onmel (Itraconazole Oral Administration)- Multum are preceded by signs of Onmel (Itraconazole Oral Administration)- Multum counter regulation. Generally, the greater and more rapid the Onmel (Itraconazole Oral Administration)- Multum in blood glucose, the more marked is the phenomenon of counter regulation and its symptoms.

A marked change in glycaemic control may cause temporary visual impairment, due to temporary puzzle in the turgidity and refractive index of the lens. As with all insulin regimens, intensification of insulin therapy with abrupt improvement in glycaemic control may be associated with temporary visual impairment or worsening of diabetic retinopathy.

However, long-term improved glycaemic control decreases the risk of progression of diabetic retinopathy. In patients with proliferative retinopathy, particularly if not treated with photocoagulation, severe hypoglycaemic episodes may result in transient partial or complete blindness. Retinopathy was evaluated in clinical studies by means of retinal adverse events reported and fundus photography. The numbers of retinal adverse events reported for Lantus and NPH treatment groups were similar for patients with type 1 and type 2 diabetes.

Progression of retinopathy was investigated by fundus photography using a grading protocol derived from the Early Treatment Diabetic Retinopathy Study (ETDRS). In a 5 year NPH controlled study, Onmel (Itraconazole Oral Administration)- Multum primary outcome was progression by 3 or more steps on the ETDRS scale at study endpoint.

The results of this analysis are shown in Table 13 for both the per protocol (primary) and intent to treat (ITT) populations, and indicate noninferiority of Lantus to NPH in the progression of diabetic retinopathy as assessed by this outcome. 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. Most Onmel (Itraconazole Oral Administration)- Multum reactions to insulins usually resolve in a few days to a few weeks. Immediate type allergic reactions are rare. Such reactions to insulin (including insulin glargine) or the excipients may, for example, be associated with generalised skin reactions, angioedema, bronchospasm, hypotension or shock and may be life threatening.

Animal studies with insulin glargine have identified significant local tolerance toxicity at the Onmel (Itraconazole Oral Administration)- Multum site following repeat subcutaneous administration. Care Onmel (Itraconazole Oral Administration)- Multum be taken to rotate the site of injection.

Insulin administration may cause the formation of antibodies to insulin. In clinical studies, antibodies that cross react with human insulin and insulin glargine were observed in both NPH human insulin and insulin glargine treatment groups with similar incidences. In rare cases, the presence of such insulin antibodies may necessitate adjustment of the insulin dose in order to correct a tendency to hyperglycaemia or hypoglycaemia.

Insulin may cause sodium retention and oedema, particularly if previously poor metabolic control is improved by intensified insulin therapy. Medication errors have been reported in which other insulins have been accidentally administered instead of insulin glargine.

Lantus is an insulin analogue, equipotent to human insulin, with a peakless glucose lowering profile and a prolonged duration of action that permits once daily dosing. Lantus is for individual patient use only. Lantus is given subcutaneously once a day.

It Onmel (Itraconazole Oral Administration)- Multum be administered at any time during the day, however, at the same time every day. The desired blood glucose levels as well as the doses and timing of any antidiabetic medication, including Lantus, must be determined and adjusted individually.

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