Indications And Dose
Type 2 diabetes not controlled by metformin alone ▶BY MOUTH ▶Adult: 1 tablet twice daily, titration with the individual components (pioglitazone and metformin) desirable before initiation
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Drug reference
Type 2 diabetes not controlled by metformin alone ▶BY MOUTH ▶Adult: 1 tablet twice daily, titration with the individual components (pioglitazone and metformin) desirable before initiation
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Show container to patient or carer and confirm the expected version is dispensed. Units The word ’unit’ should not be abbreviated.
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→Appendix 1: metformin. pioglitazone
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NHS NEVER EVENT: OVERDOSE OF INSULIN DUE TO ABBREVIATIONS OR INCORRECT DEVICE (JANUARY 2018) The words ‘unit’ or ‘international units’ should not be abbreviated. Specific insulin administration devices should always be used to measure insulin i.e. Insulin syringes and pens. Insulin should not be withdrawn from an insulin pen or pen refill and then administered using a syringe and needle. NHS IMPROVEMENT PATIENT SAFETY ALERT: RISK OF SEVERE HARM AND DEATH DUE TO WITHDRAWING INSULIN FROM PEN DEVICES (NOVEMBER 2016) Insulin should not be extracted from insulin pen devices. The strength of insulin in pen devices can vary by multiples of 100 units/mL. Insulin syringes have graduations only suitable for calculating doses of standard 100 units/mL. If insulin extracted from a pen or cartridge is of a higher strength, and that is not considered in determining the volume required, it can lead to a significant and potentially fatal overdose.
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▶Common or very common Oedema ▶Uncommon Lipodystrophy Overdose Overdose causes hypoglycaemia.
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Dose adjustments During pregnancy, 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.
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Dose adjustments During breast-feeding, insulin requirements may alter and doses should be assessed frequently by an experienced diabetes physician.
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Insulin requirements may be decreased.
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The compensatory response to hypoglycaemia is impaired in renal impairment. Dose adjustments Insulin requirements may decrease in patients with renal impairment and therefore dose reduction may be necessary.
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▶Many patients now monitor their own blood-glucose concentrations; all carers and children need to be trained to do this. ▶Since blood-glucose concentration varies substantially throughout the day, ‘normoglycaemia’ cannot always be achieved throughout a 24-hour period without causing damaging hypoglycaemia. ▶In adults It is therefore best to recommend that patients should maintain a blood-glucose concentration of between 4 and 9 mmol/litre for most of the time (4–7 mmol/litre before meals and less than 9 mmol/litre after meals). ▶In children It is therefore best to recommend that children should maintain a blood-glucose concentration of between 4 and 10 mmol/litre for most of the time (4–8 mmol/litre before meals and less than 10 mmol/litre after meals). While accepting that on occasions, for brief periods, the blood-glucose concentration will be above these values; strenuous efforts should be made to prevent it from falling below 4 mmol/litre. Patients using multiple injection regimens should understand how to adjust their insulin dose according to their carbohydrate intake. With fixed- dose insulin regimens, the carbohydrate intake needs to be regulated, and should be distributed throughout the day to match the insulin regimen. The intake of energy and of simple and complex carbohydrates should be adequate to allow normal growth and development but obesity must be avoided.
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There can be variation in the licensing of different medicines containing the same drug. Tablet CAUTIONARY AND ADVISORY LABELS 21 ▶Pioglitazone with metformin (Non-proprietary) Pioglitazone (as Pioglitazone hydrochloride) 15 mg, Metformin hydrochloride 850 mg Pioglitazone 15mg / Metformin 850mg tablets | 56 tablet P £35.89 DT = £29.31 ▶Competact (Takeda UK Ltd) Pioglitazone (as Pioglitazone hydrochloride) 15 mg, Metformin hydrochloride 850 mg Competact 15mg/850mg tablets | 56 tablet P £35.89 DT = £29.31 INSULINS Insulins f
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Insulin is generally given by subcutaneous injection; the injection site should be rotated to prevent lipodystrophy. Injection devices (‘pens’), which hold the insulin in a cartridge and meter the required dose, are convenient to use. Insulin syringes Endocrine system (for use with needles) are required for insulins not available in cartridge form, but are less popular with children and carers. For intensive insulin regimens multiple subcutaneous injections (3 or more times daily) are usually recommended.
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Hypoglycaemia Hypoglycaemia is a potential problem with insulin therapy. All patients must be carefully instructed on how to avoid it; this involves appropriate adjustment of insulin type, dose and frequency together with suitable timing and quantity of meals and snacks. Insulin Passport Insulin Passports and patient information booklets should be offered to patients receiving insulin. The Insulin Passport provides a record of the patient’s current insulin preparations and contains a section for emergency information. The patient information booklet provides advice on the safe use of insulin. They are available for purchase from: 3M Security Print and Systems Limited Gorse Street, Chadderton Oldham OL9 9QH Tel: 0845 610 1112 GP practices can obtain supplies through their Local Area Team stores. NHS Trusts can order supplies from www.nhsforms.co.uk/ or by emailing nhsforms@mmm.com. Further information is available at www.npsa.nhs.uk. Driving and skilled tasks Drivers need to be particularly careful to avoid hypoglycaemia and should be warned of the problems. INSULINS › RAPID-ACTING eiiii F above
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1 tablet twice daily, titration with the individual
First-line fragment. Read the complete Indications and Dose section above.
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