Why is nph insulin given

The use of NPH has declined with the availability of other long-acting insulin options, specifically, the long-acting insulin analogs, insulin glargine and insulin detemir. Self assessment quizzes are available for topics covered in this website. To find out how much you have learned about Treatment of Type 1 Diabetes , take our self assessment quiz when you have completed this section. The quiz is multiple choice. Please choose the single best answer to each question.

At the end of the quiz, your score will display. 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 Monitor patients receiving insulin closely for changes in diabetic control, specifically hyperglycemia, when anti-retroviral protease inhibitors are instituted.

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. Dexamethasone: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued.

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.

Dextromethorphan; Promethazine: Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. 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. Drospirenone: Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. 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. 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. 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. 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: Moderate Estramustine may decrease glucose tolerance leading to hyperglycemia. 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 ethanol ingestion when treated with insulin. Ethanol 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 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; Desogestrel: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.

Ethinyl Estradiol; Ethynodiol Diacetate: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Ethinyl Estradiol; Etonogestrel: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.

Ethinyl Estradiol; Levonorgestrel: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.

Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate: 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; Norethindrone Acetate; Ferrous fumarate: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.

Ethinyl Estradiol; Norethindrone: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued. Ethinyl Estradiol; Norethindrone; Ferrous fumarate: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.

Ethinyl Estradiol; Norgestimate: 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. Etonogestrel: Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. 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. Fluoxetine; Olanzapine: Moderate Atypical antipsychotic therapy may aggravate diabetes mellitus and cause metabolic changes such as hyperglycemia.

Moderate In patients with diabetes mellitus, fluoxetine may alter glycemic control. 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. It is unclear if hemoglobin A1C is improved or if improvements are sustained with continued treatment beyond 24 weeks. Other reviews suggest that garlic may provide modest improvements in blood lipids, but few studies demonstrate decreases in blood glucose in diabetic and non-diabetic patients. More controlled trials are needed to discern if garlic has an effect on blood glucose in patients with diabetes. Gemfibrozil: Moderate Dose reductions and increased frequency of glucose monitoring may be required when antidiabetic agents are administered with fibric acid derivatives e.

Glecaprevir; Pibrentasvir: Moderate Closely monitor blood glucose levels if glecaprevir 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 glecaprevir.

Moderate Closely monitor blood glucose levels if pibrentasvir 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 pibrentasvir. Glimepiride; Rosiglitazone: Major Use of insulins with rosiglitazone is not recommended by the manufacturer due to a potential increased risk for edema or heart failure.

These trials included patients with chronic diabetes and a high prevalence of coexisting medical conditions, including peripheral neuropathy, retinopathy, ischemic heart disease, vascular disease, and congestive heart failure.

In these clinical studies, an increased incidence of heart failure and other cardiovascular adverse events was seen in patients receiving combination rosiglitazone and insulin therapy compared to insulin monotherapy; the incidence of new onset or exacerbated heart failure was 0. Some of the patients who developed cardiac failure on combination therapy during the double blind part of the studies had no known prior evidence of congestive heart failure, or pre-existing cardiac condition.

Additionally, the results of a meta-analysis that included the same 5 randomized, controlled trials mentioned previously indicate that the rate of myocardial ischemia may be increased in patients taking rosiglitazone in combination with insulin; the incidence of myocardia ischemia was 1. One each of myocardial ischemia and sudden death were reported in patients taking combination therapy compared to zero patients taking insulin monotherapy.

Glipizide; Metformin: Moderate Coadministration of metformin with an insulin may increase the risk of hypoglycemia. Glucagon: 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. Glyburide; Metformin: Moderate Coadministration of metformin with an insulin may increase the risk of hypoglycemia. Green Tea: Moderate Green tea catechins have been shown to decrease serum glucose concentrations. Patients with diabetes mellitus taking antidiabetic agents should be monitored closely for hypoglycemia if consuming green tea products.

Guaifenesin; Hydrocodone; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.

Guaifenesin; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Guaifenesin; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Hydralazine; Hydrochlorothiazide, HCTZ: Moderate Monitor patients receiving insulin closely for changes in diabetic control when thiazide diuretics are instituted or discontinued; dosage adjustments may be required.

Hydrochlorothiazide, HCTZ: Moderate Monitor patients receiving insulin closely for changes in diabetic control when thiazide diuretics are instituted or discontinued; dosage adjustments may be required.

Hydrochlorothiazide, HCTZ; Irbesartan: Moderate Monitor patients receiving angiotensin II receptor antagonists concomitantly with insulin for changes in glycemic control. Hydrochlorothiazide, HCTZ; Lisinopril: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control.

Hydrochlorothiazide, HCTZ; Losartan: Moderate Monitor patients receiving angiotensin II receptor antagonists concomitantly with insulin for changes in glycemic control. Hydrochlorothiazide, HCTZ; Methyldopa: Moderate Monitor patients receiving insulin closely for changes in diabetic control when thiazide diuretics are instituted or discontinued; dosage adjustments may be required. Hydrochlorothiazide, HCTZ; Metoprolol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents.

Hydrochlorothiazide, HCTZ; Moexipril: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control. Hydrochlorothiazide, HCTZ; Olmesartan: Moderate Monitor patients receiving angiotensin II receptor antagonists concomitantly with insulin for changes in glycemic control.

Hydrochlorothiazide, HCTZ; Propranolol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents. Hydrochlorothiazide, HCTZ; Quinapril: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control.

Hydrochlorothiazide, HCTZ; Spironolactone: Moderate Monitor patients receiving insulin closely for changes in diabetic control when thiazide diuretics are instituted or discontinued; dosage adjustments may be required. Hydrochlorothiazide, HCTZ; Telmisartan: Moderate Monitor patients receiving angiotensin II receptor antagonists concomitantly with insulin for changes in glycemic control.

Hydrochlorothiazide, HCTZ; Triamterene: Moderate Monitor patients receiving insulin closely for changes in diabetic control when thiazide diuretics are instituted or discontinued; dosage adjustments may be required.

Minor Triamterene can decrease the hypoglycemic effects of insulin by producing an increase in blood glucose levels. Patients receiving insulin should be closely monitored for signs indicating loss of diabetic control when therapy with triamterene is instituted.

In addition, patients receiving insulin should be closely monitored for signs of hypoglycemia when therapy with any of these other agents is discontinued. Hydrochlorothiazide, HCTZ; Valsartan: Moderate Monitor patients receiving angiotensin II receptor antagonists concomitantly with insulin for changes in glycemic control.

Hydrocodone; Phenylephrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Hydrocodone; Potassium Guaiacolsulfonate; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.

Hydrocodone; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Hydrocortisone: Moderate Monitor patients receiving insulin closely for worsening glycemic control when corticosteroids are instituted and for signs of hypoglycemia when corticosteroids are discontinued. Hydroxychloroquine: Moderate Careful monitoring of blood glucose is recommended when hydroxychloroquine and antidiabetic agents, including insulins, are coadministered.

A decreased dose of the antidiabetic agent may be necessary as severe hypoglycemia has been reported in patients treated concomitantly with hydroxychloroquine and an antidiabetic agent. Hydroxyprogesterone: Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance.

Ibuprofen; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Iloperidone: Moderate Atypical antipsychotic therapy may aggravate diabetes mellitus and cause metabolic changes such as hyperglycemia.

Indapamide: Moderate A potential pharmacodynamic interaction exists between indapamide and antidiabetic agents, like insulins. Indapamide can decrease insulin sensitivity thereby leading to glucose intolerance and hyperglycemia.

Diuretic-induced hypokalemia may also lead to hyperglycemia. Indinavir: Moderate Monitor patients receiving insulin closely for changes in diabetic control, specifically hyperglycemia, when anti-retroviral protease inhibitors are instituted. Irbesartan: Moderate Monitor patients receiving angiotensin II receptor antagonists concomitantly with insulin for changes in glycemic control. Isocarboxazid: Moderate Monitor patients receiving monoamine oxidase inhibitors MAOIs concomitantly with insulin for changes in glycemic control.

Animal data indicate that MAOIs may stimulate insulin secretion. Inhibitors of MAO type A have been shown to prolong the hypoglycemic response to insulin and oral sulfonylureas. Isoproterenol: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.

Labetalol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents. Lanreotide: Moderate Monitor blood glucose levels regularly in patients with diabetes, especially when lanreotide treatment is initiated or when the dose is altered. Adjust treatment with antidiabetic agents as clinically indicated. Lanreotide inhibits the secretion of insulin and glucagon. Patients treated with lanreotide may experience either hypoglycemia or hyperglycemia.

Ledipasvir; Sofosbuvir: Moderate Closely monitor blood glucose levels if ledipasvir is administered with antidiabetic agents. Dose adjustments of the antidiabetic agent s 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 ledipasvir.

Moderate Closely monitor blood glucose levels if sofosbuvir 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 sofosbuvir. Leuprolide; Norethindrone: Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance.

Levobetaxolol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents. Levobunolol: Moderate Increased frequency of blood glucose monitoring may be required when a beta blocker is given with antidiabetic agents. Levonorgestrel: Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. Levothyroxine: Minor Monitor patients receiving insulin closely for changes in diabetic control whenever there is a change in thyroid treatment.

It may be necessary to adjust the dose of antidiabetic agents if thyroid hormones are added or discontinued. Thyroid hormones are important in the regulation of carbohydrate metabolism, gluconeogenesis, the mobilization of glycogen stores, and protein synthesis.

When thyroid hormones are added to existing diabetes therapy, the glucose-lowering effect may be reduced. Levothyroxine; Liothyronine Porcine : Minor Monitor patients receiving insulin closely for changes in diabetic control whenever there is a change in thyroid treatment. Levothyroxine; Liothyronine Synthetic : Minor Monitor patients receiving insulin closely for changes in diabetic control whenever there is a change in thyroid treatment.

Linagliptin; Metformin: Moderate Coadministration of metformin with an insulin may increase the risk of hypoglycemia. Linezolid: Moderate Hypoglycemia, including symptomatic episodes, has been noted in post-marketing reports with linezolid in patients with diabetes mellitus receiving therapy with antidiabetic agents, such as insulin and oral hypoglycemic agents. Diabetic patients should be monitored for potential hypoglycemic reactions while on linezolid.

If hypoglycemia occurs, discontinue or decrease the dose of the antidiabetic agent or discontinue the linezolid therapy. Linezolid is a reversible, nonselective MAO inhibitor and other MAO inhibitors have been associated with hypoglycemic episodes in diabetic patients receiving insulin or oral hypoglycemic agents. Liothyronine: Minor Monitor patients receiving insulin closely for changes in diabetic control whenever there is a change in thyroid treatment.

Lisdexamfetamine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. Lisinopril: Moderate Monitor patients receiving angiotensin-converting enzyme inhibitors ACE inhibitors concomitantly with insulin for changes in glycemic control. Lithium: Moderate Monitor patients receiving insulin closely for changes in glycemic control when lithium is instituted; dosage adjustments of insulin may be necessary.

Lithium may cause variable effects on glycemic control when used in patients receiving insulin or other antidiabetic therapy. Lomefloxacin: Moderate Disturbances of blood glucose, including hyperglycemia and hypoglycemia, have been reported in patients treated concomitantly with quinolones and an antidiabetic agent. Therefore, careful monitoring of blood glucose is recommended when quinolones and antidiabetic agents are co-administered. Lopinavir; Ritonavir: Moderate Monitor patients receiving insulin closely for changes in diabetic control, specifically hyperglycemia, when anti-retroviral protease inhibitors are instituted.

Loratadine; Pseudoephedrine: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically. In clinical trials, lorcaserin use was associated with reports of hypoglycemia. Blood glucose monitoring is warranted in patients with type 2 diabetes prior to starting and during lorcaserin treatment.

Dosage adjustments of anti-diabetic medications should be considered. If a patient develops hypoglycemia during treatment, adjust anti-diabetic drug regimen accordingly. Of note, lorcaserin has not been studied in combination with insulin.

Losartan: Moderate Monitor patients receiving angiotensin II receptor antagonists concomitantly with insulin for changes in glycemic control. Lovastatin; Niacin: Moderate Monitor patients receiving insulin closely for changes in diabetic control when niacin, niacinamide is instituted or discontinued. Dosage adjustments may be necessary. Niacin interferes with glucose metabolism and can result in hyperglycemia. When used at daily doses of to mg, niacin significantly lowers LDL cholesterol and triglycerides while increasing HDL cholesterol.

Changes in glycemic control can usually be corrected through modification of hypoglycemic therapy. Lurasidone: Moderate Atypical antipsychotic therapy may aggravate diabetes mellitus and cause metabolic changes such as hyperglycemia. Macimorelin: Major Avoid use of macimorelin in patients receiving exogenous insulin therapy. In addition, healthcare providers are advised to discontinue insulin therapy and observe a sufficient washout period before administering macimorelin.

Use of exogenous insulin may impact the accuracy of the macimorelin growth hormone test by directly affecting pituitary growth hormone secretion and by transiently elevating growth hormone concentrations. Magnesium Salicylate: Moderate Use large doses of aspirin cautiously in patients receiving insulin.

Patients should be advised to eat within 20 minutes of mecasermin administration. Glucose monitoring is important when initializing or adjusting mecasermin therapies, when adjusting concomitant antidiabetic therapy, and in the event of hypoglycemic symptoms. An increased risk for hypoglycemia is possible. The hypoglycemic effect induced by IGF-1 activity may be exacerbated.

The amino acid sequence of mecasermin rh-IGF-1 is approximately 50 percent homologous to insulin and cross binding with either receptor is possible. Treatment with mecasermin has been shown to improve insulin sensitivity and to improve glycemic control in patients with either Type 1 or Type 2 diabetes mellitus when used alone or in conjunction with insulins.

Medroxyprogesterone: Minor Progestins can decrease the hypoglycemic effects of antidiabetic agents by impairing glucose tolerance. Meperidine; Promethazine: Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Mepivacaine; Levonordefrin: Moderate Sympathomimetic agents and adrenergic agonists tend to increase blood glucose concentrations when administered systemically.

Mesoridazine: Minor Phenothiazines, especially chlorpromazine, may increase blood glucose concentrations. Mestranol; Norethindrone: Minor Patients receiving antidiabetic agents should be periodically monitored for changes in glycemic control when hormone therapy is instituted or discontinued.

Metformin: Moderate Coadministration of metformin with an insulin may increase the risk of hypoglycemia. Metformin; Pioglitazone: Moderate Coadministration of metformin with an insulin may increase the risk of hypoglycemia.

Metformin; Repaglinide: Moderate Coadministration of metformin with an insulin may increase the risk of hypoglycemia.

Long-acting insulin glargine is also available in U This is three times more concentrated than U long-acting insulin. Be sure to check the concentration of your insulin so you take the right amount.

Insulin is made by different companies. Make sure you use the same type of insulin consistently. Rapid-acting insulins work over a narrow, more predictable range of time. Because they work quickly, they are used most often at the start of a meal. Rapid-acting insulin acts most like insulin that is produced by the human pancreas. It quickly drops the blood sugar level and works for a short time.

If a rapid-acting insulin is used instead of a short-acting insulin at the start of dinner, it may prevent severe drops in blood sugar level in the middle of the night. Short-acting insulins take effect and wear off more quickly than long-acting insulins. A short-acting insulin is often used 30—60 minutes before a meal so that it has time to work. These liquid insulins are clear and do not settle out when the bottle vial sits for a while. Intermediate- and long-acting insulins contain added substances buffers that make them work over a long time and that may make them look cloudy.

When these types of insulin sit for even a few minutes, the buffered insulin settles to the bottom of the vial. But insulin glargine and insulin detemir are clear liquids not cloudy. Mixtures of insulin can sometimes be combined in the same syringe, for example, intermediate-acting and rapid- or short-acting insulin.

Not all insulins can be mixed together. For convenience, there are premixed rapid- and intermediate-acting insulin.