What it is and what it is used for

for

NovoRapid® is a modern insulin (insulin analogue) with a rapid-acting effect. Modern insulin products are improved versions of human insulin. NovoRapid® is used to reduce the high blood sugar level in adults, adolescents and children aged 1 year and above with diabetes mellitus (diabetes). Diabetes is a disease where your body does not produce enough insulin to control the level of your blood sugar. Treatment with NovoRapid® helps to prevent complications from your diabetes. NovoRapid® PumpCart® is for use in a pump and covers your total daily insulin needs: both your all day (basal) and meal-time (bolus) insulin needs. Before you use NovoRapid® PumpCart® in the pump you must have received a comprehensive instruction by your doctor or nurse. Basal (all-day) insulin requirements: When you use NovoRapid® PumpCart® in a pump, your insulin will be constantly delivered to cover your basal need for insulin. If you change the basal insulin setting the change will start to affect you within 10-20 minutes. If you stop the pump, the insulin effect will last for 3 to 5 hours. Before you set or change the basal rate, carefully read the pump manual (user guide). Bolus (meal-time) insulin requirements: NovoRapid® will start to lower your blood sugar within 10-20 minutes after you start a bolus delivery (see section 3, How to use NovoRapid® PumpCart®, for more information about how to adjust your bolus dose). The maximum effect occurs between 1 and 3 hours after the bolus delivery and the effect lasts for 3 to 5 hours.

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What you need to know before you take it

e NovoRapid® PumpCart®

Do not use NovoRapid® PumpCart® ► ►

If you are allergic to insulin aspart, or any of the other ingredients in this medicine (see section 6, Contents of the pack and other information). If you suspect hypoglycaemia (low blood sugar) is starting (see a) Summary of serious and very common side effects in section 4). 1

► ► ►

If the cartridge or the device containing the cartridge is dropped, damaged or crushed. If it has not been stored correctly or been frozen (see section 5, How to store NovoRapid® PumpCart®). If the insulin does not appear clear and colourless.

If any of these applies, do not use NovoRapid® PumpCart®. Talk with your doctor, nurse or pharmacist for advice. Before using NovoRapid® PumpCart® ► ►

► ►

Check the label to make sure it is the right type of insulin. Always check the cartridge, including the rubber plunger at the bottom of the cartridge. Do not use it if any damage or leakage is seen or if the rubber plunger has been drawn above the white label band at the bottom of the cartridge. This could be a result of leakage of insulin. If you suspect the cartridge is damaged, take it back to your supplier. Infusion sets (tubing and needle) and NovoRapid® PumpCart® must not be shared. NovoRapid® PumpCart® is only suitable for injecting under the skin (subcutaneously) using a pump. Speak to your doctor if you need to inject your insulin by another method.

Warnings and precautions Some conditions and activities can affect your need for insulin. Consult your doctor: ► If you have trouble with your kidneys or liver, or with your adrenal, pituitary or thyroid glands. ► If you exercise more than usual or if you want to change your usual diet, as this may affect your blood sugar level. ► If you are ill, carry on taking your insulin and consult your doctor. ► If you are going abroad, travelling over time zones may affect your insulin needs and the timing of your injections. Skin changes at the injection site The injection site should be rotated to help prevent changes to the fatty tissue under the skin, such as skin thickening, skin shrinking or lumps under the skin. The insulin may not work very well if you inject into a lumpy, shrunken or thickened area (see section 3, How to use NovoRapid®). Tell your doctor if you notice any skin changes at the injection site. Tell your doctor if you are currently injecting into these affected areas before you start injecting in a different area. Your doctor may tell you to check your blood sugar more closely, and to adjust your insulin or your other antidiabetic medications dose. Children and adolescents Do not give this medicine to children below 1 year of age since no clinical studies have been carried out in children below the age of 1 year. Other medicines and NovoRapid® PumpCart® Tell your doctor, nurse or pharmacist if you are taking, have recently taken or might take any other medicines. Some medicines affect your blood sugar level and this may mean that your insulin dose has to change. Listed below are the most common medicines which may affect your insulin treatment. Your blood sugar level may fall (hypoglycaemia) if you take: • Other medicines for the treatment of diabetes • Monoamine oxidase inhibitors (MAOI) (used to treat depression) • Beta-blockers (used to treat high blood pressure) • Angiotensin converting enzyme (ACE) inhibitors (used to treat certain heart conditions or high blood pressure) • Salicylates (used to relieve pain and lower fever) • Anabolic steroids (such as testosterone) 2

•

Sulphonamides (used to treat infections).

Your blood sugar level may rise (hyperglycaemia) if you take: • Oral contraceptives (birth control pills) • Thiazides (used to treat high blood pressure or excessive fluid retention) • Glucocorticoids (such as 'cortisone' used to treat inflammation) • Thyroid hormones (used to treat thyroid gland disorders) • Sympathomimetics (such as epinephrine [adrenaline], or salbutamol, terbutaline used to treat asthma) • Growth hormone (medicine for stimulation of skeletal and somatic growth and pronounced influence on the body's metabolic processes) • Danazol (medicine acting on ovulation). Octreotide and lanreotide (used for treatment of acromegaly, a rare hormonal disorder that usually occurs in middle-aged adults, caused by the pituitary gland producing excess growth hormone) may either increase or decrease your blood sugar level. Beta-blockers (used to treat high blood pressure) may weaken or suppress entirely the first warning symptoms which help you to recognise low blood sugar. Pioglitazone (tablets used for the treatment of type 2 diabetes) Some patients with long-standing type 2 diabetes and heart disease or previous stroke who were treated with pioglitazone and insulin experienced the development of heart failure. Inform your doctor as soon as possible if you experience signs of heart failure such as unusual shortness of breath or rapid increase in weight or localised swelling (oedema). If you have taken any of the medicines listed here, tell your doctor, nurse or pharmacist. Drinking alcohol and taking NovoRapid® ►

If you drink alcohol, your need for insulin may change as your blood sugar level may either rise or fall. Careful monitoring is recommended.

Pregnancy and breast-feeding ►

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If you are pregnant, think you may be pregnant or are planning to have a baby, ask your doctor for advice before taking this medicine. NovoRapid® can be used during pregnancy. Your insulin dose may need to be changed during pregnancy and after delivery. Careful control of your diabetes, particularly prevention of hypoglycaemia, is important for the health of your baby. There are no restrictions on treatment with NovoRapid® during breast-feeding.

Ask your doctor, nurse or pharmacist for advice before taking this medicine while pregnant or breastfeeding. Driving and using machines ► • •

Please ask your doctor whether you can drive a car or operate a machine: If you have frequent hypoglycaemia. If you find it hard to recognise hypoglycaemia.

If your blood sugar is low or high, your concentration and ability to react might be affected and therefore also your ability to drive or operate a machine. Bear in mind that you could endanger yourself or others. Important information about some of the ingredients of NovoRapid® NovoRapid® contains less than 1 mmol sodium (23 mg) per dose, i.e. NovoRapid® is essentially 'sodiumfree'.

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3.

How to take it

NovoRapid® PumpCart®

Dose and when to take your insulin Always use your insulin and adjust your basal (all-day) and bolus (meal time) doses exactly as your doctor has told you. Check with your doctor, nurse or pharmacist if you are not sure. Your bolus (meal-time) insulin needs to be adjusted based on your blood sugar measurement and food intake. Eat a meal or snack within 10 minutes of the bolus dose to avoid low blood sugar. When necessary, you can take the bolus dose just after you have finished eating. Do not change your insulin unless your doctor tells you to. If your doctor has switched you from one type or brand of insulin to another, your dose may have to be adjusted by your doctor. Use in children and adolescents NovoRapid® can be used in adolescents and children aged 1 year and above. Use in special patient groups If you have reduced kidney or liver function, or if you are above 65 years of age, you need to check your blood sugar more regularly and discuss changes in your insulin dose with your doctor. How and where to inject NovoRapid® PumpCart® is only suitable for injecting under the skin (subcutaneously) using a pump. Never inject directly into a vein (intravenously) or muscle (intramuscularly). Speak to your doctor if you need to inject your insulin by another method. Before using NovoRapid® PumpCart® in a pump, you must have thorough training in the use of the pump and information about any actions to be taken in case of illness, too high or too low blood sugar or failure of the pump. Follow your doctor's instructions and advice about the use of NovoRapid® PumpCart® in the pump. Normally you will inject your insulin in the front of your waist (abdomen). Alternatively, if your doctor recommends it, you may use your thigh or upper arm. When you change the infusion set (tubing and needle), be sure to change the site for inserting the needle (injection site). This may reduce the risk of developing lumps or skin pitting (see section 4, Possible side effects). Changing the infusion set must be done according to the instructions in the manual supplied with the infusion set. When you are using an insulin pump It is best to measure your blood sugar level regularly to get the maximum benefit of insulin delivery, and to make sure the pump is working properly. If you experience any problems contact your doctor. ► ► ► ► ► ►

NovoRapid® PumpCart® is only for use with a pump designed to be used with this cartridge, such as the Accu-Chek® Insight and YpsoPump® insulin pumps. NovoRapid® PumpCart® is a pre-filled cartridge ready for use directly in the pump. Follow the pump manual (user guide). To ensure correct dosing, NovoRapid® PumpCart® must not be used in an insulin pen. NovoRapid® should never be mixed with any other medicinal product including other insulin products when used in a pump. Do not refill the cartridge. Once empty, it must be disposed of. Always carry a spare NovoRapid® PumpCart®.

Read carefully the instructions on how to use NovoRapid® PumpCart® included in this package leaflet. What to do in case of pump failure

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Make sure you have an alternative delivery method for your insulin available for injection under the skin (for example, a pen injector) in case the pump stops working. If you take more insulin than you should If you take too much insulin your blood sugar gets too low (hypoglycaemia). See a) Summary of serious and very common side effects in section 4. If you forget to take your insulin If you forget to take your insulin your blood sugar may get too high (hyperglycaemia). See c) Effects from diabetes in section 4. If you stop taking your insulin Do not stop taking your insulin without speaking with a doctor, who will tell you what needs to be done. This could lead to very high blood sugar (severe hyperglycaemia) and ketoacidosis. See c) Effects from diabetes in section 4. If you have any further questions on the use of this medicine, ask your doctor, nurse or pharmacist.

4.

Possible side effects

Like all medicines, this medicine can cause side effects, although not everybody gets them. a)

Summary of serious and very common side effects

Low blood sugar (hypoglycaemia) is a very common side effect. It may affect more than 1 in 10 people. Low blood sugar may occur if you: • Inject too much insulin. • Eat too little or miss a meal. • Exercise more than usual. • Drink alcohol (see Drinking alcohol and taking NovoRapid® in section 2). Signs of low blood sugar: Cold sweat; cool pale skin; headache; rapid heartbeat; feeling sick; feeling very hungry; temporary changes in vision; drowsiness; unusual tiredness and weakness; nervousness or tremor; feeling anxious; feeling confused; difficulty in concentrating. Severe low blood sugar can lead to unconsciousness. If prolonged severe low blood sugar is not treated, it can cause brain damage (temporary or permanent) and even death. You may recover more quickly from unconsciousness with an injection of the hormone glucagon by someone who knows how to use it. If you are given glucagon, you will need glucose or a sugar snack as soon as you are conscious. If you do not respond to glucagon treatment, you will have to be treated in a hospital. What to do if you experience low blood sugar: ► If you experience low blood sugar, eat glucose tablets or another high sugar snack (e.g. sweets, biscuits, fruit juice) and adjust insulin delivery or stop your pump. Measure your blood sugar if possible and rest. Always carry glucose tablets or high sugar snacks with you, just in case. ► When symptoms of low blood sugar have disappeared or when blood sugar level is stabilised, continue insulin treatment as usual. ► If you have such a low blood sugar that it makes you pass out, if you have had need for injection of glucagon, or if you have experienced many incidents of low blood sugar, talk with a doctor. The amount or timing of insulin, food or exercise may need to be adjusted. Tell relevant people that you have diabetes and what the consequences may be, including the risk of passing out (become unconscious) due to low blood sugar. Let them know that if you pass out, they must turn you 5

on your side and get medical help straight away. They must not give you any food or drink due to risk of suffocation. Serious allergic reactions to NovoRapid® or one of its ingredients (called a systemic allergic reaction) is a very rare side effect but can potentially be life threatening. It may affect less than 1 in 10,000 people. Seek medical advice immediately: • If signs of allergy spread to other parts of your body. • If you suddenly feel unwell, and you: start sweating; start being sick (vomiting); have difficulty in breathing; have a rapid heartbeat; feel dizzy. ► If you notice any of these signs, seek medical advice immediately. Skin changes at the injection site: If you inject insulin at the same place, the fatty tissue may shrink (lipoatrophy) or thicken (lipohypertrophy) (may affect less than 1 in 100 people). Lumps under the skin may also be caused by build-up of a protein called amyloid (cutaneous amyloidosis; how often this occurs is not known). The insulin may not work very well if you inject into a lumpy, shrunken or thickened area. Change the injection site with each injection to help prevent these skin changes. b)

List of other side effects

Uncommon side effects May affect less than 1 in 100 people. Signs of allergy: Local allergic reactions (pain, redness, hives, inflammation, bruising, swelling and itching) at the injection site may occur. These usually disappear after a few weeks of taking your insulin. If they do not disappear, or if they spread throughout your body, talk to your doctor immediately. See also Serious allergic reactions above. Vision problems: When you first start your insulin treatment, it may disturb your vision, but the disturbance is usually temporary. Swollen joints: When you start taking insulin, water retention may cause swelling around your ankles and other joints. Normally this soon disappears. If not, talk to your doctor. Diabetic retinopathy (an eye disease related to diabetes which can lead to loss of vision): If you have diabetic retinopathy and your blood sugar level improves very fast, the retinopathy may get worse. Ask your doctor about this. Rare side effects May affect less than 1 in 1,000 people. Painful neuropathy (pain due to nerve damage): If your blood sugar level improves very fast, you may get nerve related pain. This is called acute painful neuropathy and is usually transient. Reporting of side effects If you get any side effects, talk with your doctor, nurse or pharmacist. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via Great Britain: Yellow Card Scheme Website: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store.

By reporting side effects you can help provide more information on the safety of this medicine. c)

Effects from diabetes

High blood sugar (hyperglycaemia) 6

High blood sugar may occur if you: • Have not injected enough insulin. • Forget to inject your insulin or stop taking insulin. • Repeatedly inject less insulin than you need. • Get an infection and/or a fever. • Eat more than usual. • Exercise less than usual. Warning signs of high blood sugar: The warning signs appear gradually. They include: increased urination; feeling thirsty; losing your appetite; feeling sick (nausea or vomiting); feeling drowsy or tired; flushed; dry skin; dry mouth and a fruity (acetone) smell of the breath. What to do if you experience high blood sugar: ► If you get any of the above signs: test your blood sugar level, test your urine for ketones if you can, then seek medical advice immediately. ► These may be signs of a very serious condition called diabetic ketoacidosis (build-up of acid in the blood because the body is breaking down fat instead of sugar). If you do not treat it, this could lead to diabetic coma and eventually death.

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How to store it

NovoRapid® PumpCart®

Keep this medicine out of the sight and reach of children. Do not use this medicine after the expiry date which is stated on the cartridge label and carton, after 'EXP'. The expiry date refers to the last day of that month. Always keep the cartridge in the outer carton when you are not using it in order to protect it from light. NovoRapid® PumpCart® must be protected from excessive heat and light during storage and use. Before opening: NovoRapid® PumpCart® that is not being used is to be stored in the refrigerator at 2°C to 8°C, away from the cooling element. Do not freeze. During use or when carried as a spare: NovoRapid® PumpCart® in use is not to be kept in the refrigerator. NovoRapid® PumpCart® carried as a spare can be kept for up to 2 weeks below 30°C. Thereafter it can be used for up to 7 days below 37°C in a pump designed to be used with this cartridge, such as the Accu-Chek® Insight and YpsoPump® insulin pumps. Keep NovoRapid® PumpCart® in the blister until use to protect it from damage. Always protect the cartridge from light during use. Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

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Contents of the pack and other information

What NovoRapid® PumpCart® contains • •

The active substance is insulin aspart. Each ml contains 100 units of insulin aspart. Each cartridge contains 160 units of insulin aspart in 1.6 ml solution for injection. The other ingredients are glycerol, phenol, metacresol, zinc chloride, disodium phosphate dihydrate, sodium chloride, hydrochloric acid, sodium hydroxide and water for injections.

What NovoRapid® PumpCart® looks like and contents of the pack NovoRapid® PumpCart® is presented as a solution for injection. Pack size of 5 cartridges and a multipack containing 25 (5 packs of 5) cartridges of 1.6 ml. Not all pack sizes may be marketed. 7

The solution is clear and colourless. Marketing Authorisation Holder and Manufacturer Novo Nordisk A/S, Novo Allé, DK-2880 Bagsværd, Denmark Please proceed to the information in 'Instructions on how to use NovoRapid® PumpCart® pre-filled cartridge'. This leaflet was last revised in 09/2022

NovoRapid® and PumpCart® are trademarks owned by Novo Nordisk A/S, Denmark Accu-Chek® is a registered trademark owned by Roche Diagnostics GmbH. YpsoPump® is a registered trademark owned by the Ypsomed Group. © 2022 Novo Nordisk A/S

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Instructions on how to use NovoRapid® PumpCart® pre-filled cartridge. NovoRapid® PumpCart® is only for use with an insulin infusion pump system designed to be used with this cartridge, such as the Accu-Chek® Insight and YpsoPump® insulin pumps. It must not be used with other devices not designed for NovoRapid® PumpCart®, as this may result in incorrect insulin dosing and subsequent hyper- or hypoglycaemia. Please read these instructions carefully before using your NovoRapid® PumpCart®. Please also read the pump manual (user guide) that comes with your insulin pump. Pay special attention to these notes as they are important for safe use of NovoRapid® PumpCart®. •

Treat the pump and cartridge with care and carefully follow the instructions. Rough handling or misuse may cause inaccurate dosing and may lead to too high or too low blood sugar level.

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NovoRapid® PumpCart® is ready for use directly in the pump.

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NovoRapid® PumpCart® contains 1.6 ml insulin aspart solution, equivalent to 160 units.

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This medicinal product should never be mixed with any other medicinal products.

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Do not refill NovoRapid® PumpCart®. Once empty, it must be disposed of.

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Always make sure you have a spare NovoRapid® PumpCart® available.

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To ensure correct dosing, NovoRapid® PumpCart® must not be used in an insulin pen.

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NovoRapid® PumpCart® must be protected from excessive heat and light during storage and use.

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NovoRapid® PumpCart® should be kept out of reach of others, especially children. A

Top of Plunger

White label band

1.

Before inserting a NovoRapid® PumpCart® cartridge into your pump

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Bring NovoRapid® PumpCart® to room temperature.

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Take NovoRapid® PumpCart® out of its blister package.

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Check the label to make sure that it is NovoRapid® PumpCart®.

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Check the expiry date, which is stated on the label and the carton. Always check that NovoRapid® PumpCart® looks the way it should. See picture A. Only the top of the plunger should be seen above the white label band. If you suspect NovoRapid® PumpCart® is damaged, take it back to your supplier.

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Do not use it if any damage or leakage is seen or if the plunger has moved, making the bottom of the plunger visible above the white label band. This could be a result of leakage of insulin. Check that the insulin in NovoRapid® PumpCart® is clear and colourless. If the insulin looks cloudy, do not use NovoRapid® PumpCart®. The cartridge may contain a minor amount of air in the form of small bubbles.

2.

Inserting a new NovoRapid® PumpCart® cartridge in your pump

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Follow the instructions in the pump user manual that comes with your pump to insert a new NovoRapid® PumpCart® cartridge in your pump.

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Insert a NovoRapid® PumpCart® in the cartridge compartment of the pump. The plunger goes in first.

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Connect the infusion set with NovoRapid® PumpCart® by attaching the adapter onto your pump. Check the pump and cartridge regularly for damages, for example cracks or leakage. If you smell insulin this could also indicate a leakage. Do not use the cartridge if cracks or leakage are seen . Follow the instructions in the pump manual for replacing a cartridge and for cleaning the cartridge compartment in the pump. Insulin leakage can cause inaccurate dosing and may lead to high blood sugar level. See section 4c of the package leaflet. During the day and before going to sleep carefully check that your pump is delivering insulin and there are no leakages. Failure of delivery of your insulin may not result in an alert notification from the pump and you may be unaware that there is a problem. You may need to check your blood sugar levels. Tell your doctor or diabetes care team if you suspect a problem with your insulin delivery.

Always make sure you have an alternative delivery method for your insulin available (for example, a pen injector) in case the pump stops working. Seek medical advice if you think you may have very high blood sugars or diabetic ketoacidosis. 3.

Removing an empty NovoRapid® PumpCart® cartridge from your pump

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Follow the instructions in the pump user manual to remove an empty NovoRapid® PumpCart® cartridge from your pump.

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Remove the infusion set adapter from the empty NovoRapid® PumpCart® cartridge.

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Dispose of the empty NovoRapid® PumpCart® cartridge and the used infusion set as instructed by your doctor or nurse.

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Follow the steps described in section 1 and 2 to prepare and insert a new NovoRapid® PumpCart® into your pump.

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