What is this?
I am getting ready to inhale and exhale on my own in my mum's womb. But still why would any one prescribe my mum to take Betnosol injection for my lungs maturation?
I really do not understand what these doctors are upto these days!
My mom's gynecologist does not want to take any chances with my lungs maturation. I think she is also worried for the fact if I am born premature before 34 weeks..then what!
Hence to make my lungs in a workable condition she is prescribing mom to take the dose of 3ampules each for 2 consecutive days, 24 hours apart.
I am trying mom to let her know that mom I am lots of hiccups and practicing my best to make my small lungs ready for the world outside so that when I come out I can smell the fragrance of my mom's body and also gets the smell of the mouth watering kebabs and fish which my dad loves to eat and brings home sometimes.
But forget about the what if scenarios and we will have to prepare our shelves for the shots.
Mom get ready and read these info before we proceed..
Betnesol Injections during pregnancy:
Betnesol, or betamethasone, is administered during pregnancy when preterm birth is a possibility. The steroid injection helps to produce surfactant in the baby's lungs, allowing them to inflate without sticking together. Normally, babies do not make this surfactant on their own until much later in pregnancy, around 32-35 weeks. Getting steroid injections into the mother at least 24 hours prior to a premature birth improves the baby's ability to breathe, reducing ventilation time and possibly reducing NICU time.
If your doctors are recommending this injection for you, they should have detected something that tells them your baby is at risk for premature birth. While fibroids can put you at risk for miscarriage and preterm labor, a fetal fibronection test (FFN) can more conclusively tell if this pregnancy in particular is at risk. If you have not had a positive FFN test, and you are not currently having preterm labor or carrying multiples, then you should ask for documentation of why this shot is being recommended for you and what your alternatives are. Betamethasone is not without risks; it can be lifesaving for premature babies, but it can have consequences on learning and development down the road.
How does it work?
Betnesol injection contains the active ingredient betamethasone sodium phosphate, which is a type of medicine known as a corticosteroid. Corticosteroid medicines are derivatives of the corticosteroid hormones cortisol and aldosterone that are produced naturally by the adrenal glands. They are often simply called steroids, but it should be noted that they are very different from another group of steroids, called anabolic steroids, which have gained notoriety because of their abuse by some athletes and body builders.
Corticosteroids have many important functions on every organ system. They affect the strength of heart muscle and its response to natural chemicals affecting heart rate. They affect the water and salt balance in the body and also enable the body to cope with stress. Stress includes changes in temperature, pain, fear, anxiety and illness. Stress can be hazardous if the body is not equipped to cope due to low levels of corticosteroids.
Corticosteroids allow us to respond to stress by increasing the rate and force of the heartbeat, increasing blood supply to essential tissues (muscle, heart, brain), increasing the body's supply of energy by raising blood sugar and by several other effects on body systems.
If the body's natural level of steroid hormones is too low because the adrenal glands are not producing enough hormones (a condition called adrenal insufficiency, for example in Addison's disease or following surgical removal of the adrenal glands), this can cause various symptoms, such as dizziness, fatigue, weakness, gut symptoms, depression and joint and muscle pain. It can also lead to collapse and death if the body is put under stress. Low blood levels of corticosteroids must be treated with replacement therapy to allow the body to function normally. This is usually acheived with a combination of hydrocortisone and fludrocortisone tablets.
Betamethasone is given by injection in situations where the levels of corticosteroids in the body suddenly become too low, causing shock and collapse. This might be due to many reasons, including abnormal stress in people with Addison's disease. This is an emergency situation and Betnesol injection is used to provide rapid control of symptoms.
Corticosteroid hormones are also involved in controlling inflammatory responses in the body. Betamethasone has an anti-inflammatory effect and is used to decrease inflammation in various different diseases and conditions.
Betamethasone decreases inflammation by acting within cells to prevent the release of certain chemicals that are important in the immune system. These chemicals are normally involved in producing immune and allergic responses. By decreasing the release of these chemicals in a particular area, inflammation and allergic reactions are reduced. Betnesol injection is used in serious or emergency situations when rapid control of symptoms is needed, for example in severe asthma attacks or severe allergic reactions such as anaphylaxis.
Betamethasone can also be injected directly into inflamed soft tissue, for example in tennis elbow, to decrease inflammation in that particular area.
What is it used for?
* Severe allergic reactions, such as anaphylaxis, angioedema or severe asthma attack.
* Severe drop in blood pressure causing dizziness, paleness and sweating (shock) due to surgical or accidental trauma or severe infection.
* Inadequate production of natural steroid hormones by the adrenal glands (acute adrenal insufficiency) due to abnormal stress in people with Addison's disease, Simmond's disease, people who have had their adrenal glands surgically removed, and people with underactive adrenal glands due to prolonged corticosteroid therapy.
* Local injection into inflamed soft tissue, such as tennis elbow, tenosynovitis, or bursitis.
* Injection into the eye to reduce inflammation in the eye.
* This medicine must not be stopped suddenly if you have been given more than 1mg daily for more than three weeks; if you have been given high doses (more than 6mg) even if only for three weeks or less; if you have been treated with corticosteroid tablets or injections in the last year; if you had problems with your adrenal glands before treatment was started; or if you have been given repeated doses in the evening. In these situations this medicine can suppress the natural production of corticosteroids by the adrenal glands, which means that the body becomes temporarily reliant on the medicine. When it is time to stop treatment the dose should be tapered down gradually, to allow the adrenal glands to start producing adequate amounts of natural steroids again. However, in general Betnesol injection is not intended for long-term use and is unlikely to be used for longer than two or three days. If corticosteroid treatment is still needed after this you are likely to be switched to a corticosteroid taken by mouth where possible. Other steroids should also not be stopped abruptly.
* If you are having long-term or repeated treatment with steroids you will be given a steroid card that you should carry with you at all times. Show it to anyone who treats you (eg doctor, nurse, pharmacist, dentist, anaesthetist). The card contains details of your prescriber, type of steroid, dose taken and the duration of treatment. It's purpose is to act as a reminder that your medicine should not be stopped suddenly, and to provide information of your treatment to other people treating you. This is important because the effects that corticosteroids have on the body may affect other medical treatment you may be given. If you have an accident the card contains information that could save your life. You should also show your steroid card to anyone who treats you for three months after you stop treatment with steroids.
* Corticosteroids decrease the body's natural immune and inflammatory responses. They may increase your susceptibility to infections and can also mask the symptoms of infections, making you think they are less serious than they are. For this reason, it is important to consult your doctor if you get any signs of infection during treatment.
* If you have never had chickenpox you could be at risk of severe chickenpox while having long-term treatment with this medicine and should avoid close personal contact with people who have chickenpox or shingles (herpes zoster). You should also avoid contact with people who have measles. If you are exposed to people with these diseases either during treatment, or in the three months after stopping treatment, you should consult your doctor urgently, as you will need an injection of immunoglobulin to help you stop getting the diseases. This is very important as these diseases can be life-threatening in people treated with long-term corticosteroids.
* Corticosteroid treatment, especially with high doses, can alter mood and behaviour early in treatment. People may experience confusion, irritability, nightmares, difficulty sleeping, mood changes and depression, and suffer from delusions and suicidal thoughts. In a few cases these effects have also occured when corticosteroid treatment is being withdrawn. For this reason, it is important to let your doctor know if you notice any change in your mood or behaviour during treatment or when stopping treatment, particularly if you begin to feel depressed, or have any disturbing thoughts or feelings. Most of these problems go away if the dose is lowered or the medicine is stopped. However if problems do happen they might need treatment.
* Children and adolescents having long-term treatment with this medicine should have their growth regularly monitored.
Use with caution in
* Children and adolescents.
* Elderly people.
* Decreased kidney function.
* Liver failure.
* Peptic ulcer.
* Inflammation of the bowel and back passage (ulcerative colitis).
* Painful inflammation of small sacs or pouches in the wall of the gut (diverticulitis).
* People who have recently had a surgical procedure called intestinal anastomosis, which involves the joining together of ends of the intestine after a section has been removed.
* People with a history of blood clots in the blood vessels (thromboembolism).
* Heart failure.
* People who have recently had a heart attack.
* High blood pressure (hypertension).
* Diabetes, or a family history of diabetes.
* Underactive thyroid gland (hypothyroidism).
* Glaucoma, or a family history of glaucoma.
* Current severe psychiatric illness, or a personal or family history of psychiatric illness, including depression, manic depression or schizophrenia.
* History of psychiatric illness caused by the use of a corticosteroid.
* Women who have passed the menopause.
* Abnormal muscle weakness (myasthenia gravis).
* People who have previously experienced muscle disorders (myopathy) caused by steroids.
* People with a history of tuberculosis (TB).
* Herpes simplex virus infection of the eye.
* People with a low level of potassium in their blood (hypokalaemia).
Not to be used in
* People with widespread infection, unless this is being treated with specific anti-infectives.
* Corticosteroids should not be used for the management of head injury or stroke because they are unlikely to be of benefit and may even be harmful.
* Betnesol injection should not be injected directly into tendons.
This medicine should not be used if you are allergic to one or any of its ingredients. Please inform your doctor or pharmacist if you have previously experienced such an allergy.
If you feel you have experienced an allergic reaction, stop using this medicine and inform your doctor or pharmacist immediately.
Pregnancy and breastfeeding
Certain medicines should not be used during pregnancy or breastfeeding. However, other medicines may be safely used in pregnancy or breastfeeding providing the benefits to the mother outweigh the risks to the unborn baby. Always inform your doctor if you are pregnant or planning a pregnancy, before using any medicine.
* When administered for long periods or repeatedly during pregnancy, corticosteroids may increase the risk of slowed growth in the developing baby. They may also cause the baby to make less of its own steroid hormones after birth, but this usually resolves on its own and rarely causes any problems. When used during pregnancy betamethasone may also temporarily reduce the baby’s heart rate and body movements. As a result this medicine should be used with caution during pregnancy, and only if the expected benefit to the mother is greater than any possible risk to the developing baby. Seek further medical advice from your doctor.
* This medicine passes into breast milk. It should be used with caution in mothers who are breastfeeding and only if the benefits to the mother outweigh any risks to the nursing infant. Lower doses taken by the mother are unlikely to significantly affect the baby, but if the mother is taking high doses for long periods of time, the medicine could cause the baby's adrenal glands to make less of their own steroid hormones. Seek medical advice from your doctor.
Medicines and their possible side effects can affect individual people in different ways. The following are some of the side effects that are known to be associated with this medicine. Just because a side effect is stated here does not mean that all people using this medicine will experience that or any side effect.
* Raised blood sugar level.
* Increased appetite and weight gain.
* Increased susceptibility to infections and increased severity of infections (see warnings above).
* Effects on the gut, such as indigestion or abdominal bloating, nausea, ulceration in the stomach or intestine, inflammation of the pancreas (pancreatitis).
* Ulceration or thrush infection in the throat.
* Muscle weakness or wasting.
* Thinning of the bones (osteoporosis) and increased risk of breaking a bone.
* Effects on the skin, such as skin thinning, impaired healing, acne, bruising, stretch marks, increased sweating, change in pigmentation, increased hair growth (hirsutism).
* Psychiatric reactions, such as mood changes (including irritability, depression and suicidal thoughts), psychotic reactions (including mania, delusions and hallucinations), anxiety, confusion, memory loss, sleep disturbances (see warning above).
* Cushing's syndrome, characterised by a moon face.
* Menstrual disturbances.
* Decrease in the production of natural steroids by the adrenal glands (adrenal suppression - see warning above).
* Effects on the eyes, such as raised pressure inside the eye (glaucoma), cataracts.
* Slowed growth in children and adolescents.
* Blood clots in the blood vessels (thromboembolism).
The side effects listed above may not include all of the side effects reported by the medicine's manufacturer.
For more information about any other possible risks associated with this medicine, please read the information provided with the medicine or consult your doctor or pharmacist.
How can this medicine affect other medicines?
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start treatment with this medicine. Similarly, check with your doctor or pharmacist before taking any new medicines while being treated with this one, to ensure that the combination is safe.
Betamethasone may increase blood sugar levels and so may oppose the blood sugar lowering effects of antidiabetic medicines. People with diabetes may need an increase in their dose of insulin or antidiabetic tablets.
Betamethasone may enhance the anti-blood-clotting effect of anticoagulant medicines such as warfarin. People taking anticoagulant medicines in combination with betamethasone should have their blood clotting time (INR) regularly monitored, particularly after starting or stopping treatment with betamethasone and after any dose changes.
If betamethasone is used in combination with non-steroidal anti-inflammatory drugs (NSAIDs) eg ibuprofen, there may be an increased risk of side effects on the gut, such as stomach ulceration and bleeding.
Betamethasone may decrease the blood levels of salicylates such as aspirin. When betamethasone is stopped, this may result in excessive levels of the salicylate, unless the dose is readjusted.
The following medicines may increase the removal of betamethasone from the body, thus reducing its effects. You may need a larger dose of betamethasone if you are also taking any of these medicines:
* barbituates, eg amobarbital, phenobarbital
The effect of corticosteroids may be reduced in the three to four days following use of mifepristone.
The following medicines may reduce the removal of betamethasone from the body and so may increase its effects or side effects:
* ciclosporin (betamethasone may also increase the blood level and risk of side effects of ciclosporin)
* macrolide-type antibiotics, eg erythromycin
* protease inhibitors, eg ritonavir.
Betamethasone may decrease the body's immune response. This means that vaccines may be less effective if given during treatment, because the body does not produce sufficient antibodies. Live vaccines may cause serious infections. Live vaccines include: measles, mumps, rubella, MMR, BCG, chickenpox, oral polio, oral typhoid and yellow fever. These should not be given to people whose immune system is underactive due to treatment with this medicine.
Corticosteroids can cause fluid and salt retention and so may oppose the effects of antihypertensive medicines used to treat high blood pressure, and diuretics such as furosemide. However, betamethasone is much less likely than other corticosteroids to have this effect.
Corticosteroids can also lower the amount of potassium in the blood, though this is much less likely with betamethasone than with other corticosteroids. However, there may be an increased chance of the level of potassium in the blood falling too low (hypokalaemia) if betamethasone is used in combination with the following medicines:
* beta agonists, eg salbutamol, salmeterol, terbutaline
* potassium-losing diuretics, eg furosemide, bendroflumethiazide
Other medicines containing the same active ingredient
Betamethasone has many different uses and comes in many different forms. The factsheets below contain information about betamethasone used in various areas of the body.
Steroid Injection for Fetal Lung Development
Injections of corticosteroids for fetal lung development has been praised as one of the best advances in fetal medicine in the 90s. Since 1994 the National Institutes for Health and other professional organizations have encouraged their use in promoting the development of fetal lung development in moms who were at risk for preterm labor or birth.
Betamethasone and dexamethasone are the two most commonly used steroids. The average protocol was to give to intramuscular injections (IM) 24 hours apart. Some practitioners also choose to continually repeat the dosages every week until the birth. The injections had to be given 24-48 hours prior to the birth for maximum effect. They were also best used between weeks 24 and 34 gestation.
The use of the steroids provided benefits for the lung development in the premature infants to reduce the risk of respiratory distress syndrome (RDS) as well as to reduce the risk of intracranial hemorrhaging and some other potential benefits.
However, recent studies say that the benefits of multiple doses is questionable, particularly in light of potential risks. Citing the "limited quality" of the studies of multiple doses and the potential disadvantages the National Institute of Health issued a statement of August 18th that a single dose was sufficient in achieving the benefits desired.
Potential down sides to multiple doses can include: psychomotor delays, behavioral problems and the fact that the effects on neonatal mortality aren't known between the single and multiple dose courses. In separate findings by an Israeli study it was also noted that there is an increase in maternal infection with the use of steroids, so limiting doses may help with this side effect as well.
The steroid injection is to help mature the baby's lungs in case of premature delivery. Yes it has potential side effects (EVERY medication has potential side effects...there's no free ride when it comes to pharmacology). It develops the fetal lungs early because it sets up a very stressful environment for the baby. Decreased birth weight, decreased brain size, abnormal brain development, adverse effects on the fetal immune system, are just some of the potential side effects. Steroid injections for fetal lung development should not be taken lightly. It should be used only for cases where premature delivery is expected and the potential benefits outweigh the potential side effects.
I don't know why the doc told her that one injection is harmful but more than one is not. Sounds like she didn't really understand what was being explained to her.
Antenatal corticosteroids for fetal lung development
betamethasone Celestone Soluspan dexamethasone Dalalone Decadron
How It Works
Betamethasone and dexamethasone cause an immature fetus's lungs to produce a compound called surfactant. A full-term baby's lungs naturally produce surfactant, which lubricates the lining of the air sacs within the lungs. This allows the inner surfaces of the air sacs to slide against one another without sticking during breathing. Premature infants whose lungs have begun producing surfactant have an improved ability to breathe on their own, or with less respiratory treatment, after birth.
When preterm birth between 24 and 34 weeks of pregnancy (gestation) is expected within 7 days, betamethasone or dexamethasone is given to the mother in order to affect the fetus. Betamethasone is given in 2 injections, 24 hours apart. Dexamethasone is given every 12 hours for 4 doses.
If delivery does not occur within 7 days of treatment, the injections should not be repeated. Recent guidelines issued by the National Institutes of Health discourage such repeat courses of treatment, based on concerns about fetal harm from repeat treatments.1
Why It Is Used
Corticosteroids are considered standard treatment for women who are 24 to 34 weeks pregnant and may deliver within the next 1 to 7 days, with or without preterm premature rupture of membranes (pPROM).1
Betamethasone and dexamethasone are corticosteroids, also called glucocorticoids, that are given before birth (antenatally) to speed up a preterm fetus's lung development. Either is used when a mother is in preterm labor and birth may occur in 24 to 48 hours. This helps prevent the occurrence of respiratory distress syndrome (RDS) and related complications following premature birth.
Many infants born at 33 to 34 weeks' gestation have sufficient lung maturity to breathe on their own. However, considering the low-risk, high-benefit nature of this treatment, corticosteroids are typically used up to 34 weeks of pregnancy.
Betamethasone is often used in patients with premature labor at about 26-34 weeks' gestation to stimulate fetal lung maturation The benefits of this therapy are: Reduction in incidence of respiratory distress syndrome (RDS) Decreased severity of RDS if it occurs Decreased incidence of, and mortality from, intracranial hemorrhage Increased survival of premature infants Betamethasone crosses the placenta to the fetus . The drug is partially metabolized (47%) by the perfused placenta to its inactive 11-ketosteroid derivative, but less so than other corticosteroids, although the differences are not statistically significant .
In patients with premature rupture of the membranes (PROM), administration of betamethasone to the mother does not always reduce the frequency of RDS or perinatal mortality . An increased risk of maternal infection has also been observed in patients with PROM treated with corticosteroids . In a study comparing betamethasone therapy with nonsteroid management of women with PROM, neonatal sepsis was observed in 23% (5 of 22) of steroid-exposed newborns vs. only 2% (1 of 46) of the non-steroid-exposed group . A 1985 study also found increased neonatal sepsis in exposed newborns who were delivered more than 48 hours after PROM, 18.6% (14 of 75) vs. 7.4% (4 of 54) of nonexposed controls . In addition, moderate to severe respiratory morbidity was increased over that in controls, 21.3% vs. 11.1%, as well as overall mortality, 8% vs. 1.8% . Other reports, however, have noted beneficial effects of betamethasone administration to patients with PROM with no increase in infectious morbidity (15,23,24,). In women colonized with group B streptococci, the combined use of betamethasone and ampicillin improved the outcome of preterm pregnancies with PROM .
Betamethasone therapy is less effective in decreasing the incidence of RDS in male infants than in female infants . The reasons for this difference have not been discovered. Slower lung maturation in male fetuses has been cited as a major contributing factor to the sex differential noted in neonatal mortality. Therapy is also less effective in multiple pregnancies , even when doses have been doubled . In twins, only the first-born seems to benefit from antenatal steroid therapy .
An increased incidence of hypoglycemia in newborns exposed in utero to betamethasone has been reported . Other investigators have not observed this effect.
In the initial study examining the effect of betamethasone on RDS, investigators reported an increased risk of fetal death in patients with severe preeclampsia. They proposed that the corticosteroid had an adverse effect on placentas already damaged by vascular disease. A second study did not confirm these findings .
A case of suspected betamethasone-induced leukemoid reaction was observed in an 880-g, 30-weeks'-gestation female infant whose mother received 12 mg of betamethasone 4 hours prior to delivery . A second case, in a female infant born at 25-26 weeks' 71 hours after betamethasone, was published in 1997 . Within about 710 days, the white blood cell count had returned to normal in both infants. A 1984 study examined the effect of betamethasone on leukocyte counts in mothers with PROM or premature labor . No effect, as compared to untreated controls, was found in either group.
A case of acute, life-threatening exacerbation of muscular weakness requiring intubation and mechanical ventilation was reported in a 24-year-old woman who was treated with betamethasone, 12 mg IM, to enhance fetal lung maturity at 32 weeks' gestation . The onset of symptoms occurred 30 minutes after the corticosteroid dose. The authors attributed the crisis to betamethasone (adrenocorticosteroids are known to aggravate myasthenia) after other potential causes were ruled out. The infant was delivered by emergency cesarean section and, except for the typical problems related to prematurity, he had a normal hospital course.
Hypertensive crisis associated with the use of ritodrine and betamethasone has been reported . Systolic blood pressure was above 300 mm Hg with a diastolic pressure of 120 mm Hg. Although the hypertension was probably caused by ritodrine, it is not known whether the corticosteroid was a contributing factor.
Breast Feeding Summary
No reports describing the use of betamethasone during human lactation have been located. The molecular weight (about 435 for the acetate salt and about 517 for the sodium phosphate salt) are low enough, however, that excretion into milk should be expected.
What should I watch for while taking betamethasone?
Visit your prescriber or health care professional for regular checks on your progress. If you are using corticosteroids for a long time, carry an identification card with your name, the type and dose of corticosteroid, and your prescriber's name and address. Do not suddenly stop using betamethasone. You may need to gradually reduce the dose, so that your body can adjust. Follow the advice of your prescriber or health care professional.
If you receive corticosteroids for a long time, avoid contact with people who have an infection. You may be at an increased risk from infection while receiving betamethasone. Tell your prescriber or health care professional if you are exposed to anyone with measles or chickenpox, or if you develop sores or blisters that do no heal properly.
People who are taking certain dosages of betamethasone may need to avoid immunization with certain vaccines or may need to have changes in their vaccination schedules to ensure adequate protection from certain diseases. Make sure to tell your prescriber or health care professional that you are taking betamethasone before receiving any vaccine.
If you are diabetic, betamethasone can affect your blood sugar levels. Check with your prescriber or health care professional if you need help adjusting the dose of your diabetic medicine.
If you are receiving betamethasone injections every day, you may need to watch your diet. Your body can also lose potassium while you receive this medicine. Ask your prescriber or health care professional about your diet, especially about your salt intake.
If you are going to have surgery tell your prescriber or health care professional that you are receiving betamethasone, or have taken it within the last 12 months.
If betamethasone has been injected into one of your joints, do not put too much stress on the joint for a while. Talk to your prescriber or health care professional about how much you can use the joint while it is healing.
Elderly patients have an increased risk of side effects from betamethasone.
Betamethasone can interfere with certain lab tests and can cause false skin test results.
What side effects may I notice from receiving betamethasone?
Side effects that you should report to your prescriber or health care professional as soon as possible:
• bloody or black, tarry stools
• confusion, excitement, restlessness, a false sense of well-being
• eye pain, decreased or blurred vision, or bulging eyes
• fever, sore throat, sneezing, cough, or other signs of infection
• frequent passing of urine
• hallucinations (seeing and hearing things that are not really there)
• increased thirst
• irregular heartbeat
• menstrual problems
• mental depression, mood swings, mistaken feelings of self-importance, mistaken feelings of being mistreated
• muscle cramps or muscle weakness
• nausea, vomiting
• pain in hips, back, ribs, arms, shoulders, or legs
• pain, redness, inflammation or scarring at the injection site
• rounding out of face
• skin problems, acne
• stomach pain
• swelling of feet or lower legs
• thin or shiny skin at the injection site
• unusual bruising or red pinpoint spots on the skin
• unusual tiredness or weakness
• weight gain or weight loss
• wounds that will not heal
Side effects that usually do not require medical attention (report to your prescriber or health care professional if they continue or are bothersome):
• increased appetite
• increased sweating
• nervousness, restlessness, or difficulty sleeping
• unusual increased growth of hair on the face or body
Betamethasone is a corticosteroids, and as such can cause the following side effects:
Increased thirst and urination, lethargy, increased appetite, abortion during pregnancy, immune suppression (and thus more susceptible to other illnesses), muscle weakness and possible atrophy, stomach ulcers, diarrhea, panting, and possible bone weakness.
Now, keep in mind, these side effects are often rare, except for the increased drinking, urinating and eating. Also, these are much more likely to be seen in long term use, not one injection.
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