Insulin Lispro

What Is Insulin Lispro

Insulin lispro(HUMALOG) is an insulin analog that is FDA-approved for the treatment of patients with diabetes mellitus types 1 and 2 to control hyperglycemia.

What are the uses of this medicine?

• This medcine is used for the treatment of patients with diabetes mellitus types 1 and 2 to control hyperglycemia.
• Its off-label uses include treating patients with mild-to-moderate diabetic ketoacidosis, gestational diabetes mellitus, and mild-to-moderate hyperosmolar hyperglycemic state.

How does this medicine work?

• Insulin lispro is a rapid-acting, human insulin analog that works parenterally to lower blood glucose by regulating the metabolism of carbohydrates, proteins, and fats.
• It works by binding to a glycoprotein receptor specific to insulin on the surface of target cells.

How this drug synthesized in laboratory?

• The drug itself is synthesized by using a special non-pathogenic laboratory strain of the bacteria Escherichia coli which has been genetically altered by adding the gene for insulin lispro.
• Human insulin, normally secreted by the pancreas, has the amino acids lysine and proline at positions B28 and B29.
• Insulin lispro has these amino acids in the reverse positions, with proline at position B28 and lysine at position B29.

Who Should Not Use this medicine ?

• Do not use during episodes of hypoglycemia.
• Do not use in patients with hypersensitivity to HUMALOG or any of its excipients.
• As per the FDA, this drug should only be used during pregnancy when clearly indicated.
• This medicine cannot be used for nursing mothers; however, nursing mothers on insulin lispro may need a dose adjustment while lactating.

Is this medicine FDA approved

• Insulin lispro was first approved for use in the United States in 1996.
• It is a manufactured form of human insulin where an amino acid has been switched.
• In 2018, it was the 90th most commonly prescribed medication in the United States, with more than 8 million prescriptions.

How should this medicine be used?

• Insulin lispro is available in 100 units/mL and 200 units/mL concentrations.
• It can be administered subcutaneously (as an injection or as a continuous infusion), or intravenously (IV).
• Patients administer subcutaneous injections 15 minutes before or immediately after a meal into areas with fatty tissue, such as the thighs, arms, buttocks, and abdomen.
• IV administration requires very close medical supervision to ensure the patient does not become hypoglycemic or hypokalemic.
• One must also be mindful that insulin readily adsorbs into IV tubing and infusion bags; therefore, the exact amount of insulin administered can be significantly less than the apparent amount.
• In general, insulin lispro can be diluted with a sterile diluent but should not be mixed or diluted with any other insulin.
• This injection must be administered immediately after mixing.

What are the dosage forms and brand names of this medicine?

This medicine is available in following dosage forms:

Subcutaneous injection

• Administer within 15 minutes before a meal or immediately after a meal. Use in a regimen with an intermediate- or long-acting insulin.

Continuous subcutaneous infusion

• Change the HUMALOG in the reservoir at least every 7 days, change the infusion set, and the infusion set insertion site at least every 3 days. HUMALOG must not be mixed or diluted when used in an external insulin infusion pump.

Intravenous Infusion

HUMALOG should be used at concentrations from 0.1 unit/mL to 1 unit/mL in infusion systems containing 0.9% sodium chloride

HUMALOG 100 units/mL (U-100) is available as:

• 10 mL vials
• 3 mL prefilled pens
• 3 mL Humalog® KwikPen™ (prefilled)
• 3 mL cartridges

This medicine is available in following brand names:

• Admelog®
• Humalog®
• Humalog® Mix50/50
• Humalog® Mix75/25
• Lyumjev®(insulin lispro-aabc)

What side effects can this medication cause?

Common possible side effects of Insulin Lispro include:

• hypoglycemia
• allergic reactions
• injection site reactions
• lipodystrophy
• pruritus
• rash

What special precautions should I follow?

• Never share a HUMALOG prefilled pen, cartridge, reusable pen compatible with Lilly 3 mL cartridges, or syringe between patients, even if the needle is changed.
• Make changes to a patient's insulin regimen under close medical supervision with increased frequency of blood glucose monitoring.
• Monitor blood glucose and increase monitoring frequency with changes to insulin dosage, use of glucose lowering medications, meal pattern, physical activity; in patients with renal or hepatic impairment; and in patients with hypoglycemia unawareness.
• Instruct patients to check insulin labels before injection. Do not transfer HUMALOG U-200 from the HUMALOG KwikPen to a syringe as overdosage and severe hypoglycemia can result.
• Monitor potassium levels in patients at risk of hypokalemia and treat if indicated.

What to do in case of emergency/overdose?

• Excess insulin administration may cause hypoglycemia and hypokalemia.
• Mild episodes of hypoglycemia usually can be treated with oral glucose.
• More severe episodes with coma, seizure, or neurologic impairment may be treated with intramuscular/subcutaneous glucagon or concentrated intravenous glucose.
• Hypokalemia must be corrected appropriately.

Can this medicine be used in pregnency?

• As per the FDA, this drug should only be used during pregnancy when clearly indicated.

Can this medicine be used for Pediatrics?

• Insulin lispro is safe to use in the pediatric population, but a sterile diluent may be needed.
• HUMALOG is approved for use in children for subcutaneous daily injections.
• Only the U-100 formulation of HUMALOG is approved for use in children by continuous subcutaneous infusion in insulin pumps.
• HUMALOG has not been studied in pediatric patients younger than 3 years of age.
• HUMALOG has not been studied in pediatric patients with type 2 diabetes.

What should I know about storage and disposal of this medication?

• Keep this medication in the container it came in and out of reach of children.
• Store vials of insulin lispro solution and suspension in the refrigerator but do not freeze them.
• You may store the vial of solution or suspension you are using outside the refrigerator at room temperature, away from direct heat or light, for up to 28 days.
• A vial of diluted Lyumjev can be stored for 4 days in the refrigerator or12 days at room temperature.
• Store insulin lispro injection products (solution or suspension) pens and cartridges that are not in use in the refrigerator but do not freeze them.
• Store the insulin lispro injection product pen and cartridge you are using outside the refrigerator at room temperature and away from direct heat or light.
• The insulin lispro injection product solution pens and cartridges that are being used and stored outside the refrigerator should be discarded after 28 days, and the insulin lispro injection product suspension pens stored outside the refrigerator should be discarded after 10 days.

• Dailymed label info on Insulin Lispro
• FDA Insulin Lispro

Insulin Lispro Resources
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