Adult Dosing

Diabetes Mellitus

Humalog

• Individualizing regimens with an intermediate or long-acting insulin plus a rapid-acting insulin before meals is common
• 50%-70% of total insulin requirements are usually provided by rapid/ultra-short insulin, with the remaining 30%-50% provided by intermediate or long-acting insulin
• Usual total daily insulin requirements are 0.5-1 U/kg/day SC divided 2-4 times daily; give <15 min before meals
• May infuse SC by an external insulin pump. Diluted insulin should not be used in external insulin pumps. Programming insulin infusion pumps is based on the patient’s usual total daily insulin dose
• Onset approx 15-30 minutes (regular insulin 30-60 minutes), peak approx 1-3 hours, duration 3-5 hours for rapid-acting insulins
• Patient’s need to be aware that insulin dose changes should be done based upon an agreed upon protocol under medical supervision
• Notes
• Rapid Insulin may be administered IV, diluted in 0.9% sodium chloride in concentrations of 0.05-1 unit/mL
• Any change of insulin dose should be made with careful consideration of glucose levels, current dosage and patterns of high and/or low blood glucose levels
• Safety and efficacy in pediatric patients <2 yrs has not been established

• Continuous subcutaneous infusion pump
• Avoid mixing or diluting when using in an external insulin infusion pump

• Intravenous infusion
• Dilute to 0.05-1 unit/mL for IV administration in 0.9% sodium chloride in polyvinyl chloride infusion bags
• Dosing typically 0.1 U/kg/hr as an IV infusion (for DKA) [see separate topic on DKA]
• As with all IV uses of insulin; carefully monitor glycemic response and potassium levels

Pediatric Dosing

Diabetes Mellitus-Children >2 yrs

Humalog

• Individualizing regimens with an intermediate or long-acting insulin plus a rapid-acting insulin before meals is common
• 50%-70% of total insulin requirements are usually provided by rapid/ultra-short insulin, with the remaining 30%-50% provided by intermediate or long-acting insulin
• Usual total daily insulin requirements are 0.5-1 U/kg/day SC divided 2-4 times daily; give <15 min before meals
• May infuse SC by an external insulin pump. Diluted insulin should not be used in external insulin pumps. Programming insulin infusion pumps is based on the patient’s usual total daily insulin dose
• Onset approx 15-30 minutes (regular insulin 30-60 minutes), peak approx 1-3 hours, duration 3-5 hours for rapid-acting insulins
• Patient’s need to be aware that insulin dose changes should be done based upon an agreed upon protocol under medical supervision
• Notes
• Rapid Insulin may be administered IV, diluted in 0.9% sodium chloride in concentrations of 0.05-1 unit/mL
• Any change of insulin dose should be made with careful consideration of glucose levels, current dosage and patterns of high and/or low blood glucose levels
• Safety and efficacy in pediatric patients <2 yrs has not been established

• Continuous subcutaneous infusion pump
• Avoid mixing or diluting when using in an external insulin infusion pump

• Intravenous infusion
• Dilute to 0.05-1 unit/mL for IV administration in 0.9% sodium chloride in polyvinyl chloride infusion bags
• Dosing typically 0.1 U/kg/hr as an IV infusion (for DKA) [see separate topic on DKA]
• As with all IV uses of insulin; carefully monitor glycemic response and potassium levels

[Outline]

• Adult Dosing
• Pediatric Dosing

• Type I & II Diabetes mellitus

• Hypersensitivity to any of the ingredients of the product
• Episodes of hypoglycemia

• N/A

Renal Dose Adjustment

• Renal impairment: Careful glucose monitoring and dose reduction recommended but specific dose adjustments not defined

Hepatic Dose Adjustment

• Hepatic impairment: Careful glucose monitoring and dose reduction recommended but specific dose adjustments not defined

• Should be administered by subcutaneous injection shortly before meals or when necessary immediately after meals, as per patient requirements. Can also be given by continuous subcutaneous infusion using a portable infusion pump. When used in an external insulin pump, it should not be diluted nor mixed with other drugs
• Insulin lispro is a rapid-acting insulin analogue and should be used with long-acting insulin for management of type 1 diabetes mellitus. It may be used in combination with other oral hypoglycemic agents in patients with type 2 diabetes mellitus
• Hypoglycemia is the most common adverse effect of insulin. Monitor blood sugar levels regularly in all patients on insulin lispro, especially those using an external insulin pump
• Check blood sugar frequently and watch for signs of hypoglycemia. Any change should be made cautiously and only under medical supervision. Change in insulin strength, type, or frequency may require a change in the dosage
• Unexplained hyperglycemia or ketosis can occur with external insulin pump use. Prompt identification and correction of the cause is necessary. Provide interim therapy with subcutaneous insulin injections
• Dose adjustment is required if there is any change in physical activity or usual meal plan, and also during illness, emotional disturbances, or other stress
• The external insulin pump reservoir should be replaced and a new infusion site selected every 48 hours or less
• Concomitant use of thiazolidinediones can cause dose-related fluid retention, which may lead to or exacerbate heart failure. Monitor for signs and symptoms of heart failure and treat accordingly or consider discontinuation or dose reduction

Cautions: Use cautiously in

• Renal impairment
• Hepatic impairment
• Infection or stress
• Geriatric population
• Hypokalemia
• Risk of hypoglycemia

Pregnancy Category:B

Breastfeeding: No specific data available on the use of insulin lispro during breastfeeding. No adverse reactions have been reported due to insulin in breastmilk, insulin in breastmilk may decrease the risk of type 1 diabetes in breastfed infants. In general, mothers with diabetes using insulin may nurse their infants, based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 11 Jan 2011). As per manufacturer data as insulin is excreted in human milk, caution should be exercised when administering to a nursing woman. Insulin glargine is compatible with breastfeeding, but women with diabetes who are lactating may require dose adjustments.

• METABOLIC: Hypoglycemia, hypokalemia, weight gain
• MISC: Hypersensitivity and allergic reactions, peripheral edema, infection
• LOCAL: Lipodystrophy, injection site reaction

• Rapid-acting human insulin analog; stimulates peripheral glucose uptake and inhibits hepatic glucose production. Also inhibits lipolysis and proteolysis, and enhances protein synthesis
• Insulin lispro is rapidly absorbed following subcutaneous administration
• Metabolism/ Excretion: Partly metabolized at the site of injection and partly by liver, kidney, fat, muscle
• Half-life: 1 hr

US Trade Name(s)

• Humalog

US Availability

Humalog

• INJ (100 units/mL): 10 mL vials
• INJ (100 units/mL): 3 mL cartridges
• Humalog KwikPen (100 units/mL): 3 mL prefilled disposable injection device

Canadian Trade Name(s)

• Humalog

Canadian Availability

Humalog

• INJ (100 units/mL): 10 mL vials
• INJ (100 units/mL): 3 mL cartridges
• Humalog Pen (100 units/mL): 3 mL prefilled disposable injection device

UK Trade Name(s)

• Humalog

UK Availability

Humalog

• INJ (100 units/mL): 10 mL vials
• INJ (100 units/mL): 3 mL cartridges
• Humalog Pen (100 units/mL): 3 mL prefilled disposable injection device
• Humalog KwikPen (100 units/mL): 3 mL prefilled disposable injection device

Australian Trade Name(s)

• Humalog

Australian Availability

Humalog

• INJ (100 units/mL): 10 mL vials
• INJ (100 units/mL): 3 mL cartridges
• Humalog KwikPen (100 units/mL): 3 mL prefilled disposable injection device

[Outline]

Endocrine/Metabolic

Diabetic Medications

Insulins

Pricing data from www.DrugStore.com in U.S.A.

• HumaLOG 100 UNIT/ML SOLN [Vial] (LILLY)
  10 ml = $137.98
  30 ml = $376.97
• HumaLOG 100 UNIT/ML SOLN [Box] (LILLY)
  15 ml = $258
  45 ml = $729.95
• HumaLOG KwikPen 100 UNIT/ML SOLN [Box] (LILLY)
  15 ml = $268.99
  45 ml = $728.96

Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.