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Indications ⬇

BEERS REMS, High Alert

Contraind./Precautions ⬆ ⬇

Contraindicated in:

Use Cautiously in:

Adv. Reactions/Side Effects ⬆ ⬇

Endo: HYPOGLYCEMIA

F and E: hypokalemia

Local: cutaneous amyloidosis, lipodystrophy, pruritus, erythema, swelling

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

Interactions ⬆ ⬇

Drug-drug:

Drug-Natural Products:

Availability ⬆ ⬇

Insulin Lispro

  • Solution for injection (Admelog): 100 units/mL (vials, prefilled cartridges, and prefilled pens)
  • Solution for injection (Humalog, Lyumjev): 100 units/mL (vials, prefilled cartridges, and prefilled pens); 200 units/mL (prefilled pens)

Insulin Lispro Protamine Suspension/Insulin Lispro Injection Mixture

  • Solution for injection (Humalog Mix 75/25): 75% insulin lispro protamine suspension and 25% insulin lispro injection—100 units/mL (vials and prefilled pens)
  • Solution for injection (Humalog Mix 50/50): 50% insulin lispro protamine suspension and 50% insulin lispro injection—100 units/mL (prefilled pens)

Route/Dosage ⬆ ⬇

  • Lyumjev has faster onset of action and greater blood glucose lowering effect than Admelog or Humalog on a unit-to-unit basis.

Admelog, Humalog, and Lyumjev

  • SC (Adults and Children ): Initial dose range: 0.2–0.6 units/kg/day. Usual maintenance range: 0.5–1.2 units/kg/day. Adolescents during rapid growth: <1.5 units/kg/day.

Humalog Mix 75/25 or Humalog Mix 50/50

  • SC (Adults ): Initial dose range: 0.2–0.6 units/kg/day. Usual maintenance range: 0.5–1.2 units/kg/day.

US Brand Names ⬆ ⬇

insulin lispro: Admelog, Admelog SoloStar, HumaLOG, HumaLOG Junior KwikPen, HumaLOG KwikPen, HumaLOG Tempo Pen, Lyumjev, Lyumjev KwikPen, Lyumjev Tempo Pen,

insulin lispro protamine suspension/insulin lispro injection mixtures: HumaLOG Mix 50/50, HumaLOG Mix 50/50 KwikPen, HumaLOG Mix 75/25, HumaLOG Mix 75/25 KwikPen

Action ⬆ ⬇

  • Lowers blood glucose by:
    • stimulating glucose uptake in skeletal muscle and fat,
    • inhibiting hepatic glucose production.
  • Other actions of insulin:
    • inhibition of lipolysis and proteolysis,
    • enhanced protein synthesis.
  • A rapid-acting insulin with more rapid onset and shorter duration than human regular insulin; should be used with an intermediate- or long-acting insulin.
Therapeutic effects:
  • Improved glycemic control.

Classifications ⬆ ⬇

Therapeutic Classification: antidiabetics, hormones

Pharmacologic Classification: pancreatics

Pharmacokinetics ⬆ ⬇

Absorption: Very rapidly absorbed from SUBQ administration sites (within a few minutes).

Distribution: Identical to endogenous insulin.

Metabolism/Excretion: Metabolized by liver, spleen, kidney, and muscle.

Half-Life: Approximately 1 hr.

Canadian Brand Names ⬆ ⬇

insulin lispro protamine suspension/insulin lispro injection mixtures: Humalog Mix 25, Humalog Mix 50

Time/Action Profile ⬆ ⬇

(hypoglycemic effect)

ROUTEONSETPEAKDURATION
Insulin lispro SUBQwithin 15 min1–2 hr3–4 hr
75% insulin lispro protamine suspension/25% insulin lispro injection SUBQwithin 15 min2.8 hr24 hr



Patient/Family Teaching ⬆

  • Instruct patient on proper technique for administration. Include type of insulin, equipment (syringe, cartridge pens, external pumps, alcohol swabs), storage, and place to discard syringes. Discuss the importance of not changing brands of insulin or syringes, selection and rotation of injection sites, and compliance with therapeutic regimen.
  • Demonstrate technique for mixing insulins by drawing up insulin lispro first and rolling intermediate-acting insulin vial between palms to mix, rather than shaking (may cause inaccurate dose).
  • Caution patient not to share pen device with another person, even if needle is changed; may risk transmission of blood-borne pathogens.
  • Explain to patient that this medication controls hyperglycemia but does not cure diabetes. Therapy is long term.
  • Instruct patient in proper testing of serum glucose and ketones. These tests should be closely monitored during periods of stress or illness and health care professional notified of significant changes.
  • Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care professional.
  • Advise patient to notify health care professional of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care professional before taking other medications or alcohol.
  • Advise patient to notify health care professional of medication regimen prior to treatment or surgery.
  • Advise patient to notify health care professional if nausea, vomiting, or fever develops, if unable to eat regular diet, or if blood glucose levels are not controlled.
  • Instruct patient on signs and symptoms of hypoglycemia and hyperglycemia and what to do if they occur.
  • Rep: Advise females of reproductive potential to notify health care professional if pregnancy is planned or suspected or if breastfeeding.
  • Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times.
  • Emphasize the importance of regular follow-up, especially during first few wk of therapy.