insulins (rapid -acting)

Drug-drug:

Beta blockers and clonidine may mask some of the signs and symptoms of hypoglycemia.
Corticosteroids, thyroid supplements, estrogens, isoniazid, niacin, phenothiazines, and rifampin may ↑ insulin requirements.
Alcohol, ACE inhibitors, MAO inhibitors, octreotide, oral hypoglycemic agents, and salicylates may ↓ insulin requirements.
Pioglitazone may ↑ risk of fluid retention and worsening HF.

Drug-Natural Products:

Glucosamine may worsen blood glucose control.
Fenugreek, chromium, and coenzyme Q-10 may produce additive hypoglycemic effects.

Availability ⬆ ⬇

Insulin Aspart

Solution for injection: 100 units/mL (vials, prefilled cartridges, and prefilled pens)

Insulin Glulisine

Solution for injection: 100 units/mL (vials and prefilled pens)

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)

Route/Dosage ⬆ ⬇

Dose depends on blood glucose, response, and many other factors. Only insulin aspart and insulin glulisine can be administered IV. Lyumjev has faster onset of action and greater blood glucose-lowering effect than Admelog or Humalog on a unit-to-unit basis
SUBQ (Adults and Children ): Total insulin dose determined by needs of patient; generally 0.5–1 unit/kg/day; 50–70% of this dose may be given as meal-related boluses of rapid-acting insulin, and the remainder as an intermediate or long-acting insulin. SUBQ infusion pump:∼50% of total dose can be given as meal-related boluses and ∼50% of total dose can be given as basal infusion.

US Brand Names ⬆ ⬇

insulin aspart: Fiasp, Fiasp FlexTouch, Fiasp PenFill, Fiasp PumpCart, Merilog, Merilog SoloStar, NovoLOG, NovoLOG FlexPen, NovoLOG PenFill,

insulin glulisine: Apidra, Apidra SoloStar,

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

Action ⬆ ⬇

Lower blood glucose by
- stimulating glucose uptake in skeletal muscle and fat,
- inhibiting hepatic glucose production.
Other actions:
- inhibition of lipolysis and proteolysis,
- enhanced protein synthesis.
These are rapid-acting insulins with a more rapid onset and shorter duration than regular insulin; should be used with an intermediate- or long-acting insulin.

Therapeutic effects:

Control of hyperglycemia in diabetic patients.

Classifications ⬆ ⬇

Therapeutic Classification: antidiabetics, hormones

Pharmacologic Classification: pancreatics

Pharmacokinetics ⬆ ⬇

Absorption: Very rapidly absorbed from SUBQ administration sites.

Distribution: Widely distributed to tissues.

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

Half-Life: Insulin aspart: 1–1.5 hr; Insulin glulisine: 42 min; Insulin lispro: 1 hr.

Canadian Brand Names ⬆ ⬇

insulin aspart: Kirsty, NovoRapid, Trurapi, Trurapi Solostar

Time/Action Profile ⬆ ⬇

( hypoglycemic effect)

ROUTE	ONSET	PEAK	DURATION
Insulin aspart	within 15 min	1–2 hr	3–4 hr
Insulin glulisine	within 15 min	1–2 hr	3–4 hr
Insulin lispro	within 15 min	1–2 hr	3–4 hr

Patient/Family Teaching ⬆ ⬇

Explain the purpose and side effects of rapid-acting insulins. Instruct patient on proper technique for administration. Tell patient to administer <15 min before or <20 min after starting a meal, depending on product. Include type of insulin, equipment (syringe, cartridge pens, external pump, 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. Keep out of children’s reach. Advise patient to read Patient Information before starting and with each Rx refill in case of changes.
Instruct patient using an external insulin pump to change the insulin in the reservoir at least every 7 days or according to the pump user manual. Patient should not use mixed or diluted insulin in a pump. An alternate source of insulin should be available in case of pump failure.
Emphasize the importance of regular follow-up to assess effectiveness, especially during first few weeks of therapy. Periodic lab tests will be needed.
Demonstrate technique for mixing insulins by drawing up insulin aspart, insulin glulisine, or insulin lispro first. Roll 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 and clean needles are used; may be harmful and ↑ risk of transmitting bloodborne pathogens.
Instruct patient in prompt identification and correction of the cause of hyperglycemia or ketosis. Pump or infusion set malfunctions can lead to a rapid onset of hyperglycemia and ketoacidosis. Interim therapy with SUBQ injection may be required. Patients using continuous SUBQ insulin infusion pump therapy must be trained to administer insulin by injection and have alternate insulin therapy available in case of pump failure.
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 provider notified of significant changes.
Emphasize the importance of compliance with nutritional guidelines and regular exercise as directed by health care provider.
Advise patient to notify health care provider of all Rx or OTC medications, vitamins, or herbal products being taken and to consult with health care provider before taking other medications or alcohol.
Advise patient to notify health care provider of medication regimen prior to treatment or surgery.
Advise patient to notify health care provider 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.
Patients with diabetes mellitus should carry a source of sugar (candy, glucose gel) and identification describing their disease and treatment regimen at all times.
Rep: Advise women to notify health care provider if pregnancy is planned or suspected or if breastfeeding.

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Indications ⬇

Contraind./Precautions ⬆ ⬇

Adv. Reactions/Side Effects ⬆ ⬇

Interactions ⬆ ⬇