Insulin Lispro

Insulin Lispro is a rapid-acting human insulin analog synthesized in a special non-pathogenic laboratory strain of Escherichia coli bacteria. Chemically, it is Lys(B28), Pro(B29) human insulin analog, created by reversing amino acids at positions 28 and 29 on the insulin B-chain. It lowers blood glucose by binding to insulin receptors, facilitating glucose uptake in muscle and fat cells, and inhibiting glucose output from the liver.

• Control of hyperglycemia in adults and children with diabetes mellitus

Adult Dose (Subcutaneous):

• Type 1 Diabetes: Approximately one third of total daily insulin requirements; usual daily maintenance range: 0.5-1 unit/kg/day in divided doses; nonobese: 0.4-0.6; obese: 0.8-1.2
• Type 2 Diabetes (inadequately controlled on oral medication): 10 units/day SC (or 0.1-0.2 units/kg/day) at bedtime; OR rapid-acting insulin before meals
• Has a more rapid onset of action and shorter duration than regular human insulin
• Hepatic impairment: Dose reduction may be needed

Child Dose (Type 1, ≥3 years): 0.8-1.2 units/kg/day during growth spurts; otherwise adult dosing

Side Effects:

• Hypoglycemia
• Hypokalemia
• Edema
• Pruritus
• Palpitations
• Nausea
• Rash
• Hypersensitivity reactions
• Lipoatrophy or lipohypertrophy (with SC injection)

Precautions:

• Caution in renal or hepatic impairment
• Caution in pregnancy and lactation
• Caution when transferring from other insulin
• Monitor serum glucose, potassium, electrolytes, HbA1c and lipid profile
• Caution in concomitant illness, especially infections
• Lactation: Considered safe for use during breastfeeding

Contraindications:

• Hypoglycemia
• Hypersensitivity to any components

Drug Interactions:

• Oral antidiabetic agents, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAOIs, propoxyphene, salicylates, somatostatin analog, sulfonamide antibiotics increase effect
• Corticosteroids, niacin, danazol, diuretics, sympathomimetic agents, isoniazid, phenothiazine derivatives, somatropin, thyroid hormones, oral contraceptives, lithium decrease effect
• Beta-blockers, clonidine may mask signs of hypoglycemia

Use in Pregnancy: Category B; essential for patients with diabetes to maintain good metabolic control before conception and throughout pregnancy; insulin requirements decrease during 1st trimester, increase during 2nd and 3rd, decline after delivery.

Use in Lactation: Unknown whether insulin lispro is excreted in human milk; caution due to many drugs excreted in human milk; lactating women may require adjustments of insulin doses.

Renal Impairment: Patients may be at increased risk of hypoglycemia; may require more frequent dose adjustment and blood glucose monitoring.

Hepatic Impairment: Patients may be at increased risk of hypoglycemia; may require more frequent dose adjustment and blood glucose monitoring.

Overdose: Excess insulin may cause hypoglycemia and hypokalemia; mild episodes treated with oral glucose; severe episodes (coma, seizure, neurologic impairment) treated with IM/SC glucagon or IV glucose; hypokalemia must be corrected appropriately.