insulin lispro

General

High Alert Medication: This medication bears a heightened risk of causing significant patient harm when it is used in error.

insulin lispro

Trade Name(s)

  • Admelog
  • HumaLOG
  • Lyumjev

insulin lispro protamine suspension/insulin lispro injection mixtures

Trade Name(s)

  • HumaLOG Mix 75/25
  • HumaLOG Mix 50/50

Ther. Class.
antidiabetics
hormones

Pharm. Class.
pancreatics

See insulins and insulin therapy for more information concerning insulins

Indications

Control of hyperglycemia in patients with type 1 and type 2 diabetes mellitus.

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 Effect(s):

Control of hyperglycemia in diabetic patients.

Pharmacokinetics

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

Distribution: Identical to endogenous insulin.

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

Half-life: Approximately 1 hr.

TIME/ACTION PROFILE (hypoglycemic effect)

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

Contraindication/Precautions

Contraindicated in:

  • Hypoglycemia
  • Allergy or hypersensitivity to insulin lispro
  • Hypoglycemia.

Use Cautiously in:

  • Stress or infection (may temporarily ↑ insulin requirements)
  • Renal or hepatic impairment (may ↓ insulin requirements)
  • Must be used with a longer-acting insulin in patients with type 1 diabetes
  • Concomitant use with pioglitazone or rosiglitazone (↑ risk of fluid retention and worsening HF);
  • OB:  Pregnancy may temporarily ↑ insulin requirements
  • Lactation: Use while breastfeeding only if maternal benefit justifies potential risk to infant;
  • Pedi:  Safety and effectiveness not established in children <3 yr (safety of Admelog and Humalog) or <18 yr (Lyumjev and Humalog mixes).

Adverse Reactions/Side Effects

Endo: HYPOGLYCEMIA

F and E: hypokalemia

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

Misc: HYPERSENSITIVITY REACTIONS (INCLUDING ANAPHYLAXIS)

* CAPITALS indicate life-threatening.
Underline indicate most frequent.

Interactions

Drug-Drug

Drug-Natural Products:

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

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 and Humalog

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.

Lyumjev, 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.

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 (vials and prefilled pens)

Assessment

  • Assess for symptoms of hypoglycemia (anxiety; restlessness; tingling in hands, feet, lips, or tongue; chills; cold sweats; confusion; cool, pale skin; difficulty in concentration; drowsiness; nightmares or trouble sleeping; excessive hunger; headache; irritability; nausea; nervousness; tachycardia; tremor; weakness; unsteady gait)and hyperglycemia (confusion, drowsiness; flushed, dry skin; fruit-like breath odor; rapid, deep breathing, polyuria; loss of appetite; unusual thirst) periodically during therapy.
  • Monitor body weight periodically. Changes in weight may necessitate changes in insulin dose.

Lab Test Considerations:

  • Monitor blood glucose every 6 hr during therapy, more frequently in ketoacidosis and times of stress. A1C may be monitored every 3–6 mo to determine effectiveness.
  • Monitor serum potassium in patients at risk for hypokalemia (those using potassium-lowering agents, those receiving IV insulin) periodically during therapy.

Toxicity Overdose:

Overdose is manifested by symptoms of hypoglycemia. Mild hypoglycemia may be treated by ingestion of oral glucose. Severe hypoglycemia is a life-threatening emergency; treatment consists of IV glucose, glucagon, or epinephrine.

Potential Diagnoses

Implementation

  • High Alert: Medication errors involving insulins have resulted in serious patient harm and death. Clarify all ambiguous orders and do not accept orders using the abbreviation "u" for units, which can be misread as a zero or the numeral 4 and has resulted in tenfold overdoses. Insulins are available in different types and strengths. Check type, dose, and expiration date with another licensed nurse. Do not interchange insulins without consulting physician or other health care professional.
  • Do not confuse Humalog with Humulin.
  • Due to the short duration of action, insulin lispro must be used with a longer acting insulin, insulin infusion pump or in combination with oral sulfonylurea agents.
  • Use  only  insulin syringes to draw up dose. The unit markings on the insulin syringe must match the insulin's units/mL. Special syringes for doses <50 units are available. Do not draw up dose into a syringe from the Kwik Pens; syringe markings do not match-up and could lead to a medication error. Use  only  U-100 insulin syringes to draw up  insulin lispro  dose. Prior to withdrawing dose, rotate vial between palms to ensure uniform solution; do not shake.

    • When mixing insulins, draw insulin lispro into syringe first to avoid contamination of regular insulin vial.
    • Humalog U-200 should not be mixed with other insulins, administered IV, or used in insulin pumps.
    • Insulin should be stored in a cool place but does not need to be refrigerated.
  • SC 

    Administer  Admelog  and  Humalog  within 15 min before or immediately after a meal. Administer  Lyumjev  at the start of a meal or within 20 minutes after starting a meal. Rotate injection sites to prevent lipodystrophy and cutaneous amyloidosis. Repeated insulin injections into areas of localized cutaneous amyloidosis may cause hyperglycemia; a sudden change to an unaffected injection site may cause hypoglycemia.

    • May be administered via disposable external insulin pump. Do not administer solution that appears thickened, cloudy, discolored or contains particles. Store cartridges for pump in refrigerator. Do not mix with other insulins or solutions when used with pump. Choose a new infusion site and insertion site at least every 3 days. Discard cartridges after 7 days, even if solution remains.
  • Syringe Compatibility

    May be diluted with sterile diluent for Humalog, Humulin N, Humulin 50/50, and Humulin 70/30 to a concentration of 1:10 or 1:2.

IV Administration

Continuous Infusion:   Administer  Humalog-U-100  IV under medical supervision ONLY with close monitoring of blood glucose and potassium levels to avoid hypoglycemia and hypokalemia. Concentration: 0.1 unit/mL to 1.0 unit/mL. Diluent:   0.9% NaCl. Solutions of insulin lispro and 0.9% NaCl can be stored for 48 hrs in refrigerator, then used at room temperature for another 48 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.
  • Advise patient 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.

Evaluation/Desired Outcomes

Control of blood glucose levels in diabetic patients without the appearance of hypoglycemic or hyperglycemic episodes.

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