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Insulin Lispro- Uses, Dosage, Side Effects, Warnings, and Precautions

Published on Nov 21, 2022 and last reviewed on Feb 06, 2023   -  12 min read

Abstract

Insulin Lispro is used in diabetes mellitus types 1 and 2 to control hyperglycemia. Read the article below for more details on Insulin Lispro.

Overview:

Insulin Lispro injection is a man-made short-acting form of human insulin. It replaces the insulin normally produced by the body and helps shift glucose from the blood into other body tissues used for energy. Further, it also stops the liver from producing extra sugar.

Insulin Lispro is as efficient as a single unit of human insulin in reducing glucose levels. The short-acting insulin analogs are designed to overcome the limitations of traditional human insulin. Insulin Lispro was the first developed insulin analog available commercially. In contrast to regular human insulin, this insulin analog shows a greater insulin peak, faster subcutaneous absorption, and a shorter period of action.

The benefits of insulin Lispro are associated with the sequence change of two beta-chain amino acids. Human insulin is a protein hormone composed of two polypeptide chains linked with chains A and B. Insulin Lispro shows a reversal of the lysine at B-29 and proline at B-28. It causes a fast dissolution of this insulin and is absorbed faster after subcutaneous injection.

Indications:

  • Insulin Lispro is an FDA-approved insulin analog for treating patients with diabetes mellitus types 1 and 2 and controlling hyperglycemia (high blood glucose).

  • The off-label uses of this insulin analog involve treating patients with gestational diabetes mellitus, mild-to-moderate hyperosmolar hyperglycemic state, and diabetic ketoacidosis.

For Patients:

Why Is Insulin Lispro Prescribed?

Insulin Lispro injections are prescribed for treating type 1 diabetes, a disorder where blood glucose cannot be controlled as the body does not produce insulin. Insulin Lispro injection is also effective in patients with type 2 diabetes, a disorder in which the body cannot use the insulin naturally present, leading to uncontrolled glucose levels in the blood.

In type 1 diabetes patients, Insulin Lispro injections are always combined with another type of insulin apart from its use as an external insulin pump. On the contrary, in type 2 diabetes patients, Insulin Lispro injections may be used with any other form of insulin or oral medicines used to treat diabetes.

Diabetic patients may develop life-threatening or severe complications over a while. For example, the following complications might be present:

  • Heart disease.

  • Stroke.

  • Kidney problems.

  • Nerve damage.

  • Eye problems.

To avoid these complications, patients must take prescribed medications and make lifestyle changes like exercising, eating an adequate diet, and quitting smoking. The blood glucose levels must be monitored regularly to improve the condition.

How Should This Medicine Be Used?

Insulin Lispro injection is available as a solution or liquid and a suspension (liquid with particles that settle on standing). The insulin is injected under the skin (subcutaneously).

  • Insulin Lispro solution is usually injected fifteen minutes before or immediately after a meal.

  • Insulin Lispro-aabc solution must be injected at the beginning of a meal or within 20 minutes after the patient has started eating.

  • Insulin Lispro suspension needs to be injected fifteen minutes before a meal.

Insulin Lispro injection products can be injected intravenously by a doctor or nurse in a hospital where the side effects are properly monitored. Insulin Lispro injection does not cure diabetes but only controls sugar levels. The doctor prescribes the frequency or how often the injection must be injected daily. These injections must be used as directed by the doctor, and the dosage should not be increased or decreased without consulting the doctor. The injections of insulin Lispro must not be used if the patient shows hypoglycemia or low blood glucose level symptoms.

These injections must not be discontinued even if the patient feels well and must not be stopped abruptly without informing the doctor. In addition, the patient must not change the brand of the insulin without consulting the doctor. The patients must always check the label on the insulin injection to ensure they receive the correct type of insulin.

Insulin Lispro injections are sold in vials or cartridges containing the medication in a dosing pen. The patient should know the type of containers. Insulin Lispro is available in the syringes, needles, or pens required to inject the medications.

  • If the Insulin Lispro vials are prescribed, the patient will need syringes to inject the dose and must ask the doctor for instructions to use these syringes.

  • Suppose the Insulin Lispro is in the form of cartridges. In that case, the patients need to purchase an insulin pen separately and check the manufacturer's guide as to what type of pen is required depending on the cartridge size.

  • Suppose the Insulin Lispro injection is in the form of a pen. In that case, the patient must read the manufacturer's guide and ask the doctor if he has difficulty understanding the instructions.

The needles or syringes must never be reused or shared with other patients. The needle should be removed after every dose if the patient uses an insulin pen.

Sometimes the doctor may prescribe another type of insulin that has to be mixed with Insulin Lispro solution. The two insulins must be mixed as directed by the doctor.

  • Insulin Lispro solutions should not be mixed with any insulin preparations apart from Neutral Protamine Hagedorn (NPH) insulin.

  • Insulin Lispro suspension can not be mixed with any other insulin preparation.

The doctor may sometimes suggest diluting Insulin Lispro to help measure the dose easily.

This injection can be administered into the thighs, stomach, buttocks, and upper arms. The injection site must be changed with every dose. Injections are usually avoided when the skin is thick, bruised, tender, scaly, hard, or lumpy.

Before injecting Insulin Lispro, the patient must always ensure that the solution is colorless and clear and should never use the product if it is cloudy, colored, or contains particles. In the case of Insulin Lispro suspension, the insulin normally appears milky or cloudy after mixing. The suspension must not be used if there are solid clumps present. Insulin Lispro suspension must be shaken gently or rolled between the hands to mix properly before injecting. The product should not be used once the expiry date has passed.

What Special Precautions Should Be Taken?

  • Allergies: The patient should inform the doctor about allergies to Insulin Lispro or its ingredients. The patient should ask about the ingredients present in the medication.

  • Medical History: The patients must inform the doctor if they have ever experienced any nerve damage due to diabetes. Moreover, the doctor must be informed of other medical conditions like frequent episodes of hypoglycemia, low blood potassium levels, heart failure, and liver or kidney disease.

  • Drug History: The doctor should be provided with a list of prescribed or non-prescribed drugs that the patient is taking, including vitamins and natural or herbal supplements.

The patients must mention if they are taking the following drugs:

  • Angiotensin receptor blockers such as Azilsartan, Irbesartan, Candesartan, Losartan, Olmesartan, Valsartan, and Telmisartan,

  • Angiotensin-converting enzyme (ACE) inhibitors such as Benazepril, Enalapril, Fosinopril, Captopril, Lisinopril, Quinapril, Moexipril, Ramipril, Perindopril and Trandolapril.

  • Beta-blockers like Atenolol, Metoprolol, Labetalol, Nadolol, and Propranolol.

  • Certain medications for human immunodeficiency virus (HIV) like Atazanavir, Lopinavir, Darunavir, Fosamprenavir, Indinavir, Ritonavir, Nelfinavir, Saquinavir, and Tipranavir.

  • Clonidine.

  • Clozapine.

  • Certain cholesterol-lowering medications like Gemfibrozil, Fenofibrate, and Niacin.

  • Danazol.

  • Diuretics.

  • Disopyramide.

  • Fluoxetine.

  • Hormone replacement therapy.

  • Isoniazid.

  • Lithium.

  • Medications for mental illness and nausea.

  • Monoamine oxidase inhibitors like Isocarboxazid, Phenelzine, Selegiline, and Tranylcypromine.

  • Medications for asthma and colds.

  • Oral contraceptives (birth control pills).

  • Oral medications for diabetes, such as Pioglitazone and Rosiglitazone.

  • Oral steroids such as Dexamethasone, Methylprednisolone, and Prednisone.

  • Octreotide.

  • Olanzapine.

  • Pentamidine.

  • Patiromer.

  • Pentoxifylline.

  • Pramlintide.

  • Reserpine.

  • Sodium polystyrene sulfonate.

  • Somatropin.

  • Salicylate pain relievers such as Aspirin, Choline salicylate, Diflunisal, Magnesium salicylate, Choline magnesium trisalicylate, and Salsalate.

  • Sulfa antibiotics.

  • Thyroid medications.

The doctor might change the doses of the medication or monitor the patient carefully for side effects.

  • Pregnancy: The patient should tell the doctor about their pregnancy or if they are planning to conceive or are breastfeeding.

  • Alcoholism: Alcohol alters blood glucose levels. The patient should inform the doctor that they have consumed or have ever consumed large amounts of alcohol. The doctor may be consulted about the safe use of alcoholic beverages while on Insulin Lispro injection.

  • The patient must inform the doctor if they experience sickness or unusual stress and if there is an alteration in their exercise routine or diet. These changes might affect the dosage or the amount of insulin the patient needs.

  • When the Insulin Lispro injection is started initially, the patients might experience problems in vision, burning, pain, and numbness in hands, feet, arms, and legs. These side effects go away gradually. However, the doctor should be informed about it.

What Are the Special Dietary Instructions That Must Be Followed?

All dietary instructions given by the dietician or the doctor must be followed. The patients must not skip meals or change the quantity of food that is consumed every day. A proper eating routine helps maintain normal blood glucose levels.

What Should Be Done in Case of a Missed Dose?

Insulin Lispro injections are usually administered before or after meals. If the patient remembers the dose shortly after the meal, the dose could be taken immediately. However, if the patient remembers it after some time has elapsed, the doctor must be consulted before taking the injection. A double dose is never injected to compensate for the missed one.

Side Effects:

Insulin Lispro injection may cause changes in the blood glucose level. The patient should be aware of the symptoms of high and low blood glucose levels and what should be done in case of such symptoms.

Insulin Lispro injection products can have the following side effects.

  • Redness, itching, or swelling at the site of injection.

  • Skin changes like little lumps in the skin or skin thickening.

  • Weight gain.

  • Constipation.

Certain severe side effects can occur. However, they are uncommon, and the doctor must be consulted immediately.

  • Difficulty breathing.

  • Shortness of breath.

  • Urticaria.

  • Wheezing with a fast heartbeat.

  • Sweating.

  • Abnormal heartbeat.

  • Weakness and muscle cramps.

  • Drowsiness.

  • Confusion or dizziness.

  • Swelling of the face, throat, or tongue.

  • Excessive weight gain in a short period.

  • Swelling of the arms, feet, hands, ankles, or lower legs.

Storage and Disposal:

The Insulin Lispro injections are stored in the container it comes in.

Storage of Unopened Insulin Lispro Cartridges, Vials, and Pens:

  • They should be refrigerated but not kept in the freezer. They can be stored until the date mentioned by the manufacturer.

  • If a refrigerator is unavailable, the unopened vials, cartridges, or pens can be stored at room temperature, protecting them from direct sunlight and high heat. Unrefrigerated unopened cartridges, vials, and pens of Insulin Lispro solution injections must be used within 28 days and discarded.

  • Unrefrigerated unopened vials of Insulin Lispro suspension can be used within 28 days, and pens can be used within ten days.

Storage of Opened Insulin Lispro Cartridges, Vials, and Pens:

  • Opened vials can be stored for 28 days in the refrigerator or at room temperature.

  • Opened insulin Lispro solution cartridges can be stored at room temperature for 28 days and need not be refrigerated.

  • Insulin Lispro products must be discarded if exposed to extreme cold or heat.

It must be kept out of reach of children since the injections are not available in child-resistant containers. The medication must be kept in safe locations with locked safety caps.

If the injection is expired or no longer required, it should be disposed of properly so that pets and children do not consume the medications by mistake.

What Should Be Done in Case of an Emergency or Overdose?

  • In the case of an overdose, the doctor should be contacted immediately.

  • Suppose severe side effects are experienced, a bystander or family member should take the patient to an emergency room, or local poison control services should be contacted.

  • The overdose of Insulin Lispro can occur by excessive unrequired use of the injection or an irregular diet and exercise.

  • Overdose usually causes hypoglycemia.

  • Other symptoms of overdose include seizures and come.

Other Information:

Maintaining a written list of all the prescribed and non-prescribed (over-the-counter) drugs that are being taken by the patient, including other supplements like vitamins or minerals. The patient should carry this list for every visit to a doctor or a hospital. It is extremely important in case of emergencies. The doctor may suggest certain lab tests before administering Insulin Lispro injection to check the body's response to this medication.

For Doctors:

Indications:

  • Insulin Lispro is an FDA-approved insulin analog for treating patients with diabetes mellitus types 1 and 2 and controlling hyperglycemia (high blood glucose).

  • The off-label uses of this insulin analog involve treating patients with gestational diabetes mellitus, mild-to-moderate hyperosmolar hyperglycemic state, and diabetic ketoacidosis.

Pharmacology:

The pharmacology of Insulin Lispro is similar to that of natural insulins.

Pharmacokinetics and Pharmacodynamics:

The pharmacokinetics of Insulin Lispro differs from regular human insulin. Effects of this medication are seen within 15 minutes. Hence the patients must eat during this period to avoid any complications. Insulin Lispro has a faster onset of action than regular human insulin. Thus, it is injected 15 to 30 minutes before meals. This time allows regular human insulin to reach peak activity and absorption of nutrients from a meal.

Mechanism of Action:

  • Insulin Lispro is a fast-acting human insulin that acts through the blood to lower blood glucose by modulating the metabolism of proteins, carbohydrates, and fats.

  • It binds to an insulin-specific glycoprotein receptor on the surface of target cells.

  • These receptors exist in tissues like skeletal muscle, adipose tissue, and the liver. Insulin produces free fatty acids in adipose tissue by helping in circulating lipoproteins processing. It further assists in the storage of adipocytes and the synthesis of triglycerides and directly inhibits the hydrolysis of triglycerides.

  • Insulin promotes the synthesis of fatty acids and hepatic glycogen In the liver.

  • In skeletal muscle, insulin increases the synthesis of glycogen and protein.

  • Insulin also helps in the cellular uptake of amino acids and increases the permeability of the cells to various ions.

  • Lastly, insulin activates sodium-potassium ATPase and helps in the movement of potassium intracellularly.

  • Human insulin normally has lysine and proline amino acids at positions B28 and B29. Insulin Lispro contains these amino acids in the reverse positions, with lysine at position B29 and proline at position B28.

Administration:

Available concentrations of Insulin Lispro

  • 100 units/mL.

  • 200 units/mL.

  • It can be administered subcutaneously or intravenously (IV).

  • Insulin Lispro injections are administered subcutaneously 15 minutes before or after a meal into areas with fatty tissue, like the arms, thighs, buttocks, and abdomen. Insulin must be carefully given to avoid administration into muscles.

  • Subcutaneous injections can be given using a syringe or a prefilled pen with either the 100 units/mL or 200 units/mL concentrations. These prefilled pens can deliver insulin in 0.5 to 1-unit increments.

  • Insulin Lispro is usually diluted with a sterile diluent but is not mixed or diluted with any other insulin. However, there is one exception: Insulin Lispro 100 units/mL vial only with insulin NPH (Neutral Protamine Hagedorn). This injection must be administered immediately after mixing. Insulin Lispro can be used safely for pediatric patients, but a sterile diluent is required.

Adverse Effects:

  • The most common adverse effect related to Insulin Lispro is hypoglycemia. Therefore it is recommended that diabetes patients must monitor their glucose levels regularly. Special care must be taken for fasting patients while taking Insulin Lispro injections.

  • Hypokalemia is another adverse effect seen in patients using potassium-lowering drugs or taking drugs sensitive to serum potassium levels.

  • Other adverse effects include reaction, hypertrophy, and lipodystrophy (a condition that leads to a complete or partial loss and abnormal distribution of adipose tissue in certain areas of your body) at the injection site.

Contraindications:

Insulin Lispro is contraindicated in the following patients:

  • Patients with hypoglycemia.

  • Patients who are allergic to Insulin Lispro or any of its ingredients.

  • In nursing mothers, however, in some cases, mothers on Insulin Lispro may need a dose adjustment while lactating.

Insulin Lispro comes under pregnancy category B drug (animal reproduction studies have not shown any fetal risk. Nevertheless, there are no well-controlled studies on pregnant women. The FDA has recommended using this drug during pregnancy only when indicated.

Monitoring:

The therapeutic response to Insulin Lispro can be monitored by testing periodic blood glucose with a glucometer or obtaining serum glucose on regular bases. Glycosylated hemoglobin testing should be performed quarterly to bi-annually to measure long-term glycemic control and check whether the patients have stable glycemic control.

Involvement of the Healthcare Team:

Insulin Lispro is frequently prescribed by primary caregivers, nursing practitioners, endocrinologists, and other healthcare professionals to control hyperglycemia. However, the healthcare team must inform the patient that this medication may cause hypoglycemia. Thus, it is essential to monitor blood glucose levels, and any dosage alterations should be done under the supervision of a doctor.

Article Resources

Last reviewed at:
06 Feb 2023  -  12 min read

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