Insulin Lispro (Injection)

Overview

Insulin lispro is a quick-acting insulin. This is one of the number of hormones that helps your body turn food into energy. This is achieved by using the sugar (glucose) contained in the bloodstream as fast energy. Insulin also helps us store energy that we can then use for later. When you have type 1 diabetes, your body can't make enough insulin so you must take additional insulin to help regulate your blood sugar and ensure your body is healthy. When you have type 2 diabetes, your body struggles to make insulin so requires external assistance in the form of insulin or tablets. This is important as too much sugar in the bloodstream can be harmful to your health.

Insulin lispro starts to work faster than some other types of insulin, (within 15 minutes) but its effects do not last as long (typically 2-4 hours). It should mimic like the insulin your body would normally produce. Your doctor may also prescribe you a long-lasting insulin ("background" insulin) alongside a short-acting insulin. You can only obtain this medication via prescription from your doctor and it is available in the dosage form of suspension for injection.

Conditions treated

  • Type 2 diabetes mellitus

Type of medication

  • Injection

Side effects

Along with its intended effects, this drug can produce some unwanted side effects. Not all of these side effects may be present, but if they do appear, you may need to seek medical attention.

Consult your doctor or healthcare professional right away if you suffer from any of the following side effects whilst taking insulin lispro:

More common

  • Excessive hunger

Less common

  • Dry, red, hot, or irritated skin

Less common or rare

  • Skin rash or itching over the whole body

Incidence not known

  • Tightness in the chest

Some side effects that may occur with insulin lispro usually don't require medical attention as they are not severe. These side effects usually begin to disappear or reduce as your body starts to adjust to the medication. However, some people may find these side effects bothersome. If you are fining them bothersome, you can contact your local pharmacist or doctor for advice on ways to reduce or prevent these side effects. Check with your doctor if any of the following side effects linger or cause issues:

More common

  • A runny nose

Incidence not known

  • Swelling, redness, or itching at injection site

You may suffer from other side effects that are not listed above. It's best to seek advice from a doctor or healthcare professional if you notice anything strange or unusual. Remember you can report all side effects to the FDA regardless of severity.

Dosage

The final dose of all medications is dependent upon individual factors. These include your age, weight and height, other medical conditions you suffer from and corresponding drugs you take for treatment. Your doctor will also consider the strength of the medication, how many doses you are required to take a day and your reaction to the first dose.

For injection dosage form for diabetes mellitus:

Adults and children three years and older: Your dose will be based on blood sugar levels and will be determined by your doctor.

Children younger than three years: Your dose will be determined by your doctor.

Proper Use

A trained healthcare professional or a diabetic nurse may inject this medication for you to begin with. You will also be shown how to give this medication at home. This medication is typically given via injection under the skin.

Always make sure you check both the strength (concentration) of your insulin and your dose. Dose and concentration are not the same. The dose is how many units of insulin you will use, whereas the concentration lets you know how many units of insulin are in each milliliter, for example, such as 100 units/mL (U-100), but this doesn't mean you will use 100 units at a time. Ask your diabetes doctor for clarification.

Each package of insulin lispro comes with a patient information leaflet. Make sure you read this carefully and understand the following things:

  • How to prepare the insulin

It is best to rotate different sites on the body for each injection (eg, under the skin of your stomach, abdomen or thigh, upper arm, buttocks). Contact a member of your healthcare team if you have any questions about this.

If you are using this insulin at a mealtime, it typically should be taken fifteen minutes before the meal or straight after the meal.

The insulin solution should look colorless and clear. Do not use insulin lispro if it is thickened or cloudy. This means it has died. If you take insulin that has died it could cause serious side effects or illness.

When used in an insulin pump: Carefully follow the external insulin pump instructions. This insulin cannot be diluted or be mixed with any other insulin when it is being used in an insulin pump. Any insulin lispro that is used in the insulin pump should be typically changed at least every seven days (or when required) and the insertion site and infusion set changed at least every three days. You should rotate sites of the body where you place insertions. If you don't understand how to use the insulin pump, seek advice from a diabetic specialist.

Do not change the type brand or dose of your insulin without advice from a diabetic consultant first. When you receive a new supply of insulin, make sure you check the label to ensure if it's the correct type of insulin.

Don't put Humalog® U-200 from the Humalog® KwikPen into a syringe for use.

Interactions

The use of this drug can interact with a number of other drugs which could produce severe side effects or reduce the effectiveness of the workings of either drug. To help limit these interactions you should give your healthcare professional a full and complete list of all the current and past drugs you are taking. This list should include all prescription and nonprescription drugs, herbal products, and vitamin supplements. It's also best to make your doctor aware of any other health conditions you may suffer from as these too can increase your risk of interactions. In most cases your doctor will do their best to avoid interactions by avoiding treatment with drugs, however, in some cases, the risk of interactions may still be necessary.

The use of this medication with any of the following drugs is not recommended; however, in some cases, it may be required. If you are prescribed both medications together, your doctor may alter the dose or frequency in which you use either drug.

  • Enoxacin

The use of this medication alongside any of the following medications can increase your risk of certain side effects. However, in some cases, the use of both drugs may be the best treatment plan for you. If you are prescribed both medications at once, your doctor may alter the dose or frequency in which you use either medication.

  • Moclobemide

This list is not complete so you should let your doctor know of all medications you are taking.

Other Medical Conditions

If you suffer from any other medical conditions, this could affect the use of this medication. Ensure you let your doctor or healthcare professional know about any other medical conditions you suffer from including:

  • Vomiting: This condition could lower your blood sugar and lower the amount of insulin lispro or insulin you need.

Warnings

There are a number of different factors and precautions you should take into consideration before you choose to use any medication. Some of these are listed below. Seek advice from your doctor if you don't understand something or require more clarification.

Allergies

Let your doctor or healthcare professional know if you have ever suffered from an allergic reaction to this medication or similar medications. It's best to also let them know about any other allergies you may suffer from including to preservatives, dyes, animals or foods.

Pediatric population

Appropriate studies conducted to date have not indicated a pediatric-specific problem that could limit the effectiveness of insulin lispro in children. However, efficacy and safety of this drug have not been established in children younger than three years old.

Geriatric population

Appropriate studies on the relationship of age to the effects of insulin lispro have not been conducted in the geriatric population, however, a geriatric-specific problem is not expected to limit the effectiveness of this medication in the elderly.

Use in pregnancy and breastfeeding

This drug is under FDA pregnancy category B. You should follow your doctor's instructions about using insulin if you are pregnant or breastfeeding a child. It is very important to keep your blood sugar levels controlled during pregnancy and your doses may change during each trimester of the pregnancy. You may also need different doses whilst you are breastfeeding. Insulin cannot harm an unborn child or pass into a child whilst breastfeeding.

Under no circumstances should you share insulin cartridges or pens with other people. It isn't safe for one pen to be used for more than one person. If you share needles or pens it can result in transmission of HIV, hepatitis viruses or other bloodborne illnesses.

Your doctor will want to monitor your progress at regular visits, especially during the first few weeks you take this medication. Your doctor may take blood or urine tests to check for any side effects.

It's extremely important to follow instruction for your diabetic team about:

Alcohol: Drinking alcohol can cause severe low blood sugar. You need to discuss the consumption of alcohol with your diabetes specialist team.

Other medicines: Don't take other medication whilst you are taking this insulin unless they have been previously discussed with your diabetic doctor. This is particularly true for nonprescription medications such as aspirin, and medicines for asthma, appetite control, cough, colds, hay fever, or sinus problems.

Counseling: Close family members need to learn how to help with side effects if they occur and things they can do to prevent side effects. Also, patients with diabetes may require special counseling about diabetes medicine dosing changes that could occur because of lifestyle changes, such as changes in diet and exercise or pregnancy.

Furthermore, counseling on pregnancy and contraception may be required because of the problems that can occur in patients with diabetes whilst pregnant.

Travel: You should keep a prescription for your insulin and other medications you are taking with you at all times and translate them into the language of the country you are visiting. Make adjustments and allowances for time zone changes, and if you are on insulin injections, keep your meal times as close as possible to your usual meal times back home. Be prepared for emergencies as you would do back home and carry some form of medical ID with you at all times.

In case of emergency: There may come a time when you need emergency help for an issue caused by your diabetes. To be prepared for these type of emergencies, it's a good idea to follow this advice

Wear a medical identification (ID) neckchain, ring or bracelet at all times. You should also carry a medical ID card in your purse or wallet that informs people that you have type 1 or type 2 diabetes and a list of your medications.

Keep an extra supply of insulin lispro and injection device, or syringes with needles on hand in case you suffer from high blood sugar.

Keep some kind of fast-acting sugar close by to treat low blood sugar (sweets, full-fat drinks, etc). Have a glucagon kit and a syringe and needle with you in case of a severe low blood sugar and make sure the people around you know how to use it in an emergency. You should check it is in date and replace any expired kits.

This medication can cause a serious allergic reaction known as anaphylaxis, which can be a life-threatening condition and requires urgent medical attention. Inform your doctor immediately if you suffer from any of the following symptoms:

  • Chest pain after you receive the medication

You may experience a rash, skin redness, itching, or swelling at the injection site. If this irritation does not go away or is severe you should speak with your doctor or a healthcare professional. Don't inject insulin lispro into a skin area that is swollen, red, or itchy.

The use of this medication alongside other diabetes medication (eg rosiglitazone, pioglitazone, Actos®, Avandia® Actoplus Met®) may cause edema (fluid retention) or serious heart problems. You should consult with your doctor right away if you experience any of the following symptoms:

  • Uneven heartbeat

Too much insulin lispro can cause low blood sugar levels (hypoglycemia). Low blood sugar can also occur if you delay or miss a snack or meal, use insulin lispro with another antidiabetic medicine, drink alcohol, exercise more than usual, or cannot eat because of vomiting or nausea or have diarrhea.

Symptoms of low blood sugar need to be treated before they lead to unconsciousness. The symptoms of low blood sugar can be different for each individual. It's therefore important that you learn which symptoms of low blood sugar you typically have so you can treat it right away.

Symptoms of low blood sugar include:

  • Excessive hunger

If you suffer from low blood sugar, you need to eat glucose gel or tablets, honey, corn syrup, sugar cubes or drink full-fat drinks, sugar dissolved in water or fruit juice to relieve the symptoms. You should also test your blood for low blood sugar. Seek urgent medical attention if your symptoms do not improve. Someone else should seek emergency help if severe symptoms occur such as seizures, or unconsciousness. Make sure there is a glucagon kit available alongside a needle and syringe. Ensure member of your household knows how to use this injection in an emergency.

Hyperglycemia (high blood sugar) can occur if you skip a dose of your insulin or don't take enough insulin, you don't follow your meal plan or overeat, have an infection or fever, feel stressed or don't do as much exercise as you usually would.

Symptoms of high blood sugar include:

  • Increased need to pee

If you suffer from any of the symptoms of high blood sugar, you should check with your doctor right away and test your blood sugar. You may need extra insulin.

Storage

This drug should be kept out of the reach of children and do not keep medication that is no longer required or has expired. You should ask your local pharmacist for advice on how to dispose of medication you no longer need.

You should store unused pens, vials, or cartridges in the refrigerator. Don't allow insulin to freeze - if frozen it cannot be used again. This medication can be refrigerated for only twenty-eight days. Throw the medication away after it has passed the expiration date.

The insulin vial that you are currently using can be kept at room temperature in a cool place or in the refrigerator; however, it should be kept away from direct light and heat, for up to twenty-eight days.

The pen or cartridge that you are currently using cannot be refrigerated when taken from the fridge. You need to store the pen or cartridge at room temperature in a cool, dry place, away from direct light or heat, for up to twenty-eight days.

Summary

When used as directed, insulin lispro is successful in helping to regulate blood sugar levels in those who suffer from type 1 diabetes, type 2 diabetes, and gestational diabetes. Due to a large number of interactions possible, it's important that you give your doctor a full list of all the drugs you are currently taking. This drug may require different doses when pregnant and breastfeeding. You should, therefore, seek professional advice from a diabetes specialist on controlling your blood sugars whilst pregnant. There are many different factors that can contribute to a high or low blood sugar, you need to take these into account and seek advice from your doctor if you have severe high blood sugars (DKA) or severe low blood sugars (risk of diabetic coma). Your doses may regularly change of this medication dependent on your lifestyle. If you don't know how to change doses you should seek advice from a doctor who is specialized in diabetes care. This drug is not for use in children under the age of three years old. If your child is under three they will be given a different type of insulin. If you require any further information about the practical uses of insulin lispro or have any other questions or queries, contact your local healthcare professional or doctor for advice.