insulin lispro: clinical use

Prescribing considerations

• Confirm the exact brand, formulation, device and route; switching should occur under close clinical supervision.
• Review requirements during illness, altered food intake or activity, pregnancy, and changes in renal or hepatic function.
• For pump users, provide a plan for pump or infusion-set failure.
• Record the product name and batch number for traceability.

Contraindications and cautions

• Current hypoglycaemia
• Hypersensitivity to insulin lispro or a formulation excipient
• Humalog Mix25 must not be administered intravenously

Monitoring

• Capillary or sensor glucose
• HbA1c and individualised glycaemic outcomes
• Frequency, severity and awareness of hypoglycaemia
• Injection or infusion sites for lipodystrophy, cutaneous amyloidosis and local reactions
• Ketones and signs of ketoacidosis during significant hyperglycaemia, particularly with pump malfunction
• Fluid retention or heart-failure symptoms with a thiazolidinedione

Clinical pharmacology

Insulin lispro activates insulin receptors, promotes peripheral glucose uptake and suppresses hepatic glucose output. It is absorbed faster and acts for less time than soluble human insulin.

Formulation and product differences

• Lyumjev is a clear mealtime solution supplied in vials, cartridges and pre-filled pens; suitable vials can be used for continuous subcutaneous insulin infusion.
• Humalog Mix25 is a white premixed suspension containing rapid insulin lispro and insulin lispro protamine; it is for subcutaneous injection only.
• The Lyumjev Tempo Pen contains a magnet that should be kept away from implantable electronic medical devices as specified in its instructions.

Injection

Route: Parenteral

Strengths: 100 units/mL, 200 units/mL