Insulin Lispro, rDNA Origin
Humalog: 100 OR 200 units of insulin lispro per mL
Humalog Mix 75/25: 25% insulin lispro solution and 75% insulin lispro protamine suspension
Humalog Mix 50/50: 50% insulin lispro solution and 50% insulin lispro protamine suspension
Treatment of Type I (insulin dependent) diabetes mellitus or Type II (non-dependent) diabetes mellitus that cannot be properly controlled by diet, exercise, and weight reduction: Dosage must be individualized. Insulin lispro has a more rapid onset and a shorter duration of action than regular insulin. Insulin lispro protamine suspension has a longer duration of action.
Pharmacology/Pharmacokinetics:
Insulin is the primary hormone responsible for carrying out proper glucose utilization in metabolic processes. In adipose and muscle tissue, insulin activates specific enzymes, promotes the transport of monosaccharides (including glucose) across cell membranes, and facilitates the transformation of intracellular amino acids into proteins. Insulin also decreases the formation of triglycerides. Insulin lispro is synthesized in a non-pathogenic strain of E. coli that has been genetically altered by the addition of the gene for insulin lispro. The difference between insulin lispro and human lispro is the reversal of the amino acids at the 28 and 29 positions on the B-chain. Peak serum levels are attained in 30-90 minutes. Terminal half-life is one hour.
Drug Interactions:
The following drugs may decrease the hypoglycemic effects of insulin detemir: corticosteroids, diltiazem, dobutamine, epinephrine and other sympathomimetic agents, oral contraceptives, thiazide diuretics, thyroid hormones, and tobacco smoke. The following drugs may increase the hypoglycemic effect of insulin detemir: Alcohol, anabolic steroids, nonselective beta-blockers, clofibrate, fenfluramine, guanethidine, MAO inhibitors, phenylbutazone, salicylates, sulfinpyrazone, and tetracyclines.
Contraindications/Precautions:
Insulin dosage is very individualized and small changes in dose, syringe brand or size, or insulin brand may necessitate the need for an adjustment of dose. Hypoglycemic reactions are not uncommon in diabetics and may be caused by excessive insulin dose or when glucose absorption is decreased due to fasting, diarrhea, or vomiting. Hypoglycemia may be differentiated from ketoacidosis not only by lab tests but by its symptoms. Hypoglycemia has a sudden onset, causes headaches, shallow breathing, psychosis, convulsions or even nervousness, causes hunger instead of anorexia, and a normal pulse instead of a rapid pulse. Hypoglycemia may be treated with sugar or candy.
Adverse Effects:
Hypoglycemia, hypersensitivity—characterized by redness, swelling, and itching at the injection site, and lipodystrophy at the injection site.
Follow prescribed diet carefully.
Administer 15 minutes before eating.
Do not change syringe brands or dose without first notifying a physician.
Consult a physician during any illness.
Do not change the order of mixing insulins as prescribed by a physician.
Continually monitor blood or urine glucose as prescribed.
Wear or carry diabetic identification in case of emergency.
Store in a refrigerator, but not in a freezer.
Patient should be aware of the signs of hypoglycemia including sweating, tremor, blurred vision, weakness, hunger, and confusion. When two or more of these effects are seen, treat with oral glucose or contact a physician.
