Insulin Lispro

A to Z Drug Facts

 Action Regulates proper glucose use in normal metabolic processes.

 Indications

Insulin Aspart: Treatment of patients with diabetes mellitus for the control of hyperglycemia; however, because of rapid onset and short duration of action, insulin aspart should normally be used in regimens that include an intermediate- or long-acting insulin.

Insulin Glargine: Treatment of patients with diabetes mellitus who require long-acting insulin for control of hypoglycemia.

Insulin Lispro: Treatment of patients with diabetes mellitus for control of hyperglycemia. In patients with type 1 diabetes, use in regimens that include a longer-acting insulin. In patients with type 2 diabetes, may be used without longer-acting insulin when used concurrently with sulfonylureas.

 Contraindications During episodes of hypoglycemia; hypersensitivity to any component.

 Route/Dosage

ADULTS: SC Individualized; determined by physician in accordance with patient's needs (usual requirement 0.5 to 1 units/kg/day). ADULTS AND CHILDREN ³ 6 YRS: SC Once daily at bedtime, dose determined by close monitoring under medical supervision during change from a treatment regimen with an intermediate- or long-acting insulin. Insulin Lispro: Type 1 diabetes ADULTS: SC Variable; determined by health care professional. Type 2 diabetes ADULTS AND CHILDREN > 3 YRS (in combination with sulfonylureas): SC Variable; determined by health care professional. ADULTS: SC Variable; determined by health care professional.

 Interactions

Oral contraceptives, corticosteroids, estrogens, isoniazid, niacin, phenothiazines, thyroid hormone: May decrease hypoglycemic effects of insulin lispro. Alcohol, angiotensin-converting enzyme inhibitors, beta blockers, MAO inhibitors, oral hypoglycemic agents, pancreatic function inhibitors (eg, octreotide, salicylates, sulfa antibiotics): May increase hypoglycemic effects of insulin lispro. Beta blockers may mask the symptoms of hypoglycemia in some patients.

 Lab Test Interferences None well documented.

 Adverse Reactions

META: Hypoglycemia; hypokalemia. DERM: Lipodystrophy (from repeated insulin injection into same site). OTHER: Hypersensitivity reaction (eg, rash, shortness of breath, fast pulse, sweating, hypotension, anaphylaxis, angioedema); local reactions (eg, redness, swelling, and itching at injection site).

 Precautions

Pregnancy: Category B (insulin lispro); Category C (insulin aspart, insulin glargine). Lactation: Undetermined. Children: Insulin aspart: Safety and efficacy not establised. Insulin glargine: Safety and efficacy not established in children < 6 yrs with type 1 diabetes. Insulin lispro: In combination with sulfonylureas, safety and efficacy not established in children £ 3 yrs. Insulin lispro mix: Safety and efficacy not established in children £ 18 yrs. Changing insulin: Changes in purity, strength, brand, type, species source, or method of manufacture (rDNA vs animal source) of insulin may necessitate dosage adjustment. Make changes cautiously under medical supervision. Renal/Hepatic impairment: Insulin lispro dose may need to be reduced. Hypoglycemia: May result from excessive insulin dose, missed meals, increased work, or exercise without eating.

 Administration/Storage

• When mixing insulins, draw insulin lispro into syringe first. Administer immediately after mixing.
• Do not administer mixtures IV.
• Use only insulin syringes.
• Select appropriate injection site according to patient history and needs; rotate injection sites to prevent lipodystrophy. SC insulin lispro is absorbed most rapidly at abdominal injection sites, more slowly at sites on arms, and slowest at sites on anterior thigh.
• Administer insulin lispro 15 min before meals.
• Do not freeze. Do not use insulin lispro if previously frozen.
• Do not expose to extreme temperature or direct sunlight.

 Assessment/Interventions

• Obtain patient history, including drug history and any known allergies.
• Assess patient for signs of hypoglycemia (eg, anxiety, chills, confusion, cool and pale skin, drowsiness, excessive hunger, headache, irritability, nausea, rapid pulse, tremors).
• Observe patient for signs of hyperglycemia (eg, drowsiness, fruitlike breath odor, frequent urination, loss of appetite, thirst).
• Monitor blood glucose levels throughout course of therapy.
• Observe injection sites for signs of local hypersensitivity reaction, such as redness, itching, or burning.
• Notify physician if hypoglycemia or adverse reactions occur.
• If lipoatrophy or lipohypertrophy develop at injection site, use alternate sites or use purified insulin.
• Document injection sites used.

 Patient/Family Education

• Teach name, dose, action, and side effects of insulin.
• Tell patient not to change brand, strength, type, or dose without physician's knowledge.
• Dosage adjustments may be necessary when type of insulin is changed.
• Tell patient to consult physician for dosage changes during illness.
• Instruct patient to use same type and brand of syringe each time to prevent dosage errors.
• Explain potential long-term complications of diabetes and encourage regular general physical and eye examinations.
• Tell patient to report redness, swelling, or itching at injection site.
• Explain significance and importance of reporting the following: Visual changes; rash; infection that does not heal; increased thirst; increased urination; dry mouth; burning sensation in feet, legs, or hands; pain in legs after exercise; frequent episodes of low or high blood sugar levels.
• Show patient how to rotate injection sites to prevent scarring.
• Teach patient how to monitor blood glucose as directed.
• Identify source for obtaining medical ID (eg, Medi-Alert) and explain importance of information.
• Teach patient and family how to draw up and administer insulin.
• Demonstrate self-care techniques using insulin pump for patients.
• Emphasize importance of compliance with diet and exchange system for meals.
• Emphasize importance of regular exercise.
• Tell patient to carry source of sugar (eg, candy, sugar packets) to counteract hypoglycemia.

Books@Ovid
Copyright © 2003 Facts and Comparisons
David S. Tatro
A to Z Drug Facts