Insulin lisproPA study guide

Why they happen and how to manage them

Hypoglycemia

Insulin action outpaces glucose from food; risk peaks when the glucose-lowering effect is highest, soon after the meal dose. Management: Match doses to meals; treat with glucose or glucagon; review interacting drugs.

Hypokalemia

Insulin shifts potassium into cells. Management: Monitor potassium, especially with IV use or potassium-lowering drugs.

Lipodystrophy and erratic absorption

Repeated injections at the same site. Management: Rotate sites; watch for lows after moving to fresh tissue.

Sources: [1][2][3]

Common and serious

Sources: [1][2][3][4][5][6][7]

Narrow therapeutic index

The label does not describe a narrow therapeutic index or direct dosing by measured blood levels of the drug.

Sources: [1]

Blood glucose

Why

Hypoglycemia and dose adjustment

When

More often with regimen changes, renal or hepatic impairment, hypoglycemia unawareness, and IV use

Act on

Do not give during hypoglycemia; treat lows with glucose or glucagon

Normal

Fasting 70 to 99 mg/dL.

Sources: [1][2][3][4][5]

Hemoglobin A1c

Why

Long-term glycemic control

When

Periodically per diabetes care standards

Normal

Below 5.7% is normal and 6.5% or higher indicates diabetes. Many people with diabetes aim for below 7%.

Sources: [1]

Potassium

Why

Insulin-induced hypokalemia

When

Closely during IV use and in patients at risk

Act on

Treat hypokalemia

Normal

3.7 to 5.2 mEq/L.

Sources: [1][2][3]

Adult dose

Diabetes mellitus

No fixed label dose. Individualize to route, metabolic needs, glucose readings, and glycemic goal; subcutaneous doses usually pair with an intermediate- or long-acting insulin.

IV infusion

U-100 diluted to 0.1 to 1 unit/mL in 0.9% sodium chloride, under medical supervision.

Sources: [1][2]

Renal adjustment

No fixed adjustment. Hypoglycemia risk is higher, so expect more frequent dose changes and glucose checks.

Sources: [1]

Hepatic adjustment

No fixed adjustment. Hypoglycemia risk is higher, so expect more frequent dose changes and glucose checks.

Sources: [1]

Boxed warning

None on the current label.

Sources: [1]

Contraindications

• During episodes of hypoglycemia
• Hypersensitivity to insulin lispro or any excipient

Sources: [1]

Key interactions

Other diabetes drugs, ACE inhibitors, ARBs, fibrates, fluoxetine, MAO inhibitors, salicylates, sulfonamide antibiotics, octreotide, pramlintide

Raise hypoglycemia risk.

Corticosteroids, diuretics, atypical antipsychotics, estrogens and oral contraceptives, thyroid hormones, sympathomimetics such as albuterol and epinephrine, protease inhibitors

Blunt the glucose-lowering effect.

Alcohol, beta blockers, clonidine, lithium, pentamidine

May push glucose either up or down.

Beta blockers, clonidine, guanethidine, reserpine

Can hide the warning signs of hypoglycemia.

Thiazolidinediones (pioglitazone)

Fluid retention and heart failure.

Sources: [1][2]

Antidote or reversal

Hypoglycemia: oral glucose for mild episodes; a glucagon product or concentrated IV glucose for coma, seizures, or neurologic impairment. Continue carbohydrates and observation because lows can recur after apparent recovery. Correct hypokalemia.

Sources: [1]

Pregnancy

Published studies have not linked insulin lispro to birth defects, miscarriage, or poor maternal or fetal outcomes. Poorly controlled diabetes in pregnancy raises the risk of ketoacidosis, preeclampsia, miscarriage, preterm delivery, birth defects, and stillbirth.

Sources: [1]

Lactation

Insulin products, including lispro, pass into milk, with no adverse infant reactions reported.

Sources: [1]

Pediatric

Safety and effectiveness are established in children with diabetes, based on studies in children with type 1 diabetes aged 3 years and older.

Sources: [1]

Geriatric

A1c and hypoglycemia rates did not differ by age in clinical studies. The effect of age on onset of action has not been studied.

Sources: [1]