Insulin Lispro

Insulin, Rapid-acting insulin analog, Mealtime (bolus) insulin

Insulin lispro

Humalog, Admelog, Lyumjev

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Summary

Classes

Insulin, Rapid-acting insulin analog, Mealtime (bolus) insulin

Common uses

Type 1 diabetes mellitus (mealtime)▲0▼, Type 2 diabetes mellitus (mealtime)▲0▼, DKA / HHS (IV infusion)▲0▼

Pharmacy

Starting dose

SC 4-6 units (or 1 unit per 10-15 g carbs) at meals; titrate to postprandial glucose. Typical total daily dose 0.5-1 U/kg/d split between basal and prandial coverage in T1DM

Preparations

100 U/mL (Humalog, Admelog, Lyumjev) vials, pens, cartridges; 200 U/mL Humalog KwikPen

US FDA Max

Titrated to glucose; no fixed maximum

Pharmacology

Routes

Subcutaneous, IV (continuous infusion for DKA), insulin pumps

Onset

SC: 5-15 minutes; ultra-rapid Lyumjev faster

Duration

3-5 hours

Half-life

~1 hour SC

Bioavailability

~100% from subcutaneous depot

Pregnancy

Insulin is the preferred glucose-lowering therapy in pregnancy; lispro is widely used.^{[citation needed]}

Legal status

Rx-only in US (some OTC formulations exist)

Purported mechanism

Insulin lispro is a recombinant human insulin analog with reversed B28-Lys and B29-Pro residues; the substitution prevents self-association into dimers/hexamers in solution, so injected insulin dissociates to monomer immediately and absorbs rapidly enough to be given just before (or just after) the meal.▲0▼ Binds the same insulin receptor as endogenous insulin with comparable mitogenic-to-metabolic ratio. Ultra-rapid formulations (Lyumjev) add treprostinil and citrate to accelerate absorption further.