Generic Name

Insulin Lispro Protamine Recombinant and Insulin Lispro Recombinant

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Classification

FDA Approved Indications

• Management of blood glucose in patients with diabetes mellitus

Mechanism of Action

Insulin lispro is a rapid-acting insulin analog that mimics natural insulin response to glucose, facilitating cellular glucose uptake and inhibiting hepatic glucose production. The mix formulations combine rapid-acting insulin lispro with protamine suspension for intermediate activity, providing both prandial and basal insulin effects.

Dosage and Administration

Adult: Injected subcutaneously before meals; dosage varies based on individual needs.

Pediatric: Dosed similarly to adults, based on weight and blood glucose levels.

Geriatric: Start at lower doses; monitor closely due to potential hypoglycemia.

Renal Impairment: Adjustments may be necessary; monitor blood glucose closely.

Hepatic Impairment: Use with caution; hepatic dysfunction may affect insulin requirements.

Pharmacokinetics

Absorption: Rapid absorption after subcutaneous injection.

Distribution: Distributed mainly to extracellular fluid.

Metabolism: Metabolized primarily in the liver and kidneys.

Excretion: Excreted as metabolites in urine and possibly feces.

Half Life: Approximately 1 hour for insulin lispro; formulation effects vary.

Contraindications

• Hypoglycemia
• Allergy to insulin lispro or any excipients.

Precautions

• Use with caution in patients with renal or hepatic impairment, during illness, or stress, as insulin requirements may change. Monitor for hypoglycemia and hyperglycemia.

Adverse Reactions - Common

• Hypoglycemia (Common)
• Lipodystrophy at injection site (Uncommon)

Adverse Reactions - Serious

• Severe hypoglycemia leading to seizures, coma (Rare)
• Allergic reactions including anaphylaxis (Rare)

Drug-Drug Interactions

• Corticosteroids, epinephrine (may decrease insulin effectiveness)
• Other antidiabetic agents (risk of hypoglycemia)

Drug-Food Interactions

N/A

Drug-Herb Interactions

N/A

Nursing Implications

Patient/Family Teaching

• Recognize signs and symptoms of hypo- and hyperglycemia.
• Proper injection technique and site rotation.
• Importance of consistent meal timing and carbohydrate intake.
• Use of glucometer to monitor blood sugar.
• Storage of insulin properly.

Special Considerations

Black Box Warnings:

• Risk of severe hypoglycemia which may be life-threatening.

Genetic Factors: None specific.

Lab Test Interference: May affect serum potassium levels; monitor as needed.

Overdose Management

Signs/Symptoms: Severe hypoglycemia: sweating, tremors, confusion, seizures, loss of consciousness.

Treatment: Administer glucose (oral or IV), glucagon if patient is unable to take oral glucose, monitor until stable.

Storage and Handling

Storage: Store unopened vials or pens in the refrigerator; opened vials or pens may be kept at room temperature for a limited period (typically 28 days).

Stability: Stable for 28 days at room temperature once opened.