From the Research
Insulin lispro administered subcutaneously typically shifts potassium into cells at a rate of approximately 0.4-0.6 mEq/L per 10 units of insulin, as supported by the most recent and highest quality study 1.
Key Points
- The potassium-lowering effect of insulin lispro occurs because insulin activates the sodium-potassium ATPase pump in cell membranes, which moves potassium from the bloodstream into cells 2.
- This mechanism is the basis for using insulin (often with glucose to prevent hypoglycemia) as a temporary treatment for hyperkalemia 3.
- The exact potassium shift varies between individuals based on their insulin sensitivity, baseline potassium levels, and other factors like acid-base status 4.
- When using insulin for hyperkalemia management, patients should be monitored closely with serial potassium measurements, as the effect is temporary and potassium levels may rebound once the insulin effect wanes 5.
Monitoring and Management
- Blood glucose should be monitored to prevent hypoglycemia, especially when insulin is administered with glucose 2.
- Patients receiving insulin for hyperkalemia should be monitored for hypoglycemia hourly for at least 4-6 hours after administration 2.
- The use of reduced-dose IV insulin for treatment of hyperkalemia was significantly less effective in lowering serum potassium levels and did not decrease prevalence of hypoglycemia, as shown in the most recent study 1.