From the FDA Drug Label
Insulin Lispro is a rapid acting human insulin analog indicated to improve glycemic control in adult and pediatric patients with diabetes mellitus. (1) The recommended use of fast-acting insulin, such as lispro, in the Emergency Department (ED) setting for hyperglycemia is to improve glycemic control in patients with diabetes mellitus 1.
- Key points:
- Indication: Improve glycemic control
- Patient population: Adult and pediatric patients with diabetes mellitus
- Setting: Not explicitly stated as ED, but can be applied in this setting for patients with diabetes mellitus.
From the Research
Fast-acting insulin analogs, such as lispro, aspart, and glulisine, are the preferred choice for managing hyperglycemia in the Emergency Department setting due to their rapid onset and shorter duration of action, allowing for more precise glucose control and reduced risk of delayed hypoglycemia. The most recent and highest quality study, 2, published in 2022, compared the rapid-acting insulin analogue glulisine with lispro and aspart for the pump treatment of patients with type 1 diabetes, and found that glulisine had comparable glucose control to lispro/aspart.
Key Considerations for ED Setting:
- For IV administration, regular insulin is typically used at 0.1 units/kg/hour, titrated to maintain blood glucose between 140-180 mg/dL with hourly monitoring 3.
- For subcutaneous dosing, calculate a correction dose using the formula: (blood glucose - target)/correction factor, where the correction factor is typically 1800/total daily insulin dose or approximately 50 for insulin-naive patients.
- Administer subcutaneous rapid-acting insulin every 4 hours as needed, with blood glucose checks before each dose.
- Patients with diabetic ketoacidosis or hyperosmolar hyperglycemic state require IV insulin and fluid resuscitation per specific protocols.
- Potassium levels should be monitored and maintained above 4.0 mEq/L before insulin administration to prevent hypokalemia.
Benefits of Fast-Acting Insulins:
- Quick onset of action (10-15 minutes)
- Peak action (1-2 hours)
- Shorter duration of action (4-5 hours)
- More precise glucose control
- Reduced risk of delayed hypoglycemia compared to regular insulin The study 3 also found that there were no major differences in effects on hypoglycemia, hyperglycemia, weight, or long-term safety between the three available rapid-acting insulins (lispro, aspart, and glulisine) among insulin-naive individuals with type 2 diabetes in clinical practice.
Monitoring and Maintenance:
- Regular blood glucose monitoring
- Potassium level monitoring
- Maintenance of potassium levels above 4.0 mEq/L
- Adjustment of insulin doses as needed to maintain target blood glucose levels.