What is the recommended dosage and administration of Lispro (insulin lispro) for managing diabetes mellitus?

From the Guidelines

Insulin lispro should be administered subcutaneously within 15 minutes before meals or immediately after eating, with a recommended starting dose of 4 U per meal or 0.1 U/kg per meal, and dose adjustments made in small increments (1-2 units) every 3-7 days until target blood glucose levels are achieved. The dosage of insulin lispro is individualized based on the patient's blood glucose levels, weight, and insulin sensitivity 1. For adults with type 1 diabetes, the initial daily insulin requirement often ranges from 0.4 to 1.0 units/kg/day, with approximately 50-70% given as basal insulin and the remainder as mealtime insulin lispro. For type 2 diabetes, starting doses are commonly 0.1-0.2 units/kg/day before the largest meal or 4 units before each meal, adjusting based on blood glucose monitoring.

Key Considerations

• Insulin lispro works rapidly, with onset within 15 minutes, peak effect at 30-90 minutes, and duration of 3-5 hours, making it ideal for mealtime coverage.
• Patients should rotate injection sites within the same region to prevent lipohypertrophy, store unopened vials in the refrigerator, and discard opened vials after 28 days.
• Blood glucose monitoring is essential when using insulin lispro to prevent hypoglycemia, which can occur if doses are too high or meals are delayed or skipped.
• A concentrated formulation of rapid-acting insulin called lispro U-200 is available, which may be more suitable for some patients because the volume of insulin being injected is significantly less than U-100 insulins, and may improve adherence for those who require large doses of insulin 1.

Administration and Dosage

• The recommended starting dose of mealtime insulin is 4 U per meal, 0.1 U/kg per meal, or 10% of the basal insulin dose per meal if the HbA1c level is less than 8% 1.
• Providers should consider decreasing the basal insulin dose by the same amount of the starting mealtime dose.
• Correctional insulin should also be administered subcutaneously every 6 h using human regular insulin or every 4 h using a rapid-acting insulin such as lispro, aspart, or glulisine 1.

From the FDA Drug Label

5.6 Mixing of Insulins HUMALOG for subcutaneous injection should not be mixed with insulin preparations other than NPH insulin. 5.7 Subcutaneous Insulin Infusion Pumps When used in an external insulin pump for subcutaneous infusion, HUMALOG should not be diluted or mixed with any other insulin.

The recommended dosage and administration of Lispro (insulin lispro) for managing diabetes mellitus is as follows:

• Subcutaneous Injection: HUMALOG should be administered by subcutaneous injection immediately prior to meals.
• Subcutaneous Insulin Infusion Pumps: HUMALOG should not be diluted or mixed with any other insulin when used in an external insulin pump for subcutaneous infusion.
• Mixing of Insulins: HUMALOG for subcutaneous injection should not be mixed with insulin preparations other than NPH insulin. Key points to consider:
• Dose Adjustments: Frequent glucose monitoring and insulin dose reduction may be required in patients with renal or hepatic impairment.
• Administration: Injection should occur immediately after mixing with NPH insulin, if applicable.
• Storage and Handling: HUMALOG should not be exposed to temperatures greater than 98.6°F (37°C). 2 2

From the Research

Dosage and Administration of Lispro

The recommended dosage and administration of Lispro (insulin lispro) for managing diabetes mellitus are as follows:

• Lispro should be administered immediately before meals, preferably within 15 minutes before meals 3, 4.
• The dose of Lispro should be individualized based on the patient's needs and should be adjusted to achieve optimal glucose control 5, 3.
• Lispro can be used in combination with human Ultralente insulin or other basal insulins to achieve optimal glucose control 6, 4.
• When mixing Lispro with human NPH (isophane) or Lente insulins, Lispro should be drawn into the syringe first, mixed with the long-acting insulin, and injected immediately after mixing 5.

Key Considerations

• Lispro has a more rapid onset and shorter duration of action compared to human regular insulin, which allows for more flexible injection times and reduced risk of hypoglycemia 7, 3, 4.
• The incidence of hypoglycemia with Lispro is similar to or lower than that with human regular insulin, particularly at night-time 3, 4.
• Patients using Lispro perceive an improvement in their well-being and quality of life due to flexible injection times and less frequent hypoglycemic reactions 5, 3.

Clinical Trials

• Clinical trials have shown that Lispro provides greater postprandial glycaemic control than human regular insulin without increasing the risk of hypoglycaemia 6, 3.
• Lispro has been shown to improve long-term control, as reflected by an improvement in HbA1c levels, when used in combination with an appropriate basal insulin regimen 6, 4.