What is Lispro (Humalog, insulin lispro)?

From the Guidelines

Lispro is a preferred rapid-acting insulin analog for managing blood glucose levels in people with diabetes, offering a quick onset of action and flexible meal timing. According to the 2017 American Diabetes Association standards of medical care in diabetes 1, lispro can be used as an addition to basal insulin, with a single injection before the largest meal, to achieve glycemic goals. 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.

Key Considerations

• Lispro begins working within 15 minutes after injection, peaks in about 1 hour, and continues working for 2-4 hours.
• Typical starting doses range from 0.1-0.2 units/kg/day divided before meals, though dosing must be individualized based on blood glucose monitoring.
• Lispro should be injected subcutaneously in the abdomen, thigh, or upper arm immediately before meals.
• Side effects may include hypoglycemia, injection site reactions, and allergic responses.

Administration and Monitoring

• Patients should monitor blood glucose regularly and adjust doses under medical supervision to achieve optimal glycemic control.
• 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 1.

Clinical Decision Making

• Providers should consider regimen flexibility when devising a plan for the initiation and adjustment of insulin therapy for patients with type 2 diabetes.
• If one regimen does not achieve HbA1c targets, another regimen should be considered, such as basal insulin plus a single injection of rapid-acting insulin or twice-daily premixed insulin 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Properties of Lispro

• Insulin lispro is a rapid-acting insulin analog with a faster onset of action and shorter duration of action compared to regular insulin 2, 3, 4.
• The rapid absorption of insulin lispro is due to the inversion of the proline-lysine amino acid sequence at positions 28 and 29 on the B chain 2, 3, 4.
• Insulin lispro has a more rapid onset and shorter duration of glucose-lowering activity compared to human regular insulin 3, 4.

Therapeutic Use

• Insulin lispro is used in the treatment of diabetes mellitus, providing equivalent or slightly improved glycemic control compared to regular insulin 2, 3, 4.
• Insulin lispro is suitable for patients with type 1 and type 2 diabetes, and can be used in combination with basal insulin therapy 3, 4, 5.
• The use of insulin lispro allows for greater flexibility in dosing and mealtime scheduling, and can improve postprandial glucose control 2, 3, 4, 6.

Clinical Trials

• Clinical trials have shown that insulin lispro provides greater postprandial glycaemic control than human regular insulin without increasing the risk of hypoglycaemia 3, 4, 5, 6.
• Insulin lispro has been compared to other rapid-acting insulin analogues, such as aspart and glulisine, and has been shown to have a similar or improved profile 5.
• Recent phase 3 trials have demonstrated the efficacy and safety of ultra-rapid lispro, a new formulation of insulin lispro, in patients with type 1 and type 2 diabetes 5.

Patient Outcomes

• Patients using insulin lispro have reported an improvement in their well-being and quality of life due to flexible injection times and less frequent hypoglycemic reactions 3, 4.
• Insulin lispro has been shown to reduce the risk of hypoglycemic episodes, including nighttime hypoglycemia, in patients with type 1 diabetes 3, 4, 6.