From the Guidelines
Lispro is a recommended rapid-acting insulin analog for managing blood glucose levels in people with diabetes, particularly for mealtime coverage and correcting high blood glucose levels. According to the 2017 American Diabetes Association standards of medical care in diabetes 1, lispro can be used as an adjunct to basal insulin, with a single injection before the largest meal, or as part of a twice-daily premixed insulin regimen. The dosage of lispro varies based on individual needs, blood glucose levels, and carbohydrate intake, and it can be used in insulin pumps or as part of a multiple daily injection regimen.
Some key points to consider when using lispro include:
- Its rapid onset of action, which begins within 15 minutes after injection, peaks in about 1 hour, and continues working for 2-4 hours 1
- Its compatibility with basal insulins like glargine or detemir in multiple daily injection regimens 1
- The importance of dose titration and adjustments based on blood glucose levels and the pharmacodynamic profile of each formulation 1
- The potential benefits of using lispro as part of a basal-bolus regimen, including improved glycemic control and reduced risk of hypoglycemia 1
- The availability of concentrated formulations of lispro, such as lispro U-200, which may be more suitable for patients requiring large doses of insulin 1
Overall, lispro is a valuable option for managing blood glucose levels in people with diabetes, offering flexibility and effectiveness in a variety of treatment regimens. As noted in the 2017 American Diabetes Association standards of medical care in diabetes, providers should consider regimen flexibility and individual patient needs when devising a plan for insulin therapy 1.
From the FDA Drug Label
HUMALOG® is a rapid acting human insulin analog indicated to improve glycemic control in adults and children with diabetes mellitus. The main use of lispro is to improve glycemic control in adults and children with diabetes mellitus.
- It is a rapid-acting insulin analog.
- Key points:
- Used to treat people with diabetes for the control of high blood sugar.
- Should be taken within fifteen minutes before eating or right after eating a meal.
- Should not be mixed with any other insulin or liquid when used in a pump.
- Should be injected under the skin (subcutaneously) in the upper arm, abdomen, thigh, or buttocks. 2
From the Research
Insulin Lispro Overview
- Insulin lispro is a recombinant human insulin analogue, identical to endogenous human insulin except for the transposition of two amino acids 3, 4.
- It has a faster onset of action and shorter duration of activity than regular human insulin, mimicking the physiological response of endogenous human insulin to food intake 3, 4.
Pharmacological Properties
- Insulin lispro has a more rapid absorption rate than human regular insulin due to its reduced capacity for self-association in solution 4.
- Maximum insulin concentrations are higher and reached earlier with insulin lispro, and insulin concentrations return to baseline values more quickly 4.
Therapeutic Use
- Insulin lispro is indicated for the treatment of hyperglycaemia in diabetes mellitus, and can be administered immediately before or after meals 3.
- It has demonstrated postprandial blood glucose control similar to or better than regular human insulin, without an increased risk of hypoglycaemia 3, 4, 5.
- Insulin lispro has been shown to reduce postprandial glucose excursions and improve glycated haemoglobin A values in patients with type 1 and type 2 diabetes 6, 7, 4, 5.
Comparison to Humalog
- Ultra-rapid lispro (URLi) has been compared to Humalog in several studies, and has been shown to have accelerated pharmacokinetics and greater postprandial glucose reduction 6, 7.
- URLi has been shown to reduce postprandial glucose excursion over 5 hours by 29%-105% compared to Humalog 6.
- The pharmacokinetic and glucodynamic profiles of URLi were sustained after daily subcutaneous dosing for 2 weeks in patients with type 1 and type 2 diabetes 6, 7.