insulin lispro
Brand: Humalog, Admelog
ISMP High Alert Prototype Drug
Drug Class: insulin
Drug Family: insulin
Subclass: rapid-acting insulin analog
Organ Systems: endocrine
Mechanism of Action
Rapid-acting analog in which proline and lysine at positions B28–B29 are reversed, preventing hexamer formation and allowing rapid dissociation into active monomers at the injection site. Activates the insulin receptor almost immediately after injection for precise mealtime glucose control.
insulin receptor (IR)
Indications
- type 1 diabetes mellitus (mealtime coverage)
- type 2 diabetes mellitus (mealtime coverage)
- insulin pump therapy (CSII)
Contraindications
- hypoglycemia
- hypersensitivity to insulin lispro
Adverse Effects
Common
- hypoglycemia
- injection site reactions
- weight gain
Serious
- severe hypoglycemia
- hypokalemia
Pharmacokinetics (ADME)
| Absorption | subcutaneous; rapid absorption due to monomeric form |
| Distribution | low protein binding |
| Metabolism | proteolytic |
| Excretion | renal |
| Half-life | 1 hour |
| Onset | 15–30 minutes |
| Peak | 0.5–2 hours |
| Duration | 3–5 hours |
| Protein Binding | minimal |
| Vd | low |
Drug Interactions
| Drug / Agent | Mechanism | Severity |
|---|---|---|
| beta-blockers | mask hypoglycemia symptoms | moderate |
| pramlintide | delays gastric emptying, altering mealtime insulin timing needs | moderate |
Nursing Considerations
- Administer immediately before meals (within 15 minutes) or even right after starting a meal due to rapid onset.
- For insulin pump use, insulin lispro is the most commonly used analog; check pump catheter for clogs, and change infusion site every 2–3 days.
- Educate patients not to confuse lispro (rapid-acting) with glargine (long-acting); confusion between insulin types is a common medication error.
- If a patient eats less than planned, the dose may need to be reduced to prevent hypoglycemia.
Clinical Pearls
- Rapid-acting insulin analogs (lispro, aspart, glulisine) can be given immediately before or even after meals in patients with unpredictable intake (e.g., young children, nausea), unlike regular insulin which requires 30-minute pre-meal dosing.
- Insulin lispro U-200 (Humalog U-200) contains twice the concentration of standard U-100; ensure correct concentration is prescribed and dispensed.
Safety Profile
Pregnancy generally-safe
Lactation safe
Renal Adjustment Required
Hepatic Adjustment Required
TDM Not required
Concordance Terms
Cross-referenced clinical concepts — click any term to see all content where it appears.