Humalog insulin is rapid-acting insulin, also called insulin lispro. It was approved by the FDA in 1996 for the treatment of both type1 diabetes mellitus and type 2 diabetes mellitus.
Insulin lispro is clear and colorless liquid. It is almost like the human insulin, except for small difference in the insulin protein. It is said to be human insulin analog.
This insulin can be used in both adult and children. The usual concentration is 100 units per milliliter or 100U/ml. It can be diluted to produce less concentrated insulin down to 10 units per milliliter or 10U/ml. Lispro that is used in insulin pump or insulin pens cannot be diluted. The blood glucose lowering effects of lispro is comparable to that of regular insulin. Lispro, however works faster than regular human insulin when administered subcutaneously, that is, in the fat layer under the skin.
Other components of Humalog which are inactive ingredients are zinc, dibasic sodium phosphate, Metacresol, glycerin and phenol. Patients should inform their doctors if they are allergic to any of these components before starting on lispro.
Lispro gets absorbed soon after injection and starts to work minutes after administration. It peaks between 30 minutes to 90 minutes after injection. This can be influenced by the part of the body where it was administered. It works faster than regular human insulin when given subcutaneously. When given intravenously, both lispro and regular insulin appear to have the same duration of action.
3ml prefilled pens
3ml prefilled Humalog KwikPen
3ml cartridges – for use in insulin pumps
Only a doctor can order Humalog or adjust its dose. Close blood glucose monitoring is necessary when a patient is on lispro.
The dose may need to be lowered for people with liver and/or kidney problems.
Protect lispro from light and direct heat. Always keep the insulin vial in the carton to shield the insulin from light. Keep unopened lispro in refrigerator and the lispro inuse at room temperature, but below 86˚F or 30˚C. Discard opened lispro vials after 28days.
Insulin lispro can only be mixed with NPH. It cannot be mixed with any other insulin or medication preparation. If lispro is to be mixed with NPH, insulin lispro needs to be drawn into the syringe first, and then followed by the NPH. This mixture is only for immediate injection, not to be stored.
Lispro insulin cannot be diluted, mixed with NPH or any other insulin or drug when used in an infusion pump.
Monitor insulin pumps for malfunction or failure. In the event of insulin infusion pump failure, use subcutaneous injections of insulin to prevent hyperglycemia or diabetic ketoacidosis.
Inject within 15 minutes of meal time or immediately after a meal.
Inject into the fat layer under the skin when the treatment with lispro is used in combination with intermediate or long-acting insulin regimen. The injection should be in the fat layer in the upper arms, thighs and abdomen.
If you are using an infusion pump, change the infusion set and infusion site every 3 days. Lispro insulin in the reservoir of the infusion pump should be changed every 7days.
Always check the finger-stick blood sugar before administering Lispro. Do not inject if blood glucose is too low. It is a good idea to get the limits or blood glucose parameters from your doctor.
Rotate the injection site to avoid lipodystrophy. Lipodystrophy is the thickening or thinning of the fat layer under the skin.
Thinning of the fat layer is called lipoatrophy.
When patient switches from subcutaneous injections to the pump, the total daily dose for Lispro is the same as the total daily dose before the pump. The doctor may divide up half of that dose to be given basally in equal divided hourly doses through the 24 our period. The other half is divided up and programed as meal-time boluses to take care of blood glucose spikes that follow meal times.
Infusion pumps that can be used for Humalog are MiniMed, Disetronic or comparable pumps)
Check the insulin label before each use in order to avoid mistaking other kinds of insulin for lispro. Use sterile insulin injection needles. Dispose of the injection needles into secure containers. This protects you and others from needle-stick injury and stops the spread of diseases.
Insulin doses may need to be adjusted during illness.
Do not give to patients in hypoglycemia
Do not give to people who are allergic to Humalog or any other material in the formulation)
Do not Freeze insulin lispro.
Do not combine use of insulin pump with a regimen of long or intermediate acting insulin.
A major adverse reaction of lispro is hypoglycemia or low blood glucose
Hypokalemia or decreased blood potassium level is another adverse reaction of Humalog
Allergic reactions in those with allergy to lispro or any of its components. This can be in the form of redness, itch, trouble breathing, hypotension or low blood pressure, sweating, increased heart rate or even anaphylaxis.
Some localized reactions and generalized myalgias are allergic reactions to metacresol, which is a component of Humalog known as its excipient.
There may be infusion site reactions in those using insulin pump. This can be in the form of itch, redness, or swelling.
Blurred vision- this may be due to sudden drop in blood pressure levels and will get better or resolve over time.
Weight gain results from better use of blood glucose due to the presence of insulin.
Swelling in hands and feet, also called peripheral edema.
Increase in antibodies specific to insulin circulating in blood. These decrease and disappear over time and do not seem to affect blood glucose action of the insulin.
Drugs that lower blood glucose like oral diabetes medications, ACE inhibitors, salicylates like aspirin, fluoxetine, monoamine oxidase inhibitors, sulfonamide antibiotics, ACE inhibitors, angiotensin receptor blockers, propoxyphene, and other drugs that lower blood sugar may cause the hypoglycemia in patients receiving lispro.
Drugs that increase blood sugar may cause hyperglycemia in patients who are taking insulin lispro. Examples of these medications are corticosteroids like prednisone, diuretics, niacin, albuterol, epinephrine, glucagon, isoniazid, thyroid hormones, oral contraceptives, atypical antipsychotics, including olanzapine and clozapine, thyroid hormones, protease inhibitors, somatropin and others.
Other drugs can affect the drug lowering effects in an unpredictable manner. These medications include beta blockers, clonidine, lithium, alcohol and Pentamidine.
Lispro insulin can be used to control diabetes in pregnant women. Caution should be exercised because the insulin need fluctuates during pregnancy. Insulin need reduces in early pregnancy, increases in the second trimester and third trimester, and then reduces again after delivery. Close monitoring of blood sugar is especially important and includes the postprandial blood sugar or blood glucose after meals, in addition to fasting blood sugar.
Insulin lispro can be used during breastfeeding by the mother with caution. The breastfeeding mother may need the dose of Humalog lowered from previous dose as determined by the doctor.
Insulin lispro can be used for pediatric patients both by subcutaneous route and by insulin pump. Use cautiously in pediatric patients who are less than 3 years of age as this rapid-acting insulin has not been studied in that population.
Insulin lispro can be used in elderly patients as studies did not show difference in response between this population and other adult patients.
Overdose of Humalog can result in both hypoglycemia and hypokalemia.
Hypoglycemia, which is low blood glucose, can be either mild or severe. In mild hypoglycemia, the patient should take foods that offer rapid release of glucose into the blood stream. These foods can include glucose tablets, orange juice, sugar, skim milk or regular soda. Patients with severe hypoglycemia should be taken to the nearest hospital emergency room and treated in a hospital environment. These patients can be treated with IV high concentration glucose, up to Dextrose 50%, glucagon and/or any others as the physicians see fit. All episodes of hypoglycemia should be reported to the patient’s doctor.
Hypokalemia is low blood potassium and needs to be treated immediately to bring up potassium levels to normal. Severe hypokalemia may cause changes in the heart’s rhythm, problems with breathing or even death and should be treated in a hospital setting.
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