Medication Insulin Lispro

Due July 2, 2017

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(see information noted from my initial research)

Pharmacokinetics of Lispro

(Information to use) Used in management of Diabetes mellitus, types 1 and 2: Treatment of type 1 diabetes mellitus (insulin dependent, IDDM) and type 2 diabetes mellitus (noninsulin dependent, NIDDM) to improve glycemic control

Onset of action

Peak

Rapid acting: insulin lispro (Humalog)

              0 to 15 minutes (Peak)

30 to 90 minutes (Onset of Action)

Half-life

Duration of action

Pharmacodynamics of Lispro insulin

Pharmacotherapeutics of Lispro

Include Drug-to-drug interactions,

Drug-to-food interactions,

Drug-to-herb interactions

Routes and dosage ranges

For Children

        For Adults

(Information to consider in writing paper)

Type 1 Diabetic : Note: Multiple daily doses or continuous subcutaneous infusions guided by blood glucose monitoring are the standard of diabetes care. Combinations of insulin formulations are commonly used. The daily doses presented below are expressed as the total units/kg/day of all insulin formulations combined.

Initial total insulin dose: 0.2 to 0.6 units/kg/day in divided doses. Conservative initial doses of 0.2 to 0.4 units/kg/day are often recommended to avoid the potential for hypoglycemia. A rapid-acting insulin may be the only insulin formulation used initially.

Usual maintenance range: 0.5 to 1 units/kg/day in divided doses. An estimate of anticipated needs may be based on body weight and/or activity factors as follows:

Nonobese: 0.4 to 0.6 units/kg/day

Obese: 0.8 to 1.2 units/kg/day

Adverse effects of Lispro

·       Cardiovascular: Peripheral edema

·       Central nervous system: Headache (type 1 diabetes: 30%; type 2 diabetes: 12%), pain (11% to 20%)

·       Endocrine & metabolic: Hypoglycemia, hypokalemia, weight gain

·       Gastrointestinal: Diarrhea (type 1 diabetes: 9%), nausea (type 1 diabetes: 6%)

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·       Genitourinary: Urinary tract infection (type 1 diabetes: 6%)

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·       Hypersensitivity: Hypersensitivity reaction

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·       Immunologic: Antibody development

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·       Infection: Infection (10% to 14%)

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·       Local: Hypertrophy at injection site, injection site reaction, lipoatrophy at injection site

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·       Neuromuscular & skeletal: Myalgia (type 1 diabetes: 7%; most likely secondary to excipient metacresol)

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·       Respiratory: Flu-like symptoms (type 1 diabetes: 35%; type 2 diabetes: 6%), pharyngitis (type 1 diabetes: 33%; type 2 diabetes: 7%), rhinitis (type 1 diabetes: 25%; type 2 diabetes: 8%)

• Glycemic control: The most common adverse effect of insulin is hypoglycemia. The timing of hypoglycemia differs among various insulin formulations. Hypoglycemia may result from changes in meal pattern (eg, macronutrient content or timing of meals), changes in the level of physical activity, increased work or exercise without eating or changes to co-administered medications. Hyperglycemia is also a concern; may occur with CSII pump or infusion set malfunctions or insulin degradation; hyper- or hypoglycemia may result from changes in insulin strength, manufacturer, type or administration method. Use of long-acting insulin preparations (eg, insulin detemir, insulin glargine) may delay recovery from hypoglycemia. Patients with renal or hepatic impairment may be at a higher risk. Symptoms differ in patients and may change over time in the same patient; awareness may be less pronounced in those with long standing diabetes, diabetic nerve disease, patients taking beta-blockers or in those who experience recurrent hypoglycemia. Profound and prolonged episodes of hypoglycemia may result in convulsions, unconsciousness, temporary or permanent brain damage or even death. Insulin requirements may be altered during illness, emotional disturbances or other stressors. Instruct patients to use caution with ethanol; may increase risk of hypoglycemia.

• Hypersensitivity: Hypersensitivity reactions (serious, life-threatening and anaphylaxis) have occurred. If hypersensitivity reactions occur, discontinue administration and initiate supportive care measures.

• Hypokalemia: Insulin (especially IV insulin) causes a shift of potassium from the extracellular space to the intracellular space, possibly producing hypokalemia. If left untreated, hypokalemia may result in respiratory paralysis, ventricular arrhythmia and even death. Use with caution in patients at risk for hypokalemia (eg, loop diuretic use).

Monitoring

·       Monitor serum potassium frequently with IV insulin use and supplement potassium when necessary.

Patient teaching