Insulin Lispro Injection

Insulin lispro is used to treat type 1 diabetes (condition in which the body does not produce insulin and therefore cannot control the amount of sugar in the blood). It is also used to treat people with type 2 diabetes (condition in which the body does not use insulin normally and therefore cannot control the amount of sugar in the blood) who need insulin to control their diabetes. In patients with type 1 diabetes, insulin lispro is always used with another type of insulin, unless it is used in an external insulin pump. In patients with type 2 diabetes, insulin lispro may be used with another type of insulin or with oral medication(s) for diabetes. Insulin lispro is a short-acting, man-made version of human insulin. Insulin lispro works by replacing the insulin that is normally produced by the body and by helping move sugar from the blood into other body tissues where it is used for energy. It also stops the liver from producing more sugar.

Insulin lispro comes as a solution (liquid) to inject subcutaneously (under the skin). It is usually injected 15 minutes before a meal or immediately after a meal. Your doctor will tell you how many times you should inject insulin lispro each day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use insulin lispro exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.

Never use insulin lispro when you have symptoms of hypoglycemia (low blood sugar) or if you have checked your blood sugar and found it to be low. Do not inject insulin into a skin area that is red, swollen, itchy, or thickened.

Insulin lispro controls diabetes but does not cure it. Continue to use insulin lispro even if you feel well. Do not stop using insulin lispro without talking to your doctor. Do not switch to another brand or type of insulin or change the dose of any type of insulin you are using without talking to your doctor. Always check the insulin label to make sure you received the right type of insulin from the pharmacy.

Insulin lispro comes in vials, cartridges that contain medication and are to be placed in dosing pens, and dosing pens that contain cartridges of medication. Be sure you know what type of container your insulin lispro comes in and what other supplies, such as needles, syringes, or pens you will need to inject your medication.

If your insulin lispro comes in vials, you will need to use syringes to inject your dose. Ask your doctor or pharmacist to show you how to inject insulin lispro using a syringe. Ask your doctor or pharmacist if you have questions about the type of syringe you should use.

If your insulin lispro comes in cartridges, you will need to purchase an insulin pen separately. Check the manufacturer's information for the patient to see what type of pen is right for the cartridge size you are using. Carefully read the instructions that come with your pen, and ask your doctor or pharmacist to show you how to use it. Ask your doctor or pharmacist if you have questions about the type of pen you should use.

If your insulin lispro comes in pens, be sure to read and understand the manufacturer's instructions. Ask your doctor or pharmacist to show you how to use the pen. Follow the directions carefully, and always prime the pen before use.

Never reuse needles or syringes and never share needles, syringes, cartridges, or pens. If you are using an insulin pen, always remove the needle right after you inject your dose. Throw away needles and syringes in a puncture-resistant container. Ask your doctor or pharmacist how to dispose of the puncture-resistant container.

Your doctor may tell you to mix your insulin lispro with another type of insulin (NPH insulin) in the same syringe. Your doctor will tell you exactly how to do this. Always draw insulin lispro into the syringe first, always use the same brand of syringe, and always inject the insulin immediately after mixing. Insulin lispro should not be mixed with insulin preparations other than NPH insulin.

Your doctor may tell you to dilute insulin lispro before injection to allow easier measurement of your dose. Your doctor will tell you exactly how to do this.

You can inject your insulin lispro in your thighs, stomach, upper arms, or buttocks. Each time you inject insulin lispro you should choose a spot that is at least 1/2 inch (1.25 centimeters) away from the spot where you gave your last injection.

Always look at your insulin lispro before you inject it. It should be clear and colorless. Do not use your insulin lispro if it is colored, cloudy, or contains solid particles, or if the expiration date on the bottle has passed.

Insulin lispro in vials or cartridges also can be used with an external insulin pump. Before using insulin lispro in a pump system, read the pump label to make sure the pump can be used for continuous delivery of fast-acting insulin. Read the pump manual for recommended reservoir and tubing sets, and ask your doctor or pharmacist to show you how to use the insulin pump. Do not dilute insulin lispro or mix it with any other type of insulin when using it with an external insulin pump. When using insulin lispro with an external insulin pump, replace the insulin in the reservoir at least every 7 days, and change the infusion set and infusion set insertion site at least every 3 days. If the infusion site is red, itchy, or thickened, tell your doctor and use a different infusion site.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before using insulin lispro,

• tell your doctor and pharmacist if you are allergic to insulin (Humulin, Novolin, others), any of the ingredients of insulin lispro, or any other medications. Ask your pharmacist or check the manufacturer's patient information for a list of the ingredients.
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: angiotensin converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril, (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); angiotensin receptor blockers such as azilsartan (Edarbi),candesartan (Atacand, in Atacand HCT), eprosartan (Teveten, in Teveten HCT), irbesartan (Avapro, in Avalide), losartan (Cozaar, in Hyzaar), olmesartan (Benicar, in Azor, Benicar HCT), telmisartan (Micardis, in Micardis HCT), and valsartan (Diovan, in Diovan HCT, Exforge); beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); certain cholesterol-lowering medications such as fenofibrate (Antara, Lofibra, TriCor, Triglide), gemfibrozil (Lopid), and niacin (Niacor, Niaspan, in Advicor); certain medications for human immunodeficiency virus (HIV) or acquired immunodeficiency syndrome (AIDS) including atazanavir (Reyataz), darunavir (Prezista), fosamprenavir (Lexiva), indinavir (Crixivan), lopinavir (Kaletra), nelfinavir (Viracept), ritonavir (Norvir), saquinavir (Invirase), and tipranavir (Aptivus); clonidine (Catapres, in Clorpres); danazol; digoxin (Digitek, Lanoxin); disopyramide (Norpace); diuretics ('water pills'); fluoxetine (Prozac, Serafem, in Symbyax); hormone replacement therapy; isoniazid (INH, Nydrazid); lithium (Eskalith, Lithobid); medications for asthma and colds; medications for mental illness and nausea; monoamine oxidase inhibitors including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl) and tranylcypromine (Parnate); octreotide (Sandostatin); oral contraceptives (birth control pills); oral medications for diabetes; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); pentamidine (NebuPent, Pentam); pentoxifylline (Trental); pramlintide (Symlin); reserpine; salicylate pain relievers such as aspirin, choline magnesium trisalicylate (Trisalate), choline salicylate (Arthropan), diflunisal (Dolobid), magnesium salicylate (Doan's, others), and salsalate (Argesic, Disalcid, Salgesic); somatropin (Nutropin, Serostim, others); sulfa antibiotics; and thyroid medications. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
• tell your doctor if you have or have ever had nerve damage caused by your diabetes or if you have any other medical conditions, including liver or kidney disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using insulin lispro, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are using insulin lispro.
• Alcohol may cause a change in blood sugar. Ask your doctor about the safe use of alcoholic beverages while you are using insulin lispro.
• ask your doctor what to do if you get sick, experience unusual stress, or change your diet, exercise, or activity schedule. These changes can affect your dosing schedule and the amount of insulin you will need.
• ask your doctor how often you should check your blood sugar. Be aware that hypoglycemia may affect your ability to perform tasks such as driving and ask your doctor if you need to check your blood sugar before driving or operating machinery.
• high blood sugar may occur quickly if an insulin pump or infusion set stops working properly or if the insulin in the pump reservoir becomes inactive (degraded). Problems can include pump malfunction or tubing problems such as blockage, leaking, disconnection, or kinking. If the problem cannot be found quickly and corrected, call your doctor. Temporary use of insulin by subcutaneous injection (using syringes or an insulin pen) may be needed. Make sure you have back-up insulin and any necessary supplies on hand, and ask your doctor or pharmacist to show you how to use them.

Be sure to follow all dietary recommendations made by your doctor or dietitian. It is important to eat a healthful diet, and to eat about the same amounts of the same kinds of food at about the same times each day. Skipping or delaying meals or changing the amount or kind of food you eat can cause problems with your blood sugar control.

Insulin lispro must be injected shortly before or after a meal. If you remember your dose before or shortly after your meal, inject the missed dose right away. If some time has passed since your meal, follow the instructions provided by your doctor or call your doctor to find out whether you should inject the missed dose. Do not inject a double dose to make up for a missed one.

This medication may cause changes in your blood sugar. You should know the symptoms of low and high blood sugar and what to do if you have these symptoms.

Insulin lispro may cause side effects. Tell your doctor if the following symptoms are severe or do not go away:

• redness, swelling, or itching in the place where you injected insulin lispro

• changes in the feel of your skin such as skin thickening or a little indentation in the skin

• swelling of the hands and feet

• weight gain

• constipation

Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:

• rash and itching

• difficulty breathing

• hives

• wheezing

• fast heartbeat

• sweating

• weakness

• muscle cramps

• abnormal heartbeat

Insulin lispro may cause other side effects. Call your doctor if you have any unusual problems while using this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online [at http://www.fda.gov/Safety/MedWatch] or by phone [1-800-332-1088].

Keep this medication in the container it came in and out of reach of children. Store vials of insulin lispro in the refrigerator but do not freeze them. If necessary, you may store the vial you are using outside the refrigerator at room temperature, away from direct heat or sunlight, for up to 28 days. If your doctor tells you to dilute your insulin lispro, the vial of diluted medication can be stored for 28 days in the refrigerator or 14 days at room temperature. Store extra insulin lispro pens and cartridges that are not in use in the refrigerator but do not freeze them. Store the pen and cartridge you are using outside the refrigerator at room temperature for up to 28 days. Store prefilled pens containing Humalog Mix75/25 or Humalog Mix50/50 that are in use outside the refrigerator at room temperature for up to 10 days. Insulin lispro used in an external insulin pump should be thrown away if it is exposed to temperatures over 98.6°F. The temperature of the insulin may be higher than the outside air temperature if the pump housing, cover, tubing, or sport case is exposed to sunlight or direct heat. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.

Insulin lispro overdose can occur if you use too much insulin lispro or if you use the right amount of insulin lispro but eat less than usual or exercise more than usual. Insulin lispro overdose can cause hypoglycemia. If you have any symptoms of hypoglycemia, follow your doctor's instructions for what you should do if you develop hypoglycemia. Other symptoms of overdose:

• coma

• seizures

Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to insulin lispro. Your doctor will also tell you how to check your response to insulin lispro by measuring your blood sugar levels at home. Follow these instructions carefully.

You should always wear a diabetic identification bracelet to be sure you get proper treatment in an emergency.

Do not let anyone else use your medication. Ask your pharmacist any questions you have about refilling your prescription.

It is important for you to keep a written list of all of the prescription and nonprescription (over-the-counter) medicines you are taking, as well as any products such as vitamins, minerals, or other dietary supplements. You should bring this list with you each time you visit a doctor or if you are admitted to a hospital. It is also important information to carry with you in case of emergencies.

Last Revised - 11/15/2011