Information from Physicians' desk reference. Montvale, N. Greater reductions in postprandial blood glucose excursions have been achieved with insulin lispro administered immediately before meals than with regular insulin given 30 minutes before meals. Peak serum concentrations of insulin lispro occur 30 to 90 minutes after subcutaneous administration. With subcutaneously administered regular human insulin, peak serum concentrations occur within two to four hours.
Therefore, regular human insulin therapy may lead to hypoglycemia between meals i. The duration of activity for insulin lispro is less than five hours, compared with six to 10 hours for regular human insulin personal communication from Eli Lilly and Company, based on data on file, September With injection in the abdomen, the peak concentration of insulin lispro is slightly higher and the duration of action slightly shorter than when the analog is administered in the arm or thigh.
However, insulin lispro is consistently absorbed faster than regular human insulin, regardless of the site of administration. Insulin lispro is available only by prescription and is indicated for the management of hyperglycemia in patients with diabetes mellitus.
Guidelines for glycemic control are listed in Table 4. Less than 80 mg per dL 4. Less than mg per dL 5. The action may include increased patient education, more frequent self-monitoring of blood glucose levels or referral to an endocrinologist. Adapted with permission from the American Diabetes Association. Standards of medical care for patients with diabetes mellitus [Position statement]. Clinical practice recommendations [Position statement]. Diabetes Care ;20 Suppl 1 :S1—S Based on product information from Eli Lilly and Company, the dosage of insulin lispro should be individualized, with therapy initiated as outlined in Table 5.
Patients who use insulin lispro should monitor their blood glucose levels frequently, especially their postprandial levels. The U. Food and Drug Administration has not approved insulin lispro for continuous subcutaneous infusion therapy, although this method has been used in clinical studies.
Insulin lispro also is not approved for intravenous or intramuscular administration. Twice-daily injection regimen. Before breakfast. Before dinner. Multiple daily injection regimens. Before lunch. Before bedtime. The selection of a specific regimen depends on the physician's judgment, based on his or her knowledge of the specific patient. Insulin lispro is physically compatible with Eli Lilly's intermediate-acting human insulins Humulin N, Humulin L and longer-acting human insulin Humulin U.
Insulin lispro may be mixed in the same syringe with these insulins, provided that the injection is administered immediately. Not enough information is available to determine whether insulin lispro can be mixed with other insulin types in pre-drawn syringes.
Animal insulins or human insulins produced by companies other than Eli Lilly should not be mixed with insulin lispro, because compatibilities have not yet been confirmed. However, it can be left unrefrigerated for up to 28 days, at which time it must be discarded. Insufficient information exists concerning the effect of impaired renal or hepatic function on insulin lispro levels.
Dose adjustments may be necessary because of the possibility of higher insulin concentrations in patients with renal or hepatic disease. Hypoglycemia can occur if patients do not eat within 15 minutes after receiving insulin lispro. Furthermore, patients may experience postprandial hypoglycemia if the carbohydrate content of a meal is too low.
Thus, the dosage of insulin lispro may need to be adjusted for meal composition and size. Late postprandial hyperglycemia can occur if the insulin lispro dosage is decreased and the patient subsequently consumes a low-carbohydrate meal. The overall rate of hypoglycemia has not differed for diabetic patients receiving insulin lispro or regular human insulin. However, patients with type 1 diabetes who are treated with insulin lispro have been found to have fewer hypoglycemic episodes between midnight and 6 a.
The DCCT 26 established that the incidence of severe treatment-induced hypoglycemia increases significantly with intensive therapy. Severe hypoglycemia is defined as any episode of hypoglycemia that impairs the patient's neurologic function so that the assistance of another person is required. Some patients with type 1 diabetes fear severe hypoglycemia as much as the long-term complications of the disease. The magnitude of exercise-induced hypoglycemia with insulin lispro depends on the interval between insulin administration and exercise.
Compared with regular human insulin, insulin lispro is more likely to prevent exercise-induced hypoglycemia in patients with type 1 diabetes who choose to exercise two to three hours after a meal. Practical considerations for patients experiencing hypoglycemic reactions are listed in Table 6.
Eyesight deteriorates as a consequence of diabetic and nondiabetic eye disease. Examine the injection sites; if necessary, remind the patient to rotate these sites. Patients with longstanding diabetes often use single injection sites because they seem relatively pain-free; insulin absorption from these sites is notoriously variable. Instruct the patient to monitor blood glucose levels frequently at the time of a change in insulin therapy.
Check the patient's monitoring technique for common mistakes, including not having sufficient blood on the stick, incorrect wiping of the sample and incorrect timing before the stick is read.
The newer self-monitoring devices have eliminated most errors of timing and wiping, and some even tell the patient that insufficient blood is on the stick. The device is programmed to deliver a preset dose of insulin. Rates of insulin allergy, lipodystrophy, hypoglycemia and abnormal laboratory test results have not differed in patients using insulin lispro or regular human insulin.
No studies have specifically evaluated drug interactions in diabetic patients who are receiving lispro insulin. Close monitoring of blood glucose levels is important when a drug regimen is changed in any patient with diabetes.
Insulin lispro has been found to be a safe and effective treatment for diabetes mellitus. Improvement in glycemic control is demonstrated by a decreased postprandial blood glucose concentration, although the clinical significance of this improvement is as yet unknown. Multinational clinical trials have shown no statistically significant difference between hemoglobin A 1c levels in patients treated with insulin lispro and patients treated with regular human insulin.
Based on risk analysis of the DCCT data, this improvement in hemoglobin A 1c represents an approximately 20 percent reduction in the risk of retinopathy in patients with diabetes. Near-normal glycemic control is necessary to prevent or delay the onset of complications in patients with type 1 or type 2 diabetes.
Patients with type 2 diabetes who have not responded to oral glucose-lowering agents often require insulin therapy to achieve the glycemic goals set forth by the American Diabetes Association.
One study 31 in both type 1 and type 2 diabetics concluded that insulin lispro improves postprandial glycemic control without increasing the risk of hypoglycemia. Special dosing considerations for insulin lispro are listed in Table 7. Because of insulin lispro's shorter duration of action, hyperglycemia may occur because the time from lunch to dinner may be too long.
Consider adding a small dose of intermediate-acting NPH insulin at lunch to meet basal insulin requirements between meals. Consider adding an additional dose of insulin lispro; if the patient also eats dinner late in the evening, this additional dose of insulin lispro can replace lunchtime basal NPH insulin supplementation.
Patient is a slow eater or a grazer i. Because of the rapid onset of insulin lispro, this type of patient may not respond as well to insulin lispro as to regular human insulin. Insulin lispro offers the patient flexibility, in that the administration of this insulin can be timed with meals.
This patient could benefit from the substitution of insulin lispro for regular human insulin to decrease postprandial blood glucose excursions. The patient who uses insulin lispro can expect fewer episodes of hypoglycemia if the exercise is undertaken 2. Information from Bohannon NJ. Benefits of lispro insulin: control of postprandial glucose levels is within reach.
Postgrad Med ; 2 —6,79— Primary care physicians should consider including mealtime insulin lispro in insulin regimens. The disadvantages of insulin lispro therapy are the increased risk of hypoglycemia if meal ingestion or absorption gastroparesis is delayed and the increased overall cost of therapy. In addition, insulin lispro is available by prescription only.
Nonetheless, a short-acting insulin analog such as insulin lispro should provide increased convenience and flexibility to patients who are currently receiving regular human insulin. People who have type 2 diabetes often take diabetes pills or insulin shots to improve their blood sugar levels. Insulin exists in suspension form. It comes in different strengths. The standard strength used in the United States is U This means that it contains units of insulin per milliliter of liquid.
While the strength of insulin varies, its action depends on three characteristics: onset, peak time, and duration. Onset refers to the length of time it takes for the insulin to start lowering the blood sugar level. Peak time refers to the time when the insulin is at its maximum efficacy in lowering blood sugar levels. Lastly, duration refers to how long insulin continues to lower blood sugar levels for.
Insulin is not available in pill form because your digestive enzymes can break it down. Insulin is, after all, a protein. Injecting it under the fat of the skin effectively transports it to the blood. There are several different types of insulin available for people who have diabetes:. Researchers have pointed out that the behavior of insulin after administration can vary. This means that there is a tendency for insulin not to follow the standard onset for it to start working.
There are different factors that influence the absorption of insulin. People with diabetes typically use three regions as the injection sites for their insulin: the upper arm, upper leg, and abdomen. Out of the three sites, the abdomen results in the most effective and rapid absorption of insulin. The upper leg region results in the slowest. The higher the insulin concentration, the more rapid the diffusion and rate of absorption. The most common insulin formulation is U, but U and old U, which is no longer manufactured, are also available.
Insulin should be injected into the fat layer just underneath the skin, where capillaries are abundant. People who are obese tend to have less blood flow in their fat tissue, which can cause a delay in insulin onset, peak, and duration following the injection. In high concentrations, such as in a vial or cartridge, human and also animal insulin clumps together. This clumping causes slow and unpredictable absorption from the subcutaneous tissue and a dose-dependent duration of action i.
In contrast, insulin analogs have a more predictable duration of action. Insulin has been available since It was initially extracted from beef and pork pancreases. Synthetic human insulin has replaced beef and pork insulin in the US. And now, insulin analogs are replacing human insulin.
Insulin is usually injected into the fatty tissue just under the skin. This is also called subcutaneous tissue. See a table of insulin action below and a graphic illustration of onset of action , peak effect and duration of action of the different insulins.
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