Lispro insulin (HumalogŪ brand), the first of the rapid-acting insulin
analogs, has been available
for a number of years.
Here are some comments, originally written in 1996,
for you to ponder before you decide whether to start using it or the other rapid-acting
insulin analogs (Novolog
and
Apidra).
-
Can take with meals (sometimes even after eating!)
- Use same number of units as Regular insulin
- Can mix with NPH or Ultralente
(there's no effect on the duration of activity of
lispro if mixed with Ultralente; there may be
a slight increase in duration of effect when mixed with NPH)
- Can be injected anywhere without difference in absorption rate
- Will not linger like Regular does:
- less nocturnal hypoglycemia (nighttime low sugar problems)
- less need for late-morning or late-afternoon snacks
- May permit better blood sugar control
- Also available in disposable glass cartridges
- More expensive
- Needs prescription (some other insulins do not)
(Ask your Diabetes Team for a "spare copy" of your lispro prescription to keep with you so you'll
always be able to get a bottle!)
- Not yet well-studied in kids under 3 nor in pregnancy
- Not advised for people with:
- Uncontrolled gastroparesis (unreliable stomach functioning);
-
acarbose (Precose) therapy;
- extremely stable diabetes with excellent control and unwilling to change;
- pregnancy (since it's not yet been extensively studied in this group of people). However, there are
a number of small studies indicating that it's probably safe for use in pregnancy (see
Pregnancy Update, below).
- Should check blood sugar frequently (at least four times per day)
when switching from Regular, including checking 2 to 3 hours after eating (at least once daily).
- Should discuss at office visit before initiating therapy
- Should have frequent telephone contact (at least weekly) when initiating therapy
- Will need revamped rules for timing of shot depending on blood sugar level:
Possible example:
if blood sugar is under 100, eat something then give lispro;
if under 80, eat entire meal then give lispro
- Insulin reactions, when they occur while on lispro insulin, will need less calories to treat
(about 15 grams of carb) (rather than 20 grams used for treating insulin reactions when on Regular insulin)
- Snacks may need a small dose of lispro to prevent the blood sugar from going up after the snack
- You might plan to use lispro at the time of some meals, and Regular 1/2 hour before other meals, if you have both insulin products, and remember
which insulin works promptly and which takes a half hour to get going.
- Although lispro works very well in insulin pumps,
we strongly advise that pump
patients using Regular should not switch to lispro without discussions
with a diabetes educator who know about both insulin pumps and
lispro insulin!
New in 2000:
Another company, Novo-Nordisk, is introducing a similar product, called
insulin aspart (NovoRapid®, NovoLog®).
Pregnancy Update, 2002:
There have been several studies looking at Humalog use in
pregnancy. None showed any adverse outcomes for the baby beyond what
would be expected in diabetes and some demonstrated better glucose control
in the mother compared to Regular insulin. Clinical experience and the current literature suggests that Humalog is probably safe for use in
pregnancy.
See the following abstracts (at
PubMed):
New in 2004:
Another company, Aventis, is introducing a similar product, called
insulin glulisine (Apidra®).
Also see
Lispro Insulin
at the
DiabetesMonitor
The Wait is Over
From the August, 1996 issue of the Diabetes Forecast.
HumalogŪ
Now Available for Diabetes
(includes technical information)
from the Doctor's Guide to the Internet.
Lispro information at
Eli Lilly's website.
The Humalog Family of Insulin Products.
From
Eli Lilly
|
|
|
