Nurses Compass
Drug Guide
Insulin Lispro Recombinant
Classification
Therapeutic: Antidiabetic agent
Pharmacological: Rapid-acting insulin
FDA Approved Indications
- Type 1 diabetes mellitus in adults and children
- Type 2 diabetes mellitus in adults and children for blood sugar control
Mechanism of Action
Insulin Lispro is a recombinant human insulin analog that mimics endogenous insulin by facilitating cellular glucose uptake, inhibiting hepatic glucose production, and promoting lipid and protein synthesis. Its rapid onset of action helps control postprandial blood sugar levels.
Dosage and Administration
Adult: Dose individualized based on patient needs, typically administered 15 minutes before or immediately after meals.
Pediatric: Dosing similar to adults, tailored based on clinical response.
Geriatric: Use with caution; start at lower doses due to increased risk of hypoglycemia.
Renal Impairment: Adjust dose based on glycemic responses; monitor closely.
Hepatic Impairment: No specific adjustments, but cautious titration is advised.
Pharmacokinetics
Absorption: Rapid absorption after subcutaneous injection, with onset within 15 minutes.
Distribution: Distributes throughout the extracellular fluid; no significant plasma protein binding.
Metabolism: Metabolized in the liver and other tissues to inactive metabolites.
Excretion: Excreted primarily in urine as metabolites.
Half Life: Approximately 1 hour.
Contraindications
- Hypoglycemia
- Allergy to insulin or any component of the formulation
Precautions
- Hypoglycemia risk, especially with improper dosing
- Adjustments needed during illness, stress, or surgery. Monitor for lipodystrophy at injection sites.
- Pregnancy category B: Use if benefits outweigh risks. Insulin is generally safe during pregnancy and lactation.
Adverse Reactions - Common
- Hypoglycemia (Common)
- Injection site reactions (redness, swelling, or itching) (Common)
Adverse Reactions - Serious
- Severe hypoglycemia leading to coma or seizures (Uncommon)
- Allergic reactions, including anaphylaxis (Rare)
Drug-Drug Interactions
- Beta-blockers (may mask hypoglycemia symptoms)
- Corticosteroids (may increase blood glucose)
- Diuretics, thyroid hormones, and other antidiabetics
Drug-Food Interactions
- Alcohol (can increase or decrease blood sugar)
Drug-Herb Interactions
N/ANursing Implications
Assessment: Monitor blood glucose levels regularly; assess for hypoglycemia and injection site reactions.
Diagnoses:
- Risk for unstable blood glucose
- Risk for hypoglycemia or hyperglycemia
Implementation: Administer subcutaneously; rotate injection sites; educate patient on blood glucose monitoring.
Evaluation: Evaluate effectiveness by blood glucose trends and reduction in hyperglycemia symptoms.
Patient/Family Teaching
- Instruct on proper injection technique and site rotation.
- Educate on recognizing and managing hypoglycemia (shaking, sweating, confusion).
- Emphasize the importance of blood glucose monitoring.
- Inform about possible side effects and when to seek medical attention.
Special Considerations
Black Box Warnings:
- Severe hypoglycemia risk with improper dosing or missed meals.
Genetic Factors: No specific genetic considerations.
Lab Test Interference: May interfere with certain laboratory blood glucose measurements.
Overdose Management
Signs/Symptoms: Severe hypoglycemia: sweating, trembling, confusion, loss of consciousness.
Treatment: Administer oral glucose if conscious; glucagon injection or IV glucose if unconscious; contact emergency services.
Storage and Handling
Storage: Store unopened vials or pens in refrigerator at 2-8°C; avoid freezing.
Stability: Unopened pens/vials are stable until the expiration date; opened pens can usually be kept at room temperature up to 28 days, depending on manufacturer instructions.