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Insulin Lispro (Humalog) by Katie Neal and…
Insulin Lispro (Humalog)
by Katie Neal and Jenna Machin
Medication Overview
Indications
Mainly used for the control of hyperglycemia in clients with Type 1 or Type 2 diabetes mellitus. Can be used off-label to treat clients with mild-to-moderate diabetic ketoacidosis or gestational diabetes mellitus.
Contraindications
Hypoglycemia
Signs and Symptoms:
anxiety, restlessness, cool pale skin, confusion, drowsiness, excessive hunger, headache, irritability, nausea
known allergies or hypersensitivities
Interactions
Insulin has significant drug-on-drug interactions due to the combined additive effects that would result in increased hypoglycemia, or antagonizing effect on insulin which would result in increased plasma glucose levels
hypoglycemic drugs
nonselective ß-blockers
anabolic steroids
salicylates
Monoamine oxidase inhibitors (MAOIs)
corticosteroids
alcohol
diuretics
thyroid drugs
sympathomimetic drugs
niacin
sulfa antibiotics
estrogens
ACE inhibitors
Natural products
Glucosamine may worsen blood glucose control
Classification
rapid-acting insulin
considered High Alert
Human recombinant rapid-acting insulin analogue
Anti-diabetic agent
Nursing Implications
Assessment
plasma glucose must be tested prior to insulin administration
Monitor body weight changes- any significant changes may need a change in insulin dose
Assess Joseph's knowledge of diabetes and insulin
Thorough medication history
Assess financial situation to determine if there will be financial barriers to frequent blood glucose monitoring
Examine appearance of vial prior to administration
Do not use if it is cloudy, unusual viscosity, coloured, or clumpy
Patient Education
medical alert
carry a physical or digital medical alert card
include diagnoses, medications, allergies
wear medical alert jewelry
foot care
Check feet and toes daily for sores, lesions, cuts, bruises, ingrown toenails, other changes
soak feet daily in lukewarm water, dry, and moisturize
Check feet and legs for abnormal changes in colour, swelling, drainage, cool temperature
contact health care provider if there is any wound or alteration in skin integrity
Report yellow discoloration of skin, dark urine, fever, sore throat, weakness, unusual bleeding, easy bruising to health care provider
Insulin lispro should be taken 15 minutes before a meal
It is important to eat a meal after this medication has been administered, otherwise hypoglycemia may occur
Cartridges should not be used by anyone else, even if the needle is changed
Storage
Store the preparation in the refrigerator between 2 and 8 degrees celsius
Store cartridges, vials, and pens that are currently in use at room temperature below 30 degrees Celsius
Discard after 28 days
Implementation
Monitor blood glucose every 6 hours during therapy, or more often while determining if this medication is improving control of Joseph's plasma glucose levels
Give 15 minutes before meal
Monitor for signs of hypoglycemia and hyperglycemia
Early signs and symptoms may be different from what Joseph experienced on his previous insulin
Monitor potassium levels since Joseph is at risk for hypokalemia
Scenario:
Joseph is a 58-year-old bus driver who received a diagnosis of type 2 diabetes 10 years ago; he has needed to take insulin for the last 2 years. He has been recovering, without complications, from a laparoscopic cholecystectomy; however, his plasma glucose levels have shown significant fluctuations over the last 24 hours. The health care provider has changed his insulin to lispro (Humalog) to evaluate whether this improves control of his plasma glucose levels.
Pharmacodynamics
Mechanism of Action
Functions as a substitute for the endogenous hormone insulin. Insulin binds to glycoprotein receptors on a variety of target tissue cells, and regulates the metabolism of carbohydrates, proteins, and fats.
Therapeutic effects
control of hyperglycemia in diabetes clients
Adverse effects
Hypoglycemia
hypersensitivity reactions
hypokalemia
rash
pruritus
injection-site reactions
weight gain
peripheral edema
lipodystrophy
Effects on Body Systems
Integumentary
Adipose tissue is a target tissue for insulin. It produces free fatty acids by supporting the processing of circulating lipoproteins. This also helps with adipocyte storage, the synthesis of triglycerides, and the inhibition of the hydrolysis of triglycerides. In summary, uptake of glucose is stimulated in fat tissue.
Musculoskeletal
Insulin binds with glycoprotein receptors of the skeletal muscle and works to increase the synthesis of protein and glycogen
Respiratory
none identified
Circulatory
decreases the amount of circulating glucose molecules
GI
The liver is one of the target tissues in which insulin binds to the glycoprotein receptors. It then stimulates the synthesis of hepatic glycogen and promotes the synthesis of fatty acids
Endocrine
exogenous hormone replacing endogenous insulin, which is typically created and distributed by this system
Neuro
not dependent on insulin for glucose uptake, so administration of insulin has little affect
GU
Short post-meal decrease in glomerular filtration and renal perfusion
Pharmacokinetics
Route
Subcutaneous is most common and advised for clients to self-administer. IV administration
Onset of Action
10-15 minutes
Peak Plasma Concentration
1-2 hours
Elimination half-life
60-80 minutes
Duration of Action
3.5-4.75 hours