ABOUT

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Insulin lispro, sold under the brand name Humalog among others, is a type of insulin used to treat type 1 and type 2 diabetes.^[3] Typically it is taken around the time of eating.^[3] It is used by injection under the skin or within an insulin pump.^[3][4] Onset of effects typically occurs within 30 minutes and lasts about 5 hours.^[3] Often a longer acting insulin like NPH is also needed.^[3]

Common side effects include low blood sugar.^[3] Other serious side effects may include low blood potassium.^[3] Use in pregnancy and breastfeeding is generally safe.^[5] It works the same as human insulin by increasing the amount of glucose that tissues take in and decreasing the amount of glucose made by the liver.^[3]

Insulin lispro was first approved for use in the United States in 1996.^[3][6][7] It is a manufactured form of human insulin where an amino acid has been switched.^[8] In 2018, it was the 90th most commonly prescribed medication in the United States, with more than 8 million prescriptions

Medical uses

Insulin lispro is used to treat people with type 1 diabetes or type 2 diabetes.^[3] People doing well on regular insulin should not generally be changed to insulin lispro.^[3]

Side effects

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Common side effects include skin irritation at the site of injection, hypoglycemia, hypokalemia, and lipodystrophy.^[6] Other serious side effects include anaphylaxis, and hypersensitivity reactions.^[6]

Contraindications

Do not administer insulin lispro during episodes of hypoglycemia, or if a person has a hypersensitivity to insulin lispro or any of its excipients.^[6]

Mechanism of action

Through recombinant DNA technology, the final lysine and proline residues on the C-terminal end of the B-chain are reversed. This modification does not alter receptor binding, but blocks the formation of insulin dimers and hexamers. This allows larger amounts of active monomeric insulin to be immediately available for postprandial injections.^[11]

Chemistry

It is a manufactured form of human insulin where the amino acids lysine and proline have been switched at the end of the B chain of the insulin molecule.^[8]

Cost

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In the United States, in 2015, the cost was between US$10.06 and US$29.36 per 100 units.^[12] In April 2019, Eli Lilly and Company announced they would produce a version selling for US$137.35 per vial, about half the then current cost. The chief executive said that this was a contribution “to fix the problem of high out-of-pocket costs for Americans living with chronic conditions”, but Patients for Affordable Drugs Now said this was just a public relations move, as “other countries pay US$20 for a vial of insulin.”^[13]