Insulin lispro
Also known as: Admelog, B28 lispro, B28Lys,B29Pro human insulin, Humalog, Insulin lispro, Lispro insulin, LY275585, Lyumjev
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Summary
Insulin lispro is a rapid‑acting insulin analogue approved for subcutaneous, intravenous, and pump delivery. It is used to control post‑prandial glucose spikes in people with type 1 or type 2 diabetes, and is also approved for use during pregnancy.
Mechanism of Action
Lispro is a modified human insulin that lacks the tendency to form hexamers, allowing it to be absorbed quickly after injection. It binds the insulin receptor on target cells, activating the PI3K‑Akt pathway to promote glucose uptake and inhibit hepatic glucose production. The rapid appearance of monomeric insulin yields a faster onset and shorter duration than regular human insulin.
What the Research Shows
A 1998 meta‑analysis of eight randomized trials (2,576 type 1 patients) found that lispro reduced severe hypoglycaemia compared with regular human insulin (3.1% vs 4.4% of participants). A 2002 review noted faster absorption and greater post‑prandial glucose lowering, but only modest HbA1c improvements and limited hypoglycaemia reduction. A 2024 network meta‑analysis of basal insulins reported that insulin lispro protamine (ILPS) was associated with higher odds of overall and nocturnal hypoglycaemia versus newer basal analogues. The SURPASS‑6 trial (2023) showed that, when added to basal insulin, lispro resulted in less HbA1c reduction, weight gain, and more hypoglycaemia than tirzepatide. A 2015 review of gestational diabetes highlighted lispro’s approval in pregnancy and its more physiological profile.
Reported Benefits
Lispro provides a rapid onset that better matches meal‑related glucose excursions, leading to improved post‑prandial control. Evidence from a meta‑analysis indicates a lower rate of severe hypoglycaemia versus regular insulin in type 1 diabetes. It is approved for use in pregnancy and can be delivered via pump for flexible dosing.
Limitations of the Evidence
Clinical trials have shown only modest HbA1c benefits and variable impact on overall hypoglycaemia risk. When formulated as a basal insulin (ILPS), lispro is linked to higher hypoglycaemia compared with newer basal analogues. Direct comparative data with other rapid‑acting analogues are limited, and optimal timing with meals is critical for efficacy.
Safety Considerations
The main safety concern is hypoglycaemia, especially if lispro is administered without adequate carbohydrate intake or at the wrong time relative to meals. Weight gain may occur with intensive use. No specific serious adverse events were reported in the cited studies, but higher hypoglycaemia rates were noted versus tirzepatide in a recent trial.
How It Is Administered
Insulin lispro is administered subcutaneously, typically 15 minutes before meals, or via continuous subcutaneous infusion pumps for basal‑bolus regimens. Intravenous use is reserved for acute settings such as hospitalization. Formulations are supplied as clear solutions for injection.
Routes of Administration
Goals & Uses
- Gestational diabetes requiring insulin therapyObstetric Glycemic ManagementModerate
- Prandial glycemic control in type 1 diabetesGlycemic ManagementHigh
- Management of diabetic ketoacidosis (IV use)Acute Diabetes ManagementModerate
- Glycemic controlDiabetesHigh
- Continuous subcutaneous insulin infusion (CSII)Delivery OptimizationHigh
- Prandial glycemic control in type 2 diabetesGlycemic ManagementHigh
Contraindications
- Hypersensitivity to insulin lispro or its excipientsImmunologicModerate
- Hypersensitivity to insulin lispro or excipientsImmunologicHigh
- Hypoglycemia (active episode)MetabolicHigh
- HypoglycemiaMetabolicHigh
Adverse Effects
- HypokalemiaElectrolyteUncommon
- HypoglycemiaMetabolicCommonAbnormally low blood glucose
- Peripheral edemaFluid BalanceUncommonSwelling of the arms or legs
- Injection site reactionsLocalUncommon
- Injection site reactions (lipohypertrophy, lipoatrophy)Local / DermatologicCommon
- Anaphylaxis/systemic allergic reactionsImmunologicRare
- Weight gainMetabolicCommonIncrease in body weight
Drug Interactions
- Thiazolidinediones (e.g., pioglitazone)Moderate
- Beta‑blockersModerate
- Salicylates (high-dose aspirin)Low
- Beta-blockersModerate
- AlcoholModerate
- CorticosteroidsModerate
- ACE inhibitorsLow
Population Constraints
- PregnancyReproductive SafetyRelative
- Hepatic impairmentOrgan FunctionRelative
- Renal impairmentOrgan ImpairmentRelative
- Pediatric patientsAgeRelative
- Elderly patientsAgeRelative
- Pregnant womenReproductiveRelative
- Pediatric patients (<2 years)AgeRelative
Regulatory Status
- European UnionApprovedApproved: type 1 diabetes mellitus, type 2 diabetes mellitusEMA approval; same brand names.
- United StatesApprovedApproved: type 1 diabetes mellitus, type 2 diabetes mellitusFDA approved 1996; marketed as Humalog.
- United KingdomApprovedApproved: type 1 diabetes mellitus, type 2 diabetes mellitusMHRA approval; available as Humalog.
Approved in the US (FDA), EU (EMA), and UK (MHRA) as a rapid‑acting mealtime insulin. Marketed under the brand name Humalog.
Evidence & Sources
- Journal ArticleHighDehghani M, et al.2024-01-01T00:00:00.000000Z
- Journal ArticleHighBrunelle BL, et al.1998-01-01T00:00:00.000000Z
- Journal ArticleModerateHeller SR2002-01-01T00:00:00.000000Z
- Journal ArticleModerateRosenstock J, et al.2023-01-01T00:00:00.000000Z
- Journal ArticleModerateAlfadhli EM2015-01-01T00:00:00.000000Z
Frequently Asked Questions
How quickly does insulin lispro start working?
Lispro begins to lower blood glucose within about 10–15 minutes after subcutaneous injection, peaks around 1 hour, and its effect wanes after 2–4 hours, matching the timing of a typical meal.
Is insulin lispro safe to use during pregnancy?
Yes, regulatory agencies have approved lispro for use in gestational diabetes. Reviews note it is more physiological than regular insulin and is associated with a lower risk of hypoglycaemia in pregnant women.
Can I use a pump with insulin lispro?
Lispro can be delivered via continuous subcutaneous insulin infusion pumps, providing flexible basal and bolus dosing. Pump use requires proper training and regular monitoring to avoid dosing errors.
Why might lispro cause more hypoglycaemia than newer basal insulins?
When formulated as a basal insulin (ILPS), lispro’s rapid action can lead to peaks that increase the chance of low blood glucose, especially at night, compared with newer long‑acting analogues that have flatter profiles.
How does lispro compare to tirzepatide for added prandial control?
In the SURPASS‑6 trial, tirzepatide added to basal insulin lowered HbA1c more, reduced weight, and caused far fewer hypoglycaemic events than adding thrice‑daily lispro. Lispro remains a standard prandial insulin but may be less effective than newer agents in some patients.
What is Insulin lispro?
Insulin lispro is a rapid‑acting insulin analogue approved for subcutaneous, intravenous, and pump delivery. It is used to control post‑prandial glucose spikes in people with type 1 or type 2 diabetes, and is also approved for use during pregnancy.
What is Insulin lispro used for?
Insulin lispro is educationally associated with: Gestational diabetes requiring insulin therapy, Prandial glycemic control in type 1 diabetes, Management of diabetic ketoacidosis (IV use), Glycemic control, Continuous subcutaneous insulin infusion (CSII), Prandial glycemic control in type 2 diabetes. Educational only — not medical advice.
How is Insulin lispro administered?
Recorded routes of administration: Continuous Subcutaneous Infusion (pump), Intravenous, Subcutaneous.
What are the potential side effects of Insulin lispro?
Reported adverse effects include: Hypokalemia, Hypoglycemia, Peripheral edema, Injection site reactions, Injection site reactions (lipohypertrophy, lipoatrophy), Anaphylaxis/systemic allergic reactions, Weight gain. This list is not exhaustive — consult a qualified clinician.
Who should avoid Insulin lispro?
Recorded contraindications: Hypersensitivity to insulin lispro or its excipients, Hypersensitivity to insulin lispro or excipients, Hypoglycemia (active episode), Hypoglycemia. Consult a qualified clinician before use.