Insulin lispro + insulin lispro protamine

Subcutaneous
Diabetes mellitus
Adult: Dosage is individualised and adjusted according to metabolic needs, blood glucose level and therapeutic goals of the patient (may refer to detailed product guidelines).
Renal impairment: Dosage reduction may be needed.
Hepatic impairment: Dosage reduction may be needed.

Hypersensitivity. Hypoglycaemic episodes.

Patient with chronic diabetes, recurrent hypoglycaemia, diabetic nerve disease, risk for hypokalaemia or with illness or emotional disturbances. Increased work or exercise without eating and changes in meal pattern or level of physical activity. Changes in insulin strength, brand, type and/or administration method may lead to abnormal glycaemic control and predispose to hypo- or hyperglycaemia. Renal and hepatic impairment. Pregnancy and lactation. Patient Counselling This drug may cause hypoglycaemia which may impair ability to concentrate and react, if affected, do not drive or operate machinery. Rotate injection sites within the same region to reduce risk of lipodystrophy. Monitoring Parameters Monitor blood glucose, HbA_1C twice a year or quarterly, renal and hepatic function, weight, serum K (as necessary), and signs and symptoms of hypoglycaemia.

Significant: Hypoglycaemia. Injury, poisoning and procedural complications: Local allergy at injection site including redness, swelling and itching, lipodystrophy. Investigations: Weight gain. Metabolism and nutrition disorders: Oedema. Skin and subcutaneous tissue disorders: Pruritus, rash.
Potentially Fatal: Severe hypoglycaemia, hypokalaemia. Severe allergic reactions, including anaphylaxis.

Symptoms: Hypokalaemia and hypoglycaemia associated with listlessness, confusion, palpitations, headache, sweating, and vomiting. Management: For mild hypoglycaemia, administer oral glucose or other saccharated products. For more severe hypoglycaemia, administer IM or SC glucagon, followed by oral carbohydrate by the time the patient recovers sufficiently; consider IV glucose solution when patient fails to respond to glucagon.

Concomitant use with peroxisome proliferator-activated receptor (PPAR)-γ agonists (e.g. pioglitazone, rosiglitazone) may cause dose-related fluid retention which may exacerbate or lead to cardiac failure. May increase risk of hypoglycaemia when given with other antidiabetic agents, antihypertensive agents (e.g. ACE inhibitors, angiotensin II receptor blockers, β-blockers), certain SSRIs (e.g. fluoxetine) or MAOIs, salicylates, somatostatin analogue (e.g. octreotide), pramlintide, and sulfonamide antibiotics. Decreased therapeutic effect with corticosteroids, danazol, diuretics, oestrogens or oral contraceptives, sympathomimetic agents (e.g. terbutaline, epinephrine), and thyroid hormones. Signs and symptoms of hypoglycaemia may be masked by β-blockers, clonidine, guanethidine and reserpine.

Increased risk of hypoglycaemia with alcohol.

Insulin lispro is a rapid-acting human insulin analogue while insulin lispro protamine is an intermediate-acting human insulin analogue. It acts by regulating glucose metabolism. Insulins inhibit hepatic glucose production and stimulate peripheral glucose uptake by skeletal muscle and fat, inhibiting lipolysis and proteolysis, and enhancing protein synthesis. Synonym: Biphasic insulin lispro.
Onset: 0.25-0.5 hours.
Duration: 14-24 hours.
Absorption: Two phases of absorption: Rapid onset of insulin lispro (early phase); prolonged absorption of insulin lispro protamine (late phase). Time to peak plasma concentration: 0.75-13.5 hours (50% insulin lispro protamine/50% insulin lispro); 0.5-4 hours (75% insulin lispro protamine/25% insulin lispro).
Excretion: Via urine.

Subcutaneous: Unopened vial/cartridge/pen: Store between 2-8°C. Do not freeze. Protect from direct heat and light. Once opened, cartridge/pre-filled pen may be stored below 30°C. Do not freeze or refrigerate. Opened vial may be stored between 2-8°C or below 30°C.

Insulin Preparations

A10AB04 - insulin lispro ; Belongs to the class of fast-acting insulins and analogues. Used in the treatment of diabetes.
A10AC04 - insulin lispro ; Belongs to the class of intermediate-acting insulins and analogues. Used in the treatment of diabetes.
A10AD04 - insulin lispro ; Belongs to the class of intermediate-acting combined with fast-acting insulins and analogues. Used in the treatment of diabetes.