Insulin lispro (patient information)

# Why this medication is prescribed
Insulin lispro is used to control blood sugar in people who have diabetes. Insulin lispro is in a class of medications called hormones. People who have diabetes do not produce enough natural insulin, a substance that is needed to break down carbohydrates, fats, and proteins from food and to move sugar from the blood to other parts of the body. Insulin lispro works by replacing the insulin that is normally produced by the body. Insulin lispro starts working more quickly but continues to work for a shorter time than regular insulin. Insulin lispro is always used with other medications for diabetes. You will need to use another type of insulin or take an oral medication, depending on the type of diabetes you have.

# How this medication should be used
Insulin lispro comes as a solution (liquid) to inject subcutaneously (under the skin). It is usually injected 15 minutes before a meal or immediately after a meal. Your doctor will tell you how many times you should inject insulin lispro each day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Use insulin lispro exactly as directed. Do not use more or less of it or use it more often than prescribed by your doctor.
Never use insulin lispro when you have symptoms of hypoglycemia (low blood sugar) or if you have checked your blood sugar and found it to be low. Call your doctor in these cases.
Insulin lispro controls diabetes but does not cure it. Continue to use insulin lispro even if you feel well. Do not stop using insulin lispro without talking to your doctor. Do not switch to another brand or type of insulin or change the dose of any type of insulin you are using without talking to your doctor.
Insulin lispro comes in vials, cartridges that contain medication and are to be placed in dosing pens, and dosing pens that contain cartridges of medication. Be sure you know what type of container your insulin lispro comes in and what other supplies, such as needles, syringes, or pens you will need to inject your medication.
If your insulin lispro comes in vials, you will need to use syringes to inject your dose. Be sure to use syringes that are marked U-100. Ask your doctor or pharmacist if you have questions about the type of syringe you should use.
If your insulin lispro comes in cartridges, you will need to purchase an insulin pen separately. Check the manufacturer's information for the patient to see what type of pen is right for the cartridge size you are using. Carefully read the instructions that come with your pen, and ask your doctor or pharmacist to show you how to use it. Ask your doctor or pharmacist if you have questions about the type of pen you should use.
If your insulin lispro comes in pens, be sure to read and understand the manufacturer's instructions. Ask your doctor or pharmacist to show you how to use the pen. Follow the directions carefully, and always prime the pen before use. Never remove the cartridge from the pen or attempt to add any other type of insulin to the cartridge.
Never reuse needles or syringes and never share needles, syringes, cartridges, or pens. If you are using an insulin pen, always remove the needle right after you inject your dose. Throw away needles and syringes in a puncture-resistant container. Ask your doctor or pharmacist how to dispose of the puncture resistant container.
Your doctor may tell you to mix your insulin lispro with another type of insulin in the same syringe. Your doctor will tell you exactly how to do this. Always draw insulin lispro into the syringe first, always use the same brand of syringe, and always inject the insulin immediately after mixing.
You can inject your insulin lispro in your thighs, stomach, or upper arms. Each time you inject insulin lispro you should choose a spot that is at least 1/2 inch away from the spot where you gave your last injection.
Always look at your insulin lispro before you inject it. It should be as clear, colorless, and fluid as water. Do not use your insulin lispro if it is colored, cloudy, thickened, or contains solid particles, or if the expiration date on the bottle has passed.
If your insulin lispro comes in vials, follow these steps to prepare your dose:
- Wash your hands.
- If you are using a new bottle, flip off the plastic cap, but do not remove the stopper.
- Wipe the top of the bottle with an alcohol swab.
- Pull back the plunger of the syringe until the top of the plunger is even with the dose your doctor told you to inject.
- Push the needle through the rubber stopper on the bottle.
- Push down on the plunger to inject the air into the bottle.
- Turn the bottle upside down without removing the syringe.
- Be sure the tip of the needle is under the liquid in the bottle. Slowly pull back on the plunger until the top of the plunger is even with the dose your doctor told you to inject.
- While the needle is still in the bottle, check whether there are air bubbles in the syringe. #If there are bubbles, hold the syringe upright and tap on it to push the bubbles to the top. #Push the plunger up to move the bubbles out of the syringe, and then pull the plunger back down to the correct dose.
- Remove the needle from the bottle and lay the syringe down so that the needle is not touching anything.
To inject a prepared dose of insulin lispro using a syringe or pen, follow these steps:
- Use an alcohol pad to wipe the area where you plan to inject your medication.
- Pinch up a large area of skin, or spread the skin flat with your hands.
- Insert the needle into your skin. Your doctor will tell you exactly how to do this.
- If you are using a syringe, push the plunger all the way down. If you are using a pen, follow the manufacturer's instructions for dispensing a dose.
- Pull the needle out and press down on the spot for several seconds, but do not rub it.

# Other uses for this medicine
This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

# Special precautions
Before using insulin lispro:
- tell your doctor and pharmacist if you are allergic to insulin (Humulin, Iletin, Novolin, Velosulin, others) or any other medications.
- tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking. Be sure to mention any of the following: angiotensin converting enzyme (ACE) inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), fosinopril (Monopril), lisinopril (Prinivil, Zestril), moexipril (Univasc), perindopril, (Aceon), quinapril (Accupril), ramipril (Altace), and trandolapril (Mavik); antacids; antihistamines; beta blockers such as atenolol (Tenormin), labetalol (Normodyne), metoprolol (Lopressor, Toprol XL), nadolol (Corgard), and propranolol (Inderal); digoxin (Digitek, Lanoxin); diuretics ('water pills'); cholesterol-lowering medications such as niacin (Niacor, Niaspan); hormone replacement therapy; isoniazid (INH, Nydrazid); laxatives; medications for mental illness and upset stomach; monoamine oxidase inhibitors including isocarboxazid (Marplan), phenelzine (Nardil), selegiline (Eldepryl) and tranylcypromine (Parnate); oral contraceptives (birth control pills); oral medications for diabetes; oral steroids such as dexamethasone (Decadron, Dexone), methylprednisolone (Medrol), and prednisone (Deltasone); salicylate pain relievers such as aspirin, choline magnesium trisalicylate (Trisalate), choline salicylate (Arthropan), diflunisal (Dolobid), magnesium salicylate (Doan's, others), and salsalate (Argesic, Disalcid, Salgesic); sodium polystyrene sulfonate (Kayexalate); sulfa antibiotics; theophylline (TheoDur) and thyroid medications. Your doctor may need to change the doses of your medications or monitor you carefully for side effects.
- tell your doctor if you have or have ever had nerve damage caused by your diabetes; any disease that affects your adrenal (a gland near the kidney that produces chemicals needed for fluid balance), pituitary (a gland in the head that produces many chemicals), or thyroid glands; or liver or kidney disease.
- tell your doctor if you are pregnant, plan to become pregnant, or are breast-feeding. If you become pregnant while using insulin lispro, call your doctor.
- if you are having surgery, including dental surgery, tell the doctor or dentist that you are using insulin lispro.
- ask your doctor what to do if you get sick, experience unusual stress, plan to travel across more than two time zones, or change your exercise or activity schedule. These changes can affect your dosing schedule and the amount of insulin you will need.
- ask your doctor how often you should check your blood sugar. Be aware that hypoglycemia may affect your ability to perform tasks such as driving and ask your doctor if you need to check your blood sugar before driving or operating machinery.

# Special dietary instructions
Be sure to follow all dietary recommendations made by your doctor or dietitian. It is important to eat a healthful diet, and to eat about the same amounts of the same kinds of food at about the same times each day. Skipping or delaying meals or changing the amount or kind of food you eat can cause problems with your blood sugar control.
Alcohol may cause a decrease in blood sugar. Ask your doctor about the safe use of alcoholic beverages while you are using insulin lispro.

# What to do if you forget a dose
Insulin lispro must be injected shortly before or after a meal. If you remember your dose before or shortly after your meal, inject the missed dose right away. If some time has passed since your meal, call your doctor to find out whether you should inject the missed dose. Do not inject a double dose to make up for a missed one.

# Side effects

## Minor side effects
This medication may cause changes in your blood sugar. You should know the symptoms of low and high blood sugar and what to do if you have these symptoms.
You may experience hypoglycemia (low blood sugar) while you are taking this medication. Your doctor will tell you what you should do if you develop hypoglycemia. He or she may tell you to check your blood sugar, eat or drink a food or beverage that contains sugar, such as hard candy or fruit juice, or get medical care. Follow these directions carefully if you have any of the following symptoms of hypoglycemia:
- shakiness
- dizziness or lightheadedness
- sweating
- nervousness or irritability
- sudden changes in behavior or mood
- headache
- numbness or tingling around the mouth
- weakness
- pale skin
- hunger
- clumsy or jerky movements
If hypoglycemia is not treated, severe symptoms may develop. Be sure that your family, friends, and other people who spend time with you know that if you have any of the following symptoms, they should get medical treatment for you immediately.
- confusion
- seizures
- loss of consciousness
Call your doctor immediately if you have any of the following symptoms of hyperglycemia (high blood sugar):
- extreme thirst
- frequent urination
- extreme hunger
- weakness
- blurred vision
If high blood sugar is not treated, a serious, life-threatening condition called diabetic ketoacidosis could develop. Call your doctor immediately if you have any of the these symptoms:
- dry mouth
- upset stomach and vomiting
- shortness of breath
- breath that smells fruity
- decreased consciousness
Insulin lispro may cause side effects. Tell your doctor if the following symptom is severe or does not go away:
- redness, swelling, or itching in the place where you injected insulin lispro

## Severe side effets
Some side effects can be serious. The following symptoms are uncommon, but if you experience any of them, call your doctor immediately:
- rash and itching
- difficulty breathing or swallowing
- hives
- wheezing
- fast heartbeat
- changes in the feel of your skin such as skin thickening or a little indentation in the skin
- muscle weakness
- tingling in arms or legs
- constipation
- stomach cramps
- depression
Insulin lispro may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.
If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration's (FDA) MedWatch Adverse Event Reporting program online  or by phone .

# Storage conditions needed for this medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store vials of insulin lispro in the refrigerator but do not freeze them. If necessary, you may store the vial you are using outside the refrigerator in a cool dark place for up to 28 days. If your doctor tells you to dilute your insulin lispro, the vial of diluted medication can be stored for 28 days in the refrigerator or 14 days at room temperature. Store extra insulin lispro pens and cartridges that are not in use in the refrigerator but do not freeze them. Store the pen and cartridge you are using outside the refrigerator in a cool dark place for up to 28 days. Throw away any medication that is outdated or no longer needed. Talk to your pharmacist about the proper disposal of your medication.

# In case of emergency/overdose
In case of overdose, call your local poison control center at 1-800-222-1222. If the victim has collapsed or is not breathing, call local emergency services at 911.
Insulin lispro overdose can occur if you take too much insulin lispro or if you take the right amount of insulin lispro but eat or exercise less than usual. Insulin lispro overdose can cause hypoglycemia. If you have any of the symptoms of hypoglycemia listed above, follow your doctor's instructions for what you should do if you develop hypoglycemia. Other symptoms of overdose:
- coma
- seizures

# Other information
Keep all appointments with your doctor and the laboratory. Your doctor will order certain lab tests to check your body's response to insulin lispro. Your doctor will also tell you how to check your response to insulin by measuring your blood or urine sugar levels at home. Follow these instructions carefully.
You should always wear a diabetic identification bracelet to be sure you get proper treatment in an emergency.
Do not let anyone else take your medication. Ask your pharmacist any questions you have about refilling your prescription.

# Brand names
- Humalog