Insulin lispro, sold under the brand name Humalog among others, is a

modified Modified may refer to: * ''Modified'' (album), the second full-length album by Save Ferris *Modified racing, or "Modifieds", an American automobile racing genre See also * Modification (disambiguation) * Modifier (disambiguation) Modifier may re ...

type of medical insulin used to treat type 1 and

type 2 diabetes Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urinatio ...

. It is used by injection under the skin or within an

insulin pump An insulin pump is a medical device used for the administration of insulin in the treatment of diabetes mellitus, also known as continuous subcutaneous insulin therapy. The device configuration may vary depending on design. A traditional pump ...

. Onset of effects typically occurs within 30 minutes and lasts about 5 hours. Often a longer-acting insulin like insulin NPH is also needed. Common side effects include

low blood sugar Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose bel ...

. Other serious side effects may include low blood potassium. Use in

pregnancy Pregnancy is the time during which one or more offspring develops ( gestates) inside a woman's uterus (womb). A multiple pregnancy involves more than one offspring, such as with twins. Pregnancy usually occurs by sexual intercourse, but ...

and

breastfeeding Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be expressed by hand or pumped and fed to the infant. The World Health Organization (WHO) recommends that bre ...

is generally safe. It works the same as human insulin by increasing the amount of

glucose Glucose is a simple sugar with the molecular formula . Glucose is overall the most abundant monosaccharide, a subcategory of carbohydrates. Glucose is mainly made by plants and most algae during photosynthesis from water and carbon dioxide, u ...

that tissues take in and decreasing the amount of glucose made by the liver. Insulin lispro was first approved for use in the United States in 1996. It is a manufactured form of human insulin where an

amino acid Amino acids are organic compounds that contain both amino and carboxylic acid functional groups. Although hundreds of amino acids exist in nature, by far the most important are the alpha-amino acids, which comprise proteins. Only 22 alpha ...

has been switched. In 2020, it was the 71st most commonly prescribed medication in the United States, with more than 10million prescriptions.

Medical uses

Insulin lispro is used to treat people with

type 1 diabetes Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that originates when cells that make insulin (beta cells) are destroyed by the immune system. Insulin is a hormone required for the cells to use blood sugar f ...

. People doing well on regular insulin should not generally be changed to insulin lispro.

Side effects

Common

side effect In medicine, a side effect is an effect, whether therapeutic or adverse, that is secondary to the one intended; although the term is predominantly employed to describe adverse effects, it can also apply to beneficial, but unintended, consequence ...

s include skin irritation at the site of injection,

hypoglycemia Hypoglycemia, also called low blood sugar, is a fall in blood sugar to levels below normal, typically below 70 mg/dL (3.9 mmol/L). Whipple's triad is used to properly identify hypoglycemic episodes. It is defined as blood glucose bel ...

hypokalemia Hypokalemia is a low level of potassium (K+) in the blood serum. Mild low potassium does not typically cause symptoms. Symptoms may include feeling tired, leg cramps, weakness, and constipation. Low potassium also increases the risk of an abno ...

, and

lipodystrophy Lipodystrophy syndromes are a group of genetic or acquired disorders in which the body is unable to produce and maintain healthy fat tissue. The medical condition is characterized by abnormal or degenerative conditions of the body's adipose tissue. ...

. Other serious side effects include

anaphylaxis Anaphylaxis is a serious, potentially fatal allergic reaction and medical emergency that is rapid in onset and requires immediate medical attention regardless of use of emergency medication on site. It typically causes more than one of the follo ...

, and

hypersensitivity Hypersensitivity (also called hypersensitivity reaction or intolerance) refers to undesirable reactions produced by the normal immune system, including allergies and autoimmunity. They are usually referred to as an over-reaction of the immune ...

reactions.

Mechanism of action

Through

recombinant DNA Recombinant DNA (rDNA) molecules are DNA molecules formed by laboratory methods of genetic recombination (such as molecular cloning) that bring together genetic material from multiple sources, creating sequences that would not otherwise be f ...

technology, the final

lysine Lysine (symbol Lys or K) is an α-amino acid that is a precursor to many proteins. It contains an α-amino group (which is in the protonated form under biological conditions), an α-carboxylic acid group (which is in the deprotonated − ...

and

proline Proline (symbol Pro or P) is an organic acid classed as a proteinogenic amino acid (used in the biosynthesis of proteins), although it does not contain the amino group but is rather a secondary amine. The secondary amine nitrogen is in the p ...

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

dimer Dimer may refer to: * Dimer (chemistry), a chemical structure formed from two similar sub-units ** Protein dimer, a protein quaternary structure ** d-dimer * Dimer model, an item in statistical mechanics, based on ''domino tiling'' * Julius Dimer ( ...

s and hexamers. This allows larger amounts of active monomeric insulin to be immediately available for

postprandial Prandial relates to a meal. Postprandial (from post prandium) means after eating a meal, while preprandial is before a meal. Usages of postprandial The term ''postprandial'' is used in many contexts. Gastronomic or social Refers to activities p ...

injections.

Chemistry

It is a manufactured form of human insulin where the

and

have been switched at the end of the B chain of the insulin molecule. This switch of amino acids mimics

Insulin-like growth factor 1 Insulin-like growth factor 1 (IGF-1), also called somatomedin C, is a hormone similar in molecular structure to insulin which plays an important role in childhood growth, and has anabolic effects in adults. IGF-1 is a protein that in humans ...

which also has lysine (K) and proline (P) in that order at positions 27 and 28.

History

Insulin lispro (brand name Humalog) was granted marketing authorization in the European Union in April 1996, and it was approved for use in the United States in June 1996. Insulin lispro (brand name Liprolog) was granted marketing authorization in the European Union in May 1997, and again in August 2001. Combination drugs combining insulin lispro and other forms of insulin were approved for use in the United States in December 1999. Insulin lispro Sanofi was granted marketing authorization as a biosimilar in the European Union in July 2017. Insulin lispro injection (brand name Admelog) was approved for use in the United States in December 2017. In January 2020, the

Committee for Medicinal Products for Human Use The Committee for Medicinal Products for Human Use (CHMP), formerly known as Committee for Proprietary Medicinal Products (CPMP), is the European Medicines Agency's committee responsible for elaborating the agency's opinions on all issues regardin ...

(CHMP) in the European Union recommended granting of a marketing authorization for insulin lispro acid (brand name Lyumjev) for the treatment of

diabetes mellitus Diabetes, also known as diabetes mellitus, is a group of metabolic disorders characterized by a high blood sugar level ( hyperglycemia) over a prolonged period of time. Symptoms often include frequent urination, increased thirst and increased ...

in adults. Insulin lispro (Lyumjev) was approved for use in the European Union in March 2020, and in the United States on 18 June 2020 as reported by Medscape.

Society and culture

Economics

In the United States, the price of for a vial of Humalog increased from in 2001 to 2015, or and per 100 units. In April 2019,

Eli Lilly and Company Eli Lilly and Company is an American pharmaceutical company headquartered in Indianapolis, Indiana, with offices in 18 countries. Its products are sold in approximately 125 countries. The company was founded in 1876 by, and named after, Colonel ...

announced they would produce a version selling for 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 for a vial of insulin." Lilly later launched their Insulin Affordability Solutions program capping all their insulin prices, including Humalog, at per month for both commercially insured and for those with no insurance. The cost in the United Kingdom was between and per 100 units, in 2017.

References

External links

* {{DEFAULTSORT:Insulin Lispro Diabetes Eli Lilly and Company brands Human proteins Insulin receptor agonists Insulin therapies Peptide hormones Recombinant proteins Wikipedia medicine articles ready to translate World Health Organization essential medicines de:Insulinpräparat#Insulin lispro