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Rapid-acting Insulin Analogue Pregnancy: Licensed for use in pregnancy (NICE NG3). Monitor closely — insulin requirements increase in second and third trimesters then fall sharply post-delivery.

Insulin Lispro

Brand names: Humalog, Admelog

Adult dose

Dose: 0.05–0.1 units/kg per meal (typical prandial dose); total daily dose individualised as part of basal-bolus regimen
Route: Subcutaneous injection (or IV in DKA under specialist supervision)
Frequency: Immediately before meals (or up to 15 minutes before); can be given immediately after meal if intake uncertain
Max: Individualised per carbohydrate intake and insulin:carb ratio
MHRA safety requirement: prescribe by brand name (Humalog). Onset 15 min, peak 30–90 min, duration 2–5 hours. Must always be used with a basal insulin in Type 1 DM.

Paediatric dose

Dose: 0.05 units/kg
Route: Subcutaneous injection
Frequency: With meals
Max: Individualised per carbohydrate intake
BNFc: Licensed from age 2 years. Carbohydrate-counting approach used — seek specialist paediatric endocrinology guidance for insulin:carb ratios.

Dose adjustments

Renal

Insulin requirements decrease with declining eGFR — monitor closely and reduce dose; hypoglycaemia risk is increased.

Hepatic

Hepatic impairment reduces gluconeogenesis — monitor closely, dose reduction may be needed.

Paediatric weight-based calculator

BNFc: Licensed from age 2 years. Carbohydrate-counting approach used — seek specialist paediatric endocrinology guidance for insulin:carb ratios.

Clinical pearls

  • Antidote for hypoglycaemia: oral glucose (if conscious); IM glucagon 1mg (GlucaGen/Baqsimi nasal) or IV dextrose 10% 150mL (if unconscious)
  • Rapid-acting analogues (lispro, aspart, glulisine) have lower postprandial glucose excursions vs. soluble human insulin
  • Missed meal after injection — risk of severe hypoglycaemia; patient education essential
  • Humalog U200 pen available — verify concentration to prevent dosing errors

Contraindications

  • Hypoglycaemia
  • Hypersensitivity to insulin lispro or excipients

Side effects

  • Hypoglycaemia
  • Injection site lipohypertrophy
  • Peripheral oedema at initiation
  • Local allergic reactions

Interactions

  • Alcohol — unpredictable glucose response
  • Beta-blockers — mask hypoglycaemia symptoms
  • Corticosteroids, growth hormone — antagonise glucose-lowering effect
  • Sulphonylureas, MAOIs — additive hypoglycaemic effect

Monitoring

  • Pre- and post-meal glucose
  • HbA1c 3 monthly
  • Continuous glucose monitoring (CGM) if available
  • Hypoglycaemia awareness

Reference: BNFc; BNF 90; NICE NG17 (Type 1 DM); NICE NG28 (Type 2 DM); MHRA Insulin Safety Alert. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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