====== Insulin Lispro ======

Insulin lispro is a rapid-acting insulin analog used for prandial (mealtime) glucose control.

It has a faster onset and shorter duration than regular insulin.

→ [[endocrine:insulin:start|Insulin Therapy]]

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===== Mechanism of Action =====

Insulin lispro binds to the insulin receptor (tyrosine kinase receptor).

This activates:

  * IRS signaling pathways
  * PI3K/Akt cascade
  * GLUT4 translocation in muscle and adipose tissue

Physiologic effects:

Liver:
  * ↓ Gluconeogenesis
  * ↑ Glycogen synthesis

Muscle:
  * ↑ Glucose uptake
  * ↑ Glycogen storage

Adipose:
  * ↑ Glucose uptake
  * ↓ Lipolysis

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===== Pharmacokinetics =====

Lispro differs structurally from human insulin by reversing two amino acids (B28 and B29).

This prevents hexamer formation and allows rapid absorption.

Onset:
  * 10–15 minutes

Peak:
  * ~1 hour

Duration:
  * 3–5 hours

Compared to:

  * [[endocrine:insulin:regular|Regular Insulin]] → faster onset, shorter duration

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===== Clinical Use =====

  * Mealtime insulin (prandial coverage)
  * Correction dosing
  * Insulin pumps
  * Basal-bolus regimens

Typically administered:

  * Immediately before meals
  * Can be given shortly after starting a meal

Often combined with:

  * [[endocrine:insulin:glargine|Glargine]]
  * [[endocrine:insulin:degludec|Degludec]]
  * Other basal insulins

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===== Advantages =====

  * More physiologic prandial insulin coverage
  * Lower risk of delayed hypoglycemia compared to regular insulin
  * Flexible timing with meals

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===== Adverse Effects =====

  * Hypoglycemia
  * Weight gain
  * Injection site reactions

Hypoglycemia risk increases with:

  * Missed meals
  * Excess dosing
  * Increased physical activity

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===== Lispro vs Other Rapid-Acting Insulins =====

Comparable to:

  * [[endocrine:insulin:aspart|Aspart]]
  * [[endocrine:insulin:glulisine|Glulisine]]

All are rapid-acting analogs used for prandial control.

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===== Clinical Pearls =====

  * Rapid-acting insulin analog
  * Give at mealtime
  * Short duration limits stacking
  * Used in basal-bolus therapy
  * Preferred over regular insulin for prandial control

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===== Related =====

  * [[endocrine:insulin:start|Insulin Therapy]]
  * [[endocrine:insulin:regular|Regular Insulin]]
  * [[endocrine:insulin:glargine|Glargine]]
  * [[endocrine:diabetes:start|Diabetes Pharmacology]]