Insulin Lispro Protamine Suspension 75% and Insulin Lispro 25%, Injection

What are other names for this medicine?

Type of medicine: antidiabetic

Generic and brand names: insulin lispro protamine suspension and insulin lispro, injection; Humalog Mix 75/25

What is this medicine used for?

This medicine is given by injection (shots) to treat diabetes mellitus. It helps maintain the proper amount of sugar in the blood.

This medicine is a mixture of 75% of long-acting insulin and 25% short-acting insulin.

What should my health care provider know before I take this medicine?

Before taking this medicine, tell your health care provider if you have ever had:

• an allergic reaction to insulin
• diabetic ketoacidosis (DKA)
• hypoglycemic episodes (low blood sugar)
• kidney disease.

Females of childbearing age: Tell your health care provider if you are pregnant, plan to become pregnant or if you are breast-feeding.

How do I use it?

This insulin is available in:

• 10 mL bulk vials (small bottles). You must purchase sterile disposable insulin syringes with needles to give the shots. Your pharmacist can help you choose the proper syringes and needles.
• Humulin Pens (disposable insulin delivery devices), which include insulin cartridges
• prefilled disposable syringes ready for use.

Follow exactly any instructions that are supplied with the product your health care provider has prescribed. If you do not understand how to use the injection devices or disposable insulin syringes, ask your health care provider or pharmacist to demonstrate. Be sure you understand how to set your correct dosage.

These shots are given in your abdomen, upper arm, or thigh. Follow your health care provider's instructions carefully regarding dosage and times of injection. Measure your doses carefully to avoid overdose (which can cause insulin shock).

Most diabetics give themselves these shots or have someone at home give them. Be sure you know how and when to have them and how much medicine to use.

Follow these steps to inject the insulin from a syringe. Use sterile, disposable syringes and needles. Use them only once and dispose of them safely, following your health care provider's instructions.

Carefully read and follow the directions that come in the package of medicine for preparing the shots.

Wash your hands before using this medicine. Follow these steps to give yourself the shots:

1. Choose a site on your abdomen around the belly button but not in the belly button (or in the thigh, upper arm, or other sites). Each day, choose a different spot for the shot to lessen irritation.
2. Use an alcohol swab to clean the skin where you will give yourself the shot.
3. Gently pinch up the skin and insert the needle into the skin at a 45° angle. After you insert the needle completely, release your grasp of the skin.
4. Inject all of the solution by gently and steadily pushing down the plunger.
5. After you have given yourself the shot, withdraw the needle and syringe and press the alcohol swab at the spot where the shot was given.
6. Discard the syringe, needle, and drug vial when empty. Use the syringes and needles ONLY ONCE. Throw them away after use. Put used needles in rigid puncture-resistant containers with lids or caps, such as heavy plastic bleach bottles with screw caps. DO NOT throw needles directly into garbage cans or dumpsters.

If you are not sure of how to give yourself the shots, ask your health care provider or pharmacist for help.

There are several types, strengths, and brands of insulin. Never change the type, strength, or brand of insulin without your health care provider's approval.

If you have the Humalog 75/25 Pen, do not use it for more than 10 days. Throw the Pen away after 10 days, even if it still has insulin in it.

Your health care provider will also give you a meal plan and an exercise schedule. This medicine is usually injected 15 minutes before a meal. If you do not follow the meal or exercise plan, you may have too much or too little insulin in your blood.

Humalog Mix75/25 should not be mixed with another insulin.

What should I watch out for?

Follow the diet and exercise program prescribed by your health care provider. Eat regular meals and avoid skipping meals. Your dosage of insulin is based on your food intake. Also, have your blood sugar tested regularly. If your health care provider wants you to test your blood or urine sugar at home, follow his or her directions carefully. Depending on the severity of your diabetes, your health care provider may want you to check your blood sugar daily using a machine. Follow your health care provider's advice exactly.

Talk to your health care provider before you take any other medicines, including nonprescription products, vitamins, and natural remedies.

Alcohol may affect your response to medicine and food. Do not drink alcohol unless your health care provider approves.

Low blood sugar (hypoglycemia) can occur if you miss or delay meals, drink too much alcohol, take too much insulin, or exercise more than usual. Symptoms of low blood sugar include confusion, shaking, weakness, strong hunger, cold sweats, headache, nausea, vision problems, and feeling faint. Treat the condition quickly by eating or drinking something with sugar in it such as candy, juice, or nondiet soda. Taking glucose tablets or gels (available in drug stores) is another quick way to treat hypoglycemia.

Contact your health care provider if you develop the signs of high blood sugar. Some of the signs of high blood sugar are increased thirst, drowsiness, fruity-smelling breath, flushing, increased urination, and loss of appetite. This can occur if you do not take enough insulin, skip a dose, or do not follow your diet.

Wear some form of identification stating that you are a diabetic (such as a Medic Alert bracelet). If you become unconscious, the ID tells emergency health care providers that you are a diabetic and need special care.

What are the possible side effects?

Along with its needed effects, your medicine may cause some unwanted side effects. Some side effects may be very serious. Some side effects may go away as your body adjusts to the medicine. Tell your health care provider if you have any side effects that continue or get worse.

Life-threatening (Report these to your health care provider right away. If you cannot reach your health care provider right away, get emergency medical care or call 911 for help): Allergic reaction (hives; itching; rash; trouble breathing; tightness in your chest; swelling of your lips, tongue, and throat).

Serious (report this to your health care provider if these symptoms happen often): Symptoms of hypoglycemia (confusion, shaking, weakness, strong hunger, cold sweats, headache, nausea, vision problems, and feeling faint).

Other: Redness at the spot where an injection has been given, minor rash or itching.

What products might interact with this medicine?

When you take this medicine with other medicines, it can change the way this or any of the other medicines work. Nonprescription medicines, vitamins, natural remedies, and certain foods may also interact. Using these products together might cause harmful side effects. Talk to your health care provider if you are taking:

• ACE inhibitors such as benazepril (Lotensin), captopril (Capoten), enalapril (Vasotec), lisinopril (Prinivil, Zestril), quinapril (Accupril), and fosinopril (Monopril)
• acetazolamide (Diamox)
• alcohol
• antiretroviral (AIDS) drugs such as: saquinavir (Invirase, Fortovase), ritonavir (Norvir, Kaletra), indinavir (Crixivan), nelfinavir (Viracept), and amprenavir (Agenerase)
• asparaginase (Elspar)
• beta blockers such as atenolol (Tenormin), betaxolol (Kerlone), carteolol (Cartrol), bisoprolol (Zebeta), pindolol (Visken), metoprolol (Lopressor, Toprol XL), timolol (Blocadren), sotalol (Betapace), nadolol (Corgard), and propranolol (Inderal)
• birth control pills
• calcitonin (Miacalcin)
• corticosteroids such as betamethasone (Celestone), prednisone (Meticorten, Deltasone), dexamethasone (Decadron), hydrocortisone (Hydrocortone, Cortef), and methylprednisolone (Medrol)
• danazol
• diazoxide (Hyperstat)
• disopyramide (Norpace)
• estrogens such as Premarin
• fluoxetine (Prozac)
• isoniazid (Nydrazid)
• lithium (Eskalith, Lithobid)
• MAO inhibitor antidepressants such as phenelzine (Nardil), tranylcypromine (Parnate), and isocarboxazid (Marplan) (Do not take this medicine and an MAO inhibitor within 14 days of each other.)
• niacin
• oral diabetes medicines such as acetohexamide (Dymelor), chlorpropamide (Diabinese), glimepiride (Amaryl), glipizide (Glucotrol), glyburide (DiaBeta, Micronase), tolazamide (Tolinase), and tolbutamide (Orinase)
• phenothiazines such as chlorpromazine (Thorazine), prochlorperazine (Compazine), promazine (Sparine), thioridazine (Mellaril), and trifluoperazine (Stelazine)
• phenytoin (Dilantin) and fosphenytoin (Cerebyx)
• propoxyphene (Darvon)
• salicylates, including aspirin
• thyroid medicines such as levothyroxine (Eltroxin, Levo-T, Levothroid, Levoxyl), thyroid USP (Armor Thyroid, Thyrar, Thyroid Strong), liothyronine (Cytomel), and liotrix (Thyrolar).

Ask your health care provider or pharmacist if medicines you are taking are in any of these groups.

Many nonprescription products contain sugar, alcohol, or other ingredients that may interfere with this medicine or increase your blood sugar. Check product labels for warnings for diabetics or ask your health care provider or pharmacist for advice.

Keep a list of all your medicines (prescription, nonprescription, supplements, natural remedies, and vitamins) with you. Be sure that you tell all health care providers who treat you about all the products you are taking.

How should I store this medicine?

Store insulin in the refrigerator, but do not let it freeze. If refrigeration is impossible, keep insulin as cool as possible (no higher than 86°F or 30°C). Do not use insulin that has been out of the refrigerator for longer than 28 days or has been frozen. Do not use insulin after the expiration date printed on the bottle.

Do not use the Humalog 75/25 Pen for more than 10 days. Throw the Pen away after 10 days, even if it still has insulin in it.

This advisory includes selected information only and may not include all side effects of this medicine or interactions with other medicines. Ask your health care provider or pharmacist for more information or if you have any questions.

Ask your pharmacist for the best way to dispose of outdated medicine or medicine you have not used. Do not throw medicines in the trash.

Keep all medicines out of the reach of children.

Do not share medicines with other people.