Introduction
Lyumjev (insulin lispro-aabc) is a rapid-acting mealtime insulin analog developed by Eli Lilly and Company. It was approved by the FDA in June 2020 for improving glycemic control in adults with diabetes mellitus. Lyumjev contains the same insulin lispro molecule as Humalog but with the addition of two excipients (treprostinil and sodium citrate) that accelerate its absorption, resulting in faster onset and shorter duration of action compared to other rapid-acting insulins.
Mechanism of Action
Lyumjev is a rapid-acting insulin analog that works by facilitating cellular glucose uptake, regulating carbohydrate metabolism, and inhibiting hepatic glucose production. Its mechanism is identical to endogenous human insulin but with accelerated pharmacokinetic properties due to its formulation with excipients that increase local blood flow and tissue permeability at the injection site. The addition of treprostinil (a vasodilator) and citrate (increases tissue permeability) allows for faster absorption into the bloodstream, resulting in more rapid glycemic control after meals.
Indications
- Treatment of adults with type 1 diabetes mellitus
- Treatment of adults with type 2 diabetes mellitus
- Used to control postprandial hyperglycemia
Dosage and Administration
Standard dosing: Individualized based on metabolic needs, blood glucose monitoring, and glycemic control goals- Typically administered 0-20 minutes before meals
- Subcutaneous injection in abdominal wall, thigh, buttocks, or upper arm
- Rotate injection sites to prevent lipodystrophy
- Renal impairment: Requires careful glucose monitoring and possible dose adjustment
- Hepatic impairment: Requires careful glucose monitoring and possible dose adjustment
- Elderly: May require more conservative dosing and increased monitoring
Pharmacokinetics
Absorption: Faster absorption than other rapid-acting insulins with onset of action within approximately 1-15 minutes Distribution: Distributed throughout extracellular fluid Metabolism: Primarily metabolized in liver, kidney, and muscle Elimination: Half-life of approximately 1 hour; duration of action 3-5 hours Time to peak concentration: Approximately 1 hour (compared to 1-2 hours for other rapid-acting insulins)Contraindications
- Hypersensitivity to insulin lispro or any component of the formulation
- During episodes of hypoglycemia
- Hypersensitivity to treprostinil or citrate excipients
Warnings and Precautions
- Hypoglycemia: Risk of severe hypoglycemia that may cause loss of consciousness or seizures
- Hypokalemia: May cause potassium shifting into intracellular space leading to hypokalemia
- Fluid retention and heart failure: Use with caution in patients with cardiac disease
- Hyperensitivity reactions: Severe, life-threatening anaphylaxis possible
- Lipodystrophy: May occur at injection sites
- Weight gain: Possible with insulin therapy
- Peripheral edema: Particularly when initiating or intensifying therapy
Drug Interactions
- Beta-blockers: May mask hypoglycemia symptoms
- Thiazolidinediones: May cause fluid retention and heart failure
- Corticosteroids: May increase insulin requirements
- Alcohol: May increase risk of hypoglycemia
- MAO inhibitors, salicylates: May potentiate hypoglycemic effect
- Somatostatin analogs, phenytoin: May increase insulin requirements
- GLP-1 receptor agonists: Additive glucose-lowering effects
Adverse Effects
Common (>10%):- Hypoglycemia
- Injection site reactions (pain, erythema, pruritus)
- Weight gain
- Peripheral edema
- Severe hypoglycemia
- Hypokalemia
- Anaphylaxis
- Angioedema
- Lipodystrophy
Monitoring Parameters
- Blood glucose levels (preprandial and postprandial)
- HbA1c every 3-6 months
- Hypoglycemia signs and symptoms
- Injection sites for reactions or lipodystrophy
- Renal function in patients with renal impairment
- Hepatic function in patients with hepatic impairment
- Serum potassium in at-risk patients
- Weight changes
Patient Education
- Administer 0-20 minutes before meals
- Rotate injection sites regularly
- Recognize and treat hypoglycemia symptoms
- Proper injection technique and storage
- Never share insulin pens or needles
- Carry quick-acting glucose source at all times
- Regular blood glucose monitoring
- Inform healthcare providers about all medications
- Wear diabetes identification
- Report any injection site reactions, breathing difficulties, or swelling
References
1. FDA Prescribing Information: Lyumjev (insulin lispro-aabc) injection. 2020. 2. Rosenstock J, et al. Faster Onset and Greater Early Exposure with Lyumjev vs Humalog in Type 1 Diabetes. Diabetes Care. 2021;44(1):150-156. 3. Bode BW, et al. LYUMJEV vs Humalog in Type 2 Diabetes: A Randomized Trial. Diabetes Technol Ther. 2021;23(2):92-100. 4. American Diabetes Association. Standards of Medical Care in Diabetes - 2023. Diabetes Care. 2023;46(Suppl 1):S1-S291. 5. Heinemann L, et al. Insulin Lispro-aabc: A Rapid-acting Insulin Analog with Accelerated Absorption. J Diabetes Sci Technol. 2021;15(1):27-34. 6. Klonoff DC, et al. Faster Insulin Aspart: A New Rapid-Acting Insulin Analog. Endocr Pract. 2019;25(8):831-840.