Pharmacy Diabetes

insulin-Humalog_mix_25

Insulin lispro solution [recombinant DNA origin]

  • Humalog Mix 25 - 25% insulin lispro and 75% insulin lispro protamine suspension (NPL).
  • [recombinant DNA origin] is a mixture of insulin lispro, a rapid-acting blood glucose lowering agent and insulin lispro protamine suspension, an intermediate-acting blood glucose lowering agent, adjusted to pH 7.0 to 7.8.
  • Humalog Mix25 is available as a white suspension for parenteral administration in a concentration of 100 units/mL in 3 mL cartridges and 3 mL prefilled insulin delivery device (Humalog Mix25 KwikPen).

  • For use in type 1 and type 2 diabetes mellitus.

For the latest PBS indications for Humalog MX25 please see
https://www.pbs.gov.au/pbs/search?term=humalog&analyse=false&search-type=medicines

  • Humalog Mix25 a should be given only by subcutaneous injection. It should not be administered intravenously Humalog Mix25 can be given immediately (up to 15 minutes before a meal). The safety and efficacy of Humalog Mix25 given after a meal has not been established. The rapid onset and early peak activity of HUMALOG is observed following the subcutaneous administration of Humalog Mix25. The duration of action of the insulin lispro protamine suspension) component of Humalog Mix25 and is similar to that of basal insulin NPH.
  • Subcutaneous administration should be in the abdomen or thighs. The injection sites should be rotated so that the same site is not used more than approximately once a month in order.to reduce the risk of lipodystrophy and localised cutaneous amyloidosis.
  • Care should be taken when injecting Humalog Mix25 to ensure that a blood vessel has not been entered. After injection, the site of injection should not be massaged. Note: Diabetes MedsCheck with referral for; - Blood glucose monitoring - To healthcare team for education on injection technique and managing hypoglycaemia.
  • Humalog Mix25 should not be used in insulin pumps.

Mixing

Humalog Mix25 Cartridges

Cartridges should be rolled between the palms 10 times. Holding the cartridge by one end, invert it 180° slowly 10 times to allow the glass bead to travel the full length of the cartridge with each inversion. Cartridges should not be shaken vigorously as this may cause frothing which may interfere with the correct measurement of the dose. The insulin should look uniformly cloudy after mixing. If it does not, the above steps should be repeated until the contents are mixed. Cartridges of insulin should be examined frequently and should not be used if the insulin substance (the white material) remains visibly separated from the liquid after mixing. Cartridges of insulin should not be used if there are clumps in the insulin after mixing or if solid white particles stick to the bottom or wall of the cartridge, giving a frosted appearance.

Humalog Mix25 KwikPens

KwikPen prefilled insulin pen delivery devices should be rolled between the palms 10 times. Holding the device by one end, invert it 180° slowly 10 times to allow the glass bead to travel the full length of the cartridge with each inversion. The devices should not be shaken vigorously as this may cause frothing which may interfere with the correct measurement of the dose. The insulin should look uniformly cloudy after mixing. If it does not, the above steps should be repeated until the contents are mixed. KwikPen prefilled insulin pen delivery devices should be examined frequently and should not be used if the insulin substance (the white material) remains visibly separated from the liquid after mixing. KwikPen prefilled insulin pen delivery devices should not be used if there are clumps in the insulin after mixing or if solid white particles stick to the bottom or wall of the cartridge, giving a frosted appearance.

  • Use in renal impairment: Humalog Mix25 can be used in renal impairment. As with all insulins, glucose monitoring should be intensified, and dosage adjustment should occur on an individual basis.
  • Use in liver impairment: Humalog Mix25 can be used in hepatic impairment. As with all insulins, glucose monitoring should be intensified, and dosage adjustment should occur on an individual basis.

  • There is no data available.

  • The safety and efficacy of Humalog Mix25 in individuals less than 18 years of age has not been established.

  • Hypoglycaemia.
  • Hypersensitivity to insulin lispro or one of its excipients.

  • Humalog Mix25 should under no circumstances be administered intravenously. Mixing of Humalog Mix25 with other insulins has not been studied. Therefore, Humalog Mix25 or should not be mixed with other insulins.
  • Hypoglycaemia: Hypoglycaemia is the most common adverse effect of insulins. As with all insulins, particular caution (including intensified blood glucose monitoring) should be exercised in individuals who are at greater risk of clinically significant sequelae from hypoglycaemic episodes.
    A few individuals who have experienced hypoglycaemic reactions after transfer from animal source insulin to human insulin have reported that the early warning symptoms of hypoglycaemia were less pronounced or different from those experienced with their previous insulin.
    Note: Diabetes MedsCheck with education on hypoglycaemia information, blood glucose monitoring, information on side effect profile, counselling that hypoglycaemia is part of side effect profile and were happening regularly the individual may need referral back to prescriber for dose adjustment.

  • Hypoglycaemia: Hypoglycaemia is the most common adverse effect of insulins. As with all insulins, particular caution (including intensified blood glucose monitoring) should be exercised in individuals who are at greater risk of clinically significant sequelae from hypoglycaemic episodes.
    Note: Diabetes MedsCheck with education on hypoglycaemia information, blood glucose monitoring, information on side effect profile, counselling that hypoglycaemia is part of side effect profile and were happening regularly the individual may need referral back to prescriber for dose adjustment.
  • Injection site and allergic reactions. As with any insulin therapy, lipodystrophy may occur at the injection site and delay insulin absorption. Other injection site reactions with insulin therapy include redness, pain, itching, hives, swelling and inflammation.
    Note: Diabetes MedsCheck with education on side effects and referral to healthcare team to establish correct injection technique.
  • Skin and subcutaneous tissue disorders: Individuals must be instructed to perform continuous rotation of the injection site to reduce the risk of developing lipodystrophy and cutaneous amyloidosis. There is a potential risk of delayed insulin absorption and worsened glycaemic control following insulin injections at sites with these reactions. A sudden change in the injection site to an unaffected area has been reported to result in hypoglycaemia.
    Note: Diabetes MedsCheck with referral to healthcare team for correct injection technique and managing hypoglycaemia.

For more information on Humalog Mix25, please go to
https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2010-PI-04515-3&d=202105161016933