Lyumjev Kwikpen (Insulin Lispro aabc) Vs Insulin Lispro

Insulin Lyumjev is a modified form of Insulin Lispro. It is actually Insulin Lispro plus the addition of citrate and treprostinil.

It is ultra-short-acting insulin and has a faster onset of action compared to Insulin Lispro.

The faster onset of action is attributed to the citrate and treprostinil molecules that result in increased absorption through the skin.

Insulin Lyumjev or Lispro-aabc Indications:

It is indicated for the treatment of Diabetes Mellitus Type 1 and Type 2. It is especially used to treat and control post-meals hyperglycemia.

Formulations and administration:

Insulin Lispro-aabc is available as:

• U-100 Kwikpen and Tempo Pen,
• U-200 Kwikpen, and
• U-100 Junior Kwikpen.

The maximum dose administered per injection is 60 units for U-100 and U-200 kwikpen and U-100 Tempo Pen and 30 units for U-100 Junior Pen.

Insulin Lispro-aabc is administered into the skin like most other insulins. The best sites are the anterior abdomen, upper arms, and thighs.

The dose is increased in increments of 1 unit per dose in adults and 0.5 units per dose in children using Insulin Lispro-aabc U-100 Junior Kwikpen until the target blood sugars are achieved or the maximum units per dose are administered.

Lyumjev Insulin U-100 but not U-200 can also be mixed with 0.9% Saline and dextrose water and administered intravenously.

The diluted insulin should not be administered intravenously if its concentration is below 1 unit/ml.

Comparing Insulin Lyumjev (Lispro-aabc) Vs Insulin Lispro:

Insulin Lispro aabc also called Lyumjev is almost identical to Insulin Lispro (Insulin Humalog and Insulin Admelog with minimal differences.

Formulations available:

• Insulin Lispro: Insulin Humalog and Admelog
• Insulin Lispro-aabc: Lyumjev

Onset Of Action:

• Insulin Lispro: 30 minutes in T1DM and 45 minutes in T2DM.
• Insulin Lispro-aabc: 15 – 17 minutes depending on the dose administered.

Peak effect:

• Insulin Lispro:
  • Insulin Humalog: 2.1 hours
  • Insulin Admelog: 2.4 hours
• Insulin Lispro-aabc:
  • 120 minutes when administered in a dose of 7 units
  • 138 minutes when administered in a dose of 15 units
  • 174 minutes when administered in a dose of 30 units

Bioavailability when administered subcutaneously:

• Insulin Lispro: 55 – 77%
• Insulin Lispro-aabc: 65%

The duration of action:

• • Insulin Admelog: About 6.9 hours.
  • Insulin Humalog: 5.7 – 6.6 hours.
  • Insulin Lyumjev: 4.6 – 7.3 hours.

Efficacy of Insulin Lyumjev (Lispro-aabc) compared to Insulin Humalog:

Insulin Lyumjev was compared in two clinical trials with Insulin Lispro. The first trial evaluated its efficacy in T1DM patients.

Insulin Lyumjev Vs Lispro in T1DM:

In patients with T1DM, mealtime administration of Lyumjev resulted in a clinically significant reduction in the glycated hemoglobin at 26 weeks of the trial.

The A1C after 26 weeks in patients who were using Insulin Lyumjev + Basal Insulin dropped from 7.3% to 7.18% compared to an A1C drop from 7.3% to 7.26%

Insulin Lyumjev Vs Lispro in T2DM:

Lyumjev Insulin was also studied in patients with T2DM. It was compared with Insulin Humalog (Insulin Lispro). All patients received basal insulin along with mealtime rapid-acting insulin.

Both Lyumjev and Insulin Humalog had a comparable reduction in the glycated hemoglobin as seen here:

The baseline HbA1C was 7.3% which dropped to 6.94% in patients who were using Lyumjev compared to 6.92% in patients who were using Insulin Lispro. The A1C reduction was almost similar in both groups.

Side effects of Insulin Lyumjev:

Lyumjev, like other insulin, reduced plasma blood glucose. Thus, hypoglycemia is the most common effect or side effect of insulin Lyumjev.

It also causes the intracellular shifts of potassium and may result in hypokalemia, especially when administered as intravenous infusions.

Other common side effects of insulins including Lyumjev include lipo-hypertrophy at the site of administration. This is especially a problem in patients who inject insulin repeatedly into one skin area.

Patients may also report weight gain and sometimes may develop antibodies against the insulin. This could result in an allergic type of reaction at the site of administration and loss of efficacy.

In Summary:

Lyumjev Insulin is ultra-short-acting insulin with better bioavailability, and rapid onset of action, and has a comparable post-meal glycemic control when compared with Insulin Lispro.

It can be administered just before meals and controls the sugar spikes that occur after a meal.

Read: FDA Prescribing Information (PDF file)