Have you ever taken your mealtime insulin, only to suddenly not have time to eat because life happens? Do you ever feel frustrated by attempting to achieve better control of post-meal glucose values? If yes, then we have great news for you! In June of 2020, the FDA approved a novel mealtime insulin for treating adults with type 1 and type 2 diabetes. Called Lyumjev (pronounced LOOM-jehv), this new insulin analog formulation is another ultra-rapid-acting insulin analog to enter the current market (we already have Fiasp and Afrezza) which may mean easier meal scheduling, better after-meal glucose control and more spontaneity for you!
What is Lyumjev?
Insulin, a naturally occurring hormone, allows your body to turn the glucose/food you eat into usable energy for your cells. For decades, a major challenge has been trying to create rapid-acting insulins to mimic the body’s natural insulin response to meals. Lyumjev (insulin lispro-aabc) is a newly constructed manmade insulin analog that has been uniquely formulated to work quickly, more closely matching the body’s natural mealtime insulin secretion. This is beneficial because it’s much easier to control postprandial (after-meal) glucose concentrations and potentially avoid delayed hypoglycemia hours after a meal.
How Does Lyumjev Work?
Produced by the pancreas in response to meals and glucose concentrations, insulin allows your body to turn blood glucose into energy and to store excess energy in your fat tissue, muscles, and liver for use later on, when your body needs it. Just like other mealtime (bolus) insulin products, Lyumjev is used to knock down and control after-meal glucose concentrations. Compared to older “fast” acting insulins, however, one big difference is Lyumjev works must faster. Lyumjev starts to work in about 20 minutes post injection, 11 minutes faster than Humalog. During the first 30 minutes after injection, Lyumjev had a 3-fold greater glucose lowering effect compared to Humalog. The maximum glucose lowering effect of Lyumjev occurred between 1 and 3 hours after injection. Lyumjev’s ultra-rapid response most closely resembles your body’s natural pattern of insulin production in response to a meal. This allows you to be more spontaneous with meal planning and to better control your glucose.
How Do You Use Lyumjev?
Lyumjev comes in two different concentrations for injection: U-100 (100 units in every 1 milliliter) and U-200 (200 units in every 1 milliliter). The U-100 injection is available as both vials and pens, while the U-200 is available only as a pen. The U-200 concentrated formulation is intended for people with type 2 diabetes on higher doses of insulin.
Because Lyumjev works so quickly, administer it under your skin immediately at the beginning of a meal. If you forget to inject or you are extra sensitive to the Lyumjev’s ultra-rapid action, you can also use it within 20 minutes after you start eating a meal. Similar to other insulins, inject in your lower abdomen (at least two-finger-widths away from your belly button), your upper outer arm, or your upper outer thighs and rotate injection sites. The amount of Lyumjev used will be based on your personal needs, which you and your healthcare provider can discuss.
What Can You Expect?
Lyumjev will help reduce post-meal glucose values as well as help you control your A1c. Two studies (PRONTO-T1D and PRONTO-T2D), which compared Lyumjev (insulin lispro-aabc) to Humalog (insulin lispro), found that Lyumjev was superior in reducing blood glucose concentrations after meals compared to Humalog. In patients with type 1 diabetes, Lyumjev given at the beginning of a meal decreased blood glucose on average of 31 mg/dL compared to Humalog. In patients with type 2 diabetes, the comparative response was about half that by an average of 17 mg/dL more compared to Humalog.
While any insulin product can cause weight gain, Lyumjev’s has an added benefit of very low weight gain. Studies demonstrated that weight gain was only 0.6 kg (1.32 lb) and 1.5 kg (3.3 lb) in participants with type 1 and type 2 diabetes, respectively. Low glucose events can also be a result with any insulin product. Prevention and being prepared is key. Symptoms of low glucose include: dizziness, blurred vision, tremors, palpitations, hunger, sweating, slurred speech, and confusion. Always carry a low glucose treatment source of at least 15 grams of carbohydrates with you. A tube of glucose tablets is compact and easy to travel with. You only need to eat 3-4 tablets, but drinking a 4 oz juice box, or eating 5-6 skittles work well too. It is important to be aware of the symptoms of hypoglycemia so that you know when and how to treat it.
Is Lyumjev Right for You?
Lyumjev might be a good choice for you if you want an insulin product that allows you more flexibility with meals, works ultra-rapidly to knock down after-meal glucose values, causes less weight gain and improves glycemic control. This medication is generally safe for pregnant and breastfeeding mothers. Lyumjev can be used in diabetes treatment regimens which include either basal insulins (e.g. Lantus, Levemir, Toujeo, Tresiba, etc.) or intermediate insulins (e.g. NPH). However, it CANNOT be mixed with other insulin products in the same syringe, not even with NPH.
In order to increase the affordability and accessibility, Lyumjev will be included in the Lilly Insulin Value Program, which allows patients with commercial insurance or no insurance at all to fill their monthly prescription for $35. If you are interested in this savings option, you can contact Lilly Diabetes Solution Center at (833) 808-1234, Monday through Friday from 8AM to 8PM (ET). TCOYD’s resources page also has a section to help with access to Lilly insulins, as well as other company’s products.
The Bottom Line:
Lyumjev offers the opportunity to finally closely mimic mealtime insulin production to better control after- meal glucose concentrations and A1c, while also causing minimal weight gain and better flexibility with meals.
Quynh My Nguyen, 4th Year Student Pharmacist at UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences
Candis M. Morello, Pharm D, APh, CDE, FCSHP, FASHP, Professor of Clinical Pharmacy at UC San Diego Skaggs School of Pharmacy and Pharmaceutical Sciences, Clinical Pharmacist Specialist at VASDHS