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Humalog Mix 50 / 50 KwikPen Side Effects

Generic Name: insulin lispro / insulin lispro protamine

Note: This page contains information about the side effects of insulin lispro / insulin lispro protamine. Some of the dosage forms included on this document may not apply to the brand name Humalog Mix 50 / 50 KwikPen.

Not all side effects for Humalog Mix 50 / 50 KwikPen may be reported. You should always consult a doctor or healthcare professional for medical advice. Side effects can be reported to the FDA here.

For the Consumer

Applies to insulin lispro / insulin lispro protamine: subcutaneous suspension

In addition to its needed effects, some unwanted effects may be caused by insulin lispro / insulin lispro protamine. In the event that any of these side effects do occur, they may require medical attention.

You should check with your doctor immediately if any of these side effects occur when taking insulin lispro / insulin lispro protamine:

Incidence not known
  • Anxiety
  • blurred vision
  • chills
  • cold sweats
  • coma
  • confusion
  • convulsions
  • cool, pale skin
  • cough
  • decreased urine
  • depression
  • difficulty with swallowing
  • dizziness
  • dry mouth
  • fast heartbeat
  • flushing or redness of the skin
  • headache
  • hives
  • increased hunger
  • increased thirst
  • irregular heartbeat
  • itching
  • loss of appetite
  • muscle pain or cramps
  • nausea or vomiting
  • nervousness
  • nightmares
  • numbness or tingling in the hands, feet, or lips
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • seizures
  • shakiness
  • shortness of breath
  • skin rash
  • slurred speech
  • sweating
  • swelling
  • tightness in the chest
  • unusual tiredness or weakness
  • unusually warm skin
  • wheezing

Some of the side effects that can occur with insulin lispro / insulin lispro protamine may not need medical attention. As your body adjusts to the medicine during treatment these side effects may go away. Your health care professional may also be able to tell you about ways to reduce or prevent some of these side effects. If any of the following side effects continue, are bothersome or if you have any questions about them, check with your health care professional:

Incidence not known
  • Bleeding, blistering, burning, coldness, discoloration of the skin, feeling of pressure, hives, infection, inflammation, itching, lumps, numbness, pain, rash, redness, scarring, soreness, stinging, swelling, tenderness, tingling, ulceration, or warmth at the injection site
  • redistribution or accumulation of body fat

For Healthcare Professionals

Applies to insulin lispro / insulin lispro protamine: subcutaneous suspension


The cardiovascular consequences of hyperinsulinemia are being evaluated. Given the high frequency of both microvascular and macrovascular diseases in patients with diabetes, some experts are evaluating insulin as a possible atherogenic agent. Controversy and continued study surround the role of hyperinsulinemia as the precursor of hypertension.[Ref]

Other cardiovascular risk factors that are accentuated in persons with carbohydrate intolerance and hypertension include abnormalities in platelet function, clotting factors, the fibrinolytic system, and dyslipidemia. The relationship between diabetes, insulin, and these disorders is currently under investigation.

Insulin may contribute to the pathogenesis of hypertension by stimulating the sympathetic nervous system, promoting renal sodium retention, and/or stimulating vascular smooth muscle hypertrophy. It may induce dyslipidemia by promoting hepatic synthesis of very low density lipoproteins (VLDLs).

Insulin may stimulate heart rate in the absence of hypoglycemia.[Ref]


Dermatologic reactions to insulin can result in lipohypertrophy (insulin is lipogenic) or lipoatrophy (probably immunologically-mediated). The incidence of lipoatrophy is markedly decreased with the use of purer forms of pork insulin or biosynthetic human insulin and when injection sites are alternated. Without proper hygiene, subcutaneous insulin injections may be complicated by infection.[Ref]


Hypoglycemia is the most common and serious side effect of insulin, occurring in approximately 16% of type 1 and 10% of type II diabetic patients (the incidence varies greatly depending on the populations studied, types of insulin therapy, etc.). Although there are counterregulatory endocrinologic responses to hypoglycemia, some responses are decreased, inefficient, or absent in some patients. Severe hypoglycemia usually presents first as confusion, sweating, or tachycardia, and can result in coma, seizures, cardiac arrhythmias, neurological deficits, and death. Blood or urine glucose monitoring is recommended in patients who are at risk of hypoglycemia or who do not recognize the signs and symptoms of hypoglycemia. The risk for developing hypoglycemia is higher in patients receiving intensive or continuous infusion insulin therapy. The association between insulin and dyslipidemia is currently being evaluated.[Ref]

Permanent neuropsychological impairment has been associated with recurrent episodes of severe hypoglycemia.

In one retrospective study of 600 randomly selected patients with insulin-treated diabetes mellitus, the only reliable predictors of severe hypoglycemia were a history of hypoglycemia, a history of hypoglycemia-related injury or convulsion, and the duration of insulin therapy. Those with a history of hypoglycemia had been treated with insulin for 17.4 years, which was significantly longer than the 14.3 years in the insulin-treated patients without a history of hypoglycemia.

Human insulin does not appear to be associated with hypoglycemic episodes more often than animal insulin. Caution is recommended when switching from animal (either bovine or pork) to purified porcine insulin or biosynthetic human insulin, however, because of increased potency or bioavailability.[Ref]


Rare cases of gastrointestinal distress have been associated with insulin. GI distress tends to resolve with dose reduction.[Ref]


General weight gain is associated with insulin use, sometimes presenting as edema associated with abrupt restoration of glucose control in a patient whose control was previously poor. Weight gain may be due to more efficient use of calories during insulin therapy, suggesting additional benefits of dietary and exercise modifications. Patients on intensive insulin therapy may be more likely to experience weight gain.[Ref]

Intensive insulin therapy causes an increase in body fat as a result of the elimination of glycosuria and reduction in 24-hour energy expenditure. The reduction in 24-h energy expenditure is the result of an insulin-associated decrease in triglyceride/free fatty acid cycling and nonoxidative glucose and protein metabolism.[Ref]


The effects of insulin-induced hypoglycemia on hemostasis may explain some of the clinical observations of embolic phenomenon during treatment of diabetic ketoacidosis.

Limited data show that diabetics have a significantly lower basal concentration of tissue plasminogen activator.[Ref]

The hematologic effects from insulin-induced hypoglycemia include an enhanced increase in the concentration of von Willebrand factor. Increased von Willebrand factor, combined with hypoglycemia-associated decreased plasma volume and increased plasma viscosity, may predispose patients to reduced peripheral perfusion or embolic phenomenon. A single case of insulin-induced hemolytic anemia has been reported.[Ref]


A diabetic patient with true allergy to insulin can undergo desensitization. Desensitization kits and protocols are available from some insulin manufacturers.[Ref]

Hypersensitivity reactions--either local or systemic--are becoming rare (less than 1% of patients) due to the use of purer forms of pork insulin or biosynthetic human insulin. Local reactions may present as erythema, swelling, heat, or subcutaneous nodules. They usually occur within the first two weeks of therapy, then disappear. True allergy to insulin is rare, and sensitization is usually associated with specific animal proteins in bovine and less pure forms of porcine insulins.[Ref]


Immunologic analysis of anaphylaxis to some insulin preparations in some cases has revealed markedly elevated serum levels of lgE and lgG to protamine, but not to regular insulin.[Ref]

Immunologic responses to insulin, particularly animal insulin formulations, include the formation of anti-insulin antibodies. The presence of these antibodies causes the elimination half-life of insulin to increase.[Ref]


Rare cases of hypophosphatemia have been associated with the use of glucose, insulin, and potassium infusions during the treatment of myocardial infarction.[Ref]

The metabolic side effects of insulin therapy may be particularly important in patients who are being treated for diabetic ketoacidosis (DKA). Insulin increases the intracellular transport of phosphate, which often results in hypophosphatemia during treatment of DKA. Hypokalemia and hypomagnesemia have been associated with DKA, and may be due to insulin.[Ref]


An unusual ocular disturbance during the beginning of therapy is bilateral presbyopia (blurry vision). This is thought to be due to changes in the osmotic equilibrium between the lens and the ocular fluids, and is usually self-limited.[Ref]


The renal effects from insulin-induced hypoglycemia include significantly decreased renal plasma flow, glomerular filtration rate, and significantly increased urinary albumin excretion rate. These changes are reversible upon resolution of hypoglycemia.[Ref]

Hypoglycemia is associated with increased plasma dopamine, epinephrine, and plasma renin activity. Acute changes in renal function during insulin-induced hypoglycemia, therefore, may result from direct stimulation of the efferent sympathetic nerves to the kidney and hormonal counterregulatory mechanisms.[Ref]


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