From the Guidelines
This patient's current sliding scale insulin regimen should be modified to align with the latest guidelines, which recommend a simplified approach for adjusting prandial insulin doses, such as giving 2 units of short- or rapid-acting insulin for premeal glucose >250 mg/dL (>13.9 mmol/L) and 4 units for premeal glucose >350 mg/dL (>19.4 mmol/L), as suggested by the 2024 standards of care in diabetes 1.
The patient is currently checking his blood sugar three times a day before meals and adjusting his lispro dose based on specific blood glucose ranges. However, the current regimen does not align with the simplified sliding scale approach recommended in the latest guidelines.
Key considerations for modifying the patient's regimen include:
- Using a simplified sliding scale for adjusting prandial insulin doses, as recommended by the 2024 standards of care in diabetes 1
- Considering the addition of a basal insulin component to provide 24-hour glucose coverage
- Adjusting the insulin dose every 2 weeks based on finger-stick glucose testing performed before lunch and before dinner, with a goal of 90–150 mg/dL (5.0–8.3 mmol/L) before meals 1
- Regular follow-up appointments to monitor the effectiveness of the regimen and make necessary adjustments based on overall glucose control patterns.
By adopting a more streamlined approach to insulin dosing and considering the addition of basal insulin, the patient's diabetes management plan can be optimized to improve glucose control and reduce the risk of complications.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Insulin Lispro Administration
- The patient is administered insulin lispro twice daily before meals, with a dosage based on blood sugar levels:
- 150-200 mg/dL: 4U
- 201-250 mg/dL: 5U
- 251-300 mg/dL: 6U
- 301-350 mg/dL: 7U
- 351-400 mg/dL: 8U
- 401-450 mg/dL: 9U
451 mg/dL: 10U
- Blood sugar levels are checked three times a day before meals 2, 3, 4, 5, 6
Efficacy of Insulin Lispro
- Studies have shown that insulin lispro is effective in achieving glycemic control in patients with type 2 diabetes 2, 3, 4, 5, 6
- Insulin lispro has been shown to reduce HbA1c levels and improve blood glucose variability compared to human insulin mix 30/70 2 and insulin glargine 5, 6
- Insulin lispro has also been shown to reduce the incidence of hypoglycemic events compared to human insulin mix 30/70 2 and insulin glargine 5, 6
Dosage and Administration
- The dosage of insulin lispro is based on blood sugar levels, with higher doses administered for higher blood sugar levels 2, 3, 4, 5, 6
- Insulin lispro is administered twice daily before meals, with the option to adjust the dosage based on blood sugar levels 2, 3, 4, 5, 6