If a patient is taking insulin lispro (Admelog) 2 units twice daily and their blood glucose remains above 10 mmol/L, can the total daily dose be increased to 6 units?

Can Admelog be Increased to 6 Units Per Day?

Yes, you can and should increase the Admelog dose to 6 units per day (3 units twice daily) if blood glucose remains above 10 mmol/L on 2 units twice daily, and you should continue titrating upward until glycemic targets are achieved.

Recommended Titration Approach

Based on the 2025 ADA Standards of Care, when initiating and titrating prandial insulin like Admelog (insulin lispro), the evidence-based approach is 1:

Initial dose adjustment:

• Start with 4 units per day OR 10% of basal insulin dose (if on basal insulin)
• Increase dose by 1-2 units or 10-15% every 3 days to reach postprandial glucose goals without hypoglycemia

For your specific scenario:

• Current dose: 2 units twice daily (4 units total)
• Blood glucose remains >10 mmol/L (>180 mg/dL)
• Recommended action: Increase to 3 units twice daily (6 units total) immediately
• Continue monitoring and titrate upward by 1-2 units per injection every 3 days until targets are met

Important Clinical Considerations

Assess the pattern of hyperglycemia first:

• If fasting glucose is elevated → prioritize basal insulin optimization
• If postprandial glucose is elevated → increase prandial insulin (Admelog)
• Your patient's BG >10 mmol/L suggests inadequate prandial coverage

Hypoglycemia management protocol 1:

• If hypoglycemia occurs: determine the cause
• If no clear reason identified: reduce the corresponding dose by 10-20%
• Prescribe glucagon for emergent hypoglycemia

Avoid These Common Pitfalls

1. Therapeutic inertia: The guidelines explicitly warn against delaying dose adjustments. Reassess and modify every 3-6 months, or sooner if targets aren't met 1

2. Inadequate titration: Don't stop at 6 units/day if glucose remains elevated. The 2023 AACE guidelines note that prandial insulin should be titrated based on individualized needs, with increases of 10-20% if pre-meal glucose remains >140 mg/dL 2

3. Ignoring basal insulin needs: If your patient isn't on basal insulin, consider adding it. The ADA recommends starting basal insulin at 10 units/day or 0.1-0.2 units/kg/day when injectable therapy is needed 1

4. Injection site issues: Ensure proper injection technique with 4-6mm needles, rotate sites to avoid lipohypertrophy which distorts insulin absorption 3

Monitoring Strategy

• Check pre-meal and 2-hour postprandial glucose values
• Titrate the morning dose based on pre-lunch/lunch glucose
• Titrate the evening dose based on bedtime/overnight glucose
• Target fasting plasma glucose <110 mg/dL (<6.1 mmol/L) and postprandial <180 mg/dL (<10 mmol/L)

The bottom line: 6 units/day is appropriate but likely still insufficient. Continue aggressive titration every 3 days until glycemic targets are achieved, monitoring closely for hypoglycemia.