What is the recommended dosing of Lyumjev (insulin lispro-aabc) for a patient with hyperglycemia?

From the Guidelines

Lyumjev dosing for a patient with a glucose level of 429 should be adjusted by increasing the dose by 1–2 units or 10–15% twice weekly, as needed, to achieve target glucose levels. When adjusting the dose, it's essential to consider the patient's individual needs and response to the medication. According to the most recent guidelines, dose titration should be based on blood glucose monitoring, with the goal of achieving target pre-meal glucose levels between 80-130 mg/dL and post-meal levels less than 180 mg/dL 1.

• Key considerations for Lyumjev dosing include:
  • Starting doses are typically individualized, but may be around 0.2-0.4 units/kg/day for patients with type 1 diabetes and 0.1-0.2 units/kg/day for type 2 diabetes
  • The total daily dose is usually divided, with approximately 50-70% given as basal insulin and the remainder as mealtime insulin
  • Lyumjev should be administered subcutaneously within 0-2 minutes before meals, though it can also be given up to 20 minutes after starting a meal
  • Dose adjustments should be made based on blood glucose monitoring, with careful consideration of the risk of hypoglycemia, especially during the first 1-3 hours after injection 1.
• It's crucial to monitor the patient's response to the adjusted dose and make further adjustments as needed to minimize the risk of hypoglycemia and achieve optimal glucose control.
• In cases where hypoglycemia occurs, the corresponding dose should be lowered by 10–20%, and the cause of the hypoglycemia should be determined and addressed 1.

From the Research

Lyumjev Dosing for Hyperglycemia

• The recommended dosing of Lyumjev (insulin lispro-aabc) for a patient with hyperglycemia is not directly stated in the provided studies 2, 3, 4, 5, 6.
• However, the studies provide information on the dosing of other types of insulin, such as basal insulin and rapid-acting insulin analogues.
• For example, a study on the addition of rapid-acting insulin to basal insulin therapy in type 2 diabetes suggests that the dose of rapid-acting insulin analogue should be adjusted based on post-meal blood glucose values 2.
• Another study on the efficacy and safety of weight-based insulin glargine dose titration regimen compared with glucose level- and current dose-based regimens in hospitalized patients with type 2 diabetes found that the initial dose of insulin glargine was 0.2 U/kg, and the dose was titrated by increments of 0.1 U/kg daily 3.
• A study on the efficacy and safety of intensive versus nonintensive supplemental insulin with a basal-bolus insulin regimen in hospitalized patients with type 2 diabetes found that the administration of supplemental sliding scale insulin for correction of hyperglycemia is frequently used with basal-bolus insulin regimens 5.
• The dosing of Lyumjev may be similar to that of other rapid-acting insulin analogues, such as insulin glulisine and insulin aspart, which have been studied in patients with type 2 diabetes 6.
• However, without direct evidence on the dosing of Lyumjev, it is difficult to provide a specific recommendation for a patient with a glucose level of 429.

Considerations for Dosing

• The patient's glucose level of 429 is significantly elevated, and the dosing of Lyumjev should be adjusted accordingly.
• The patient's individual characteristics, such as their weight, age, and renal function, should also be taken into account when determining the dose of Lyumjev.
• It is recommended to consult the prescribing information for Lyumjev and to consult with a healthcare professional to determine the appropriate dose for the patient.