From the Guidelines
All short-acting insulin analogs, including Humalog (lispro), Novolog (aspart), and Apidra (glulisine), can be safely combined with Basaglar (glargine) insulin to achieve optimal glycemic control. This combination is supported by the American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) consensus report, which suggests that short- and rapid-acting insulin formulations can be used to intensify basal insulin therapy in patients not meeting glycemic targets 1. The report highlights that rapid-acting insulin analogs have a modestly lower risk for hypoglycemia compared with human regular insulin, making them a suitable choice for combination with Basaglar.
When combining Basaglar with a short-acting insulin analog, it is essential to administer them as separate injections, rather than mixing them in the same syringe. Basaglar is typically administered once daily at the same time each day, while the short-acting insulin is given before meals based on carbohydrate intake and pre-meal blood glucose levels. The complementary action profiles of Basaglar and short-acting insulin analogs work well together, with Basaglar maintaining steady background insulin levels and the rapid-acting insulins covering meal-related glucose elevations.
Key considerations for this combination include:
- Separate injections for Basaglar and short-acting insulin analogs
- Once-daily administration of Basaglar at the same time each day
- Pre-meal administration of short-acting insulin based on carbohydrate intake and pre-meal blood glucose levels
- Monitoring of blood glucose levels to adjust insulin doses as needed.
By following this approach, patients can achieve comprehensive glucose control throughout the day, mimicking normal physiologic insulin secretion patterns and reducing the risk of hypoglycemia and other complications associated with diabetes 1.
From the Research
Short-Acting Insulin Options
To combine with Basaglar (glargine) insulin, the following short-acting insulin options can be considered:
- Humalog (lispro) 2, 3, 4, 5
- Novolog (aspart) - no direct evidence provided
- Apidra (glulisine) - no direct evidence provided
Rationale for Humalog (Lispro)
Studies have shown that Humalog (lispro) can be effectively combined with NPH insulin, which has a similar mechanism to Basaglar (glargine) insulin 3, 4. The combination of lispro and NPH insulin has been shown to improve postprandial glycemic control and reduce the risk of hypoglycemia 3, 4. Additionally, Humalog (lispro) has a faster onset of action and shorter duration of activity compared to regular human insulin, making it a suitable option for combination with Basaglar (glargine) insulin 2, 5.
Considerations for Other Options
While Novolog (aspart) and Apidra (glulisine) are also short-acting insulin options, there is no direct evidence provided in the studies to support their combination with Basaglar (glargine) insulin. However, it is possible that these options may also be effective in combination with Basaglar, but further research would be needed to confirm this.
Key Findings
- Humalog (lispro) can be combined with NPH insulin to improve postprandial glycemic control and reduce the risk of hypoglycemia 3, 4
- Humalog (lispro) has a faster onset of action and shorter duration of activity compared to regular human insulin 2, 5
- The combination of lispro and NPH insulin can be used to optimize basal-bolus insulin regimens 6