From the Guidelines
No, an additional 8 units of Humalog (insulin lispro) should not be administered now without more clinical information. Administering insulin requires careful consideration of the patient's current blood glucose level, recent food intake, planned activities, and their established insulin regimen. Humalog is a rapid-acting insulin that begins working within 15 minutes, peaks in 1-2 hours, and lasts 2-4 hours. Giving additional insulin without knowing the patient's current glycemic status could potentially cause dangerous hypoglycemia.
Key Considerations
- Before administering any supplemental insulin dose, healthcare providers should check the patient's blood glucose level, review their insulin sensitivity factor (correction factor), consider the insulin on board from previous doses, and evaluate the timing of their last meal.
- If the patient is experiencing hyperglycemia, the appropriate correction dose should be calculated based on their individualized insulin-to-carbohydrate ratio and correction factor, rather than arbitrarily administering 8 units.
- According to the American Diabetes Association standards of medical care in diabetes 1, dose titration is important, and dosing adjustments may be necessary in both mealtime and basal insulins, based on blood glucose level and an understanding of the pharmacodynamic profile of each formulation.
Recommendations
- Healthcare providers should prioritize regimen flexibility when devising a plan for the initiation and adjustment of insulin therapy for patients with type 2 diabetes.
- Rapid-acting insulin offers greater flexibility in meal planning than premixed insulin, and its use should be considered based on individual patient needs and response to therapy.
- The FDA has approved various insulin products, including fixed-ratio combination products containing basal insulin plus a GLP-1–receptor agonist, which may be considered for patients with type 2 diabetes who require more intensive therapy 1.
From the Research
Administration of Humalog
The decision to administer an additional 8 units of Humalog (insulin lispro) should be based on the patient's current blood glucose level and their individual insulin regimen.
- The studies 2, 3, 4 demonstrate the efficacy of Humalog in improving postprandial glycemic control and reducing the risk of hypoglycemic episodes, particularly when administered immediately before or after meals.
- However, the optimal dosage and administration schedule may vary depending on the patient's specific needs and circumstances, such as the type and severity of their diabetes, their diet and exercise habits, and their overall health status.
Considerations for Administration
When considering the administration of an additional 8 units of Humalog, the following factors should be taken into account:
- The patient's current blood glucose level and their target glucose range 5, 6
- The timing and content of their last meal, as well as their planned activities and schedule for the day 3, 4
- Their individual insulin sensitivity and response to Humalog, which may vary over time and require adjustments to their dosage and administration schedule 2, 5
- The potential risks and benefits of administering additional insulin, including the risk of hypoglycemia and the potential for improved glycemic control 2, 3, 4
Clinical Evidence
The clinical evidence supporting the use of Humalog is extensive, with numerous studies demonstrating its efficacy and safety in a wide range of patients with diabetes 2, 3, 5, 6, 4.
- These studies have consistently shown that Humalog can improve postprandial glycemic control, reduce the risk of hypoglycemic episodes, and enhance patient satisfaction with treatment.
- However, the specific dosage and administration schedule used in these studies may not be directly applicable to individual patients, and healthcare providers should use their clinical judgment when making decisions about insulin therapy.