Is Admelog (insulin lispro) 15 units injected twice daily an appropriate regimen?

Admelog (Insulin Lispro) Twice Daily Dosing Regimen

Yes, Admelog (insulin lispro) 15 units injected twice daily is an appropriate insulin regimen for many patients with diabetes, particularly those requiring prandial insulin coverage before meals.

Rationale for Twice Daily Insulin Lispro

Insulin lispro is a rapid-acting insulin analog with several advantages:

• Pharmacokinetic profile: Insulin lispro has a faster onset of action (within 15 minutes) and shorter duration of activity (3-5 hours) than regular human insulin, better mimicking physiological insulin response to meals 1
• Timing flexibility: Can be administered immediately before or after meals, providing more convenience for patients 1
• Postprandial control: Demonstrates better postprandial glucose control compared to regular human insulin 2
• Hypoglycemia risk: May have lower risk of nocturnal hypoglycemia compared to regular human insulin 1, 2

Dosing Considerations

The appropriateness of the 15 units twice daily regimen depends on several factors:

• Starting dose: The American Diabetes Association recommends starting insulin at 10 units per day or 0.1-0.2 units/kg/day 3
• Dose distribution: For twice-daily regimens, insulin is typically divided with approximately 2/3 given before breakfast and 1/3 given before dinner 3
• Titration needs: Doses should be adjusted based on blood glucose monitoring, typically by 1-2 units or 10-15% twice weekly 4

Clinical Scenarios Where This Regimen May Be Appropriate

1. Type 2 diabetes patients who have failed oral medications and require insulin therapy
2. Patients transitioning from basal insulin who need additional prandial coverage
3. Patients who prefer fewer daily injections compared to basal-bolus regimens (which require 4+ injections)

Potential Limitations

• Fixed dosing: A fixed dose of 15 units twice daily may not account for meal-to-meal variability in carbohydrate intake
• Coverage gaps: Twice-daily dosing may leave gaps in coverage during parts of the day
• Individual variability: Insulin requirements vary based on body weight, insulin sensitivity, and other factors 3

Alternative Regimens to Consider

If glycemic targets are not achieved with twice-daily insulin lispro:

• Basal-bolus regimen: Adding a long-acting insulin analog with mealtime insulin lispro 4
• Premixed insulin: Consider 70/30 or 75/25 premixed insulin formulations that contain both rapid and intermediate-acting insulin 4
• More frequent dosing: Adding a third injection of rapid-acting insulin if needed 4

Monitoring and Adjustment

For patients on twice-daily insulin lispro:

• Blood glucose monitoring: Check before meals and 2 hours after meals to assess effectiveness
• Dose adjustments: Increase dose by 1-2 units or 10-15% twice weekly if blood glucose remains above target 4
• Hypoglycemia management: If hypoglycemia occurs, determine the cause and reduce the corresponding dose by 10-20% 3

Bottom Line

While a twice-daily Admelog regimen of 15 units can be appropriate, the dose should be regularly reassessed based on blood glucose patterns, A1C levels, and the patient's individual needs. Regular monitoring and appropriate dose adjustments are essential for optimal glycemic control.