Can I order insulin lispro (Humalog) high dose sliding scale with nightly 10 units of Lantus (insulin glargine)?

Insulin Lispro High Dose Sliding Scale with Nightly Lantus 10 Units

Yes, you can order insulin lispro (Humalog) high dose sliding scale with nightly 10 units of Lantus (insulin glargine) as this combination represents an appropriate basal-bolus insulin regimen for diabetes management. 1

Rationale for Basal-Bolus Insulin Therapy

This regimen follows the recommended approach of combining:

• Basal insulin (Lantus/insulin glargine): Provides background insulin coverage over 24 hours
• Prandial insulin (lispro/Humalog): Covers mealtime glucose excursions
• Correction insulin (sliding scale): Addresses hyperglycemia between meals

The American Diabetes Association recommends this combination approach when basal insulin alone is insufficient to achieve glycemic targets 2, 1.

Dosing Considerations

Basal Insulin (Lantus)

• Starting with 10 units of Lantus is appropriate and aligns with guidelines recommending:
  • Initial dose of 10 units/day or 0.1-0.2 units/kg/day 1
  • Administration at the same time each night for consistent coverage 3
  • Titration based on fasting glucose levels (typically by 2 units every 3 days until target is reached) 1

Prandial/Correction Insulin (Lispro)

• High dose sliding scale with insulin lispro provides:
  • Rapid onset (15 minutes) and short duration (3-4 hours) making it ideal for mealtime and correction dosing 4
  • Flexibility to adjust doses based on carbohydrate intake and pre-meal glucose levels 1
  • Better postprandial glucose control compared to regular human insulin 5

Implementation Tips

1. Sliding Scale Parameters: Define specific blood glucose thresholds and corresponding insulin lispro doses for the high dose sliding scale based on patient's insulin sensitivity

2. Timing of Administration:

   • Administer Lantus once daily at the same time each evening 3
   • Administer lispro immediately before meals (within 15 minutes) 4

3. Monitoring Requirements:

   • Monitor blood glucose before meals and at bedtime during initiation
   • Check HbA1c every 3 months to assess overall glycemic control 1

4. Dose Adjustments:

   • Increase Lantus by 2 units every 3 days if fasting glucose remains above target 1
   • Adjust lispro sliding scale based on postprandial glucose patterns

Important Considerations

• Hypoglycemia Risk: Monitor for hypoglycemia, especially nocturnal hypoglycemia, which may occur with this combination 5

• Concomitant Medications: Consider continuing metformin if the patient has type 2 diabetes, as this can improve insulin sensitivity 1

• Patient Education: Ensure the patient understands:

  • Proper injection technique
  • Signs and symptoms of hypoglycemia
  • Importance of consistent meal timing and carbohydrate content
  • Need for regular glucose monitoring

• Warning Signs: Watch for basal insulin dose exceeding 0.5 units/kg/day, which may indicate the need for intensification of the prandial insulin regimen 1

This basal-bolus regimen with Lantus and lispro sliding scale provides a physiologic approach to insulin replacement and has been shown to improve overall glycemic control with manageable hypoglycemia risk 5.