What is the Humalog (insulin lispro) sliding scale for an 85-year-old, 100 kg female taking 32 units of Lantus (insulin glargine) at bedtime?

Humalog Sliding Scale Recommendations for an 85-Year-Old Female

For an 85-year-old female weighing 100 kg and taking 32 units of Lantus at bedtime, a simplified sliding scale for Humalog should use 2 units for blood glucose >250 mg/dL and 4 units for blood glucose >350 mg/dL before meals. 1

Rationale for Sliding Scale Recommendation

The American Diabetes Association's 2024 Standards of Care for Older Adults provides specific guidance for simplified sliding scale insulin in older adults:

• For premeal glucose >250 mg/dL (>13.9 mmol/L): Give 2 units of Humalog (rapid-acting insulin)
• For premeal glucose >350 mg/dL (>19.4 mmol/L): Give 4 units of Humalog (rapid-acting insulin) 1

This simplified approach is particularly appropriate for older adults to reduce the risk of hypoglycemia while still addressing significant hyperglycemia.

Important Considerations for This Patient

Age-Related Factors

• At 85 years old, this patient has increased risk of hypoglycemia and hypoglycemia unawareness
• Simplified insulin regimens are preferred to reduce medication errors and hypoglycemia risk
• Target blood glucose range should be 90-150 mg/dL before meals 1

Weight Considerations

• Patient weighs 100 kg and is on 32 units of Lantus (basal insulin)
• Current basal dose is approximately 0.32 units/kg/day, which is within the recommended range of 0.3-0.5 units/kg/day 2

Monitoring Recommendations

• Monitor blood glucose before meals and at bedtime
• Evaluate the need for the sliding scale regularly
• Discontinue sliding scale when not needed daily 1

Safety Precautions

• Do not use rapid-acting insulin (Humalog) at bedtime to avoid nocturnal hypoglycemia 1
• If hypoglycemia occurs (blood glucose <80 mg/dL) more than twice weekly, consider reducing the basal insulin dose by 2 units 1
• If 50% of fasting glucose readings are above target, consider increasing basal insulin by 2 units 1

Potential Adjustments

If glycemic control remains suboptimal with the sliding scale approach:

1. Reassess the basal insulin dose (Lantus)
2. Consider changing Lantus timing from bedtime to morning if nocturnal hypoglycemia is an issue 1
3. Consider adding non-insulin agents if appropriate based on renal function 1

Documentation and Follow-up

• Document blood glucose readings and insulin doses
• Evaluate the effectiveness of the sliding scale every 2 weeks
• Adjust therapy based on patterns rather than single readings 2
• Consider discontinuing the sliding scale if stable glycemic control is achieved 1

Remember that the goal of therapy in this older adult is to prevent hypoglycemia while avoiding extreme hyperglycemia, with less emphasis on tight glycemic control and more focus on quality of life and safety.