Humalog (Insulin Lispro) Dosing for Hyperglycemia
The recommended starting dose of Humalog (insulin lispro) for treating hyperglycemia is 4 units, 0.1 units/kg, or 10% of the basal insulin dose, administered immediately before meals. 1
Initial Dosing Guidelines
For Non-Critical Hyperglycemia
- Starting dose options:
- 4 units per meal
- 0.1 units/kg per meal
- 10% of the basal insulin dose per meal 1
- Administer 5-15 minutes before meals for optimal glycemic control
For Severe Hyperglycemia
- Blood glucose >250 mg/dL with symptoms:
- Initial basal insulin plus Humalog in a basal-bolus regimen
- Starting total daily insulin: 0.3-0.5 units/kg/day
- Distribution: 50% basal, 50% bolus (divided among meals) 1
- Blood glucose >300 mg/dL:
- More aggressive basal-bolus regimen required
- Starting total daily insulin: 0.5-0.6 units/kg/day 1
For Hospitalized Patients
- Target glucose range: 140-180 mg/dL for most critically and non-critically ill patients 1
- Initiate insulin therapy: When blood glucose ≥180 mg/dL (checked on two occasions) 1
- More stringent targets (110-140 mg/dL) may be appropriate for selected patients if achievable without significant hypoglycemia 1
Dose Adjustment Algorithm
Prandial Insulin Adjustment
Adjust based on 2-hour postprandial glucose patterns:
- >200 mg/dL: Increase by 2-4 units
- 150-200 mg/dL: Increase by 1-2 units
- 100-150 mg/dL: No change
- <100 mg/dL: Decrease by 1-2 units
- Any hypoglycemia: Decrease corresponding meal dose by 10-20% 2
Correction Insulin for Hyperglycemia
| Blood Glucose (mg/dL) | Additional Humalog Units |
|---|---|
| 150-200 | Add 2 units |
| 201-250 | Add 4 units |
| 251-300 | Add 6 units |
| >300 | Add 8 units and notify provider |
| [2] |
Administration Timing
- For patients with hyperglycemia, administer Humalog 15 minutes before meals for optimal postprandial glucose control 3
- Administering Humalog 15-30 minutes before meals in hyperglycemic patients significantly reduces postprandial glucose excursions compared to injection at mealtime 3
Special Considerations
Hyperglycemic Crises
- For diabetic ketoacidosis (DKA): IV regular insulin is preferred initially (0.1 units/kg/hour) 1
- Once stabilized, transition to subcutaneous Humalog
Steroid-Induced Hyperglycemia
- Higher insulin requirements may be needed
- Consider basal-bolus regimen with once-daily glargine and Humalog with each meal
- Initial dose: 0.3-0.5 units/kg/day total, split 50/50 between basal and bolus 1
Hospitalized Patients
- Point-of-care glucose monitoring before meals for patients who are eating
- Every 4-6 hours for patients who are not eating 1
- More frequent monitoring (every 30 min to 2 hours) for patients on IV insulin 1
Practical Tips
- Humalog has a faster onset of action (5-15 minutes) and shorter duration (3-4 hours) than regular human insulin 4
- The rapid onset allows for immediate pre-meal dosing, improving convenience and flexibility 4
- For patients with unpredictable eating patterns, Humalog can be administered immediately after meals, though pre-meal administration is preferred for better glycemic control 4
Monitoring and Safety
- Monitor for hypoglycemia (blood glucose <70 mg/dL)
- Treat hypoglycemia immediately with 15g of fast-acting carbohydrate
- Recheck blood glucose in 15 minutes 2
- For severe hyperglycemia that doesn't respond to correction doses, consider checking for ketones and potential DKA
Remember that while these are evidence-based recommendations, clinical judgment is still important when determining the appropriate Humalog dose for individual patients based on their specific needs and circumstances.