Recommended Starting Dose for Humalog Insulin Sliding Scale
For a starting Humalog (insulin lispro) sliding scale, use 2 units for premeal glucose >250 mg/dL (>13.9 mmol/L) and 4 units for premeal glucose >350 mg/dL (>19.4 mmol/L). 1
Sliding Scale Insulin Framework
When initiating a sliding scale insulin regimen with Humalog (insulin lispro), follow these evidence-based guidelines:
- A simplified sliding scale approach is recommended while adjusting prandial insulin therapy 1
- For premeal glucose >250 mg/dL (>13.9 mmol/L), administer 2 units of Humalog 1
- For premeal glucose >350 mg/dL (>19.4 mmol/L), administer 4 units of Humalog 1
- Discontinue sliding scale when not needed daily 1
- Do not use rapid-acting insulin like Humalog at bedtime due to risk of nocturnal hypoglycemia 1
Implementation Considerations
When implementing a Humalog sliding scale, consider these important factors:
- Monitor blood glucose before meals and at bedtime to guide insulin administration 1
- Adjust the sliding scale every 2 weeks based on fingerstick glucose patterns 1
- Target premeal glucose levels of 90-150 mg/dL (5.0-8.3 mmol/L) 1
- If 50% of premeal glucose values over 2 weeks exceed target, increase the insulin dose 1
- If >2 premeal glucose values per week are <90 mg/dL (<5.0 mmol/L), decrease the insulin dose 1
Clinical Pitfalls and Caveats
Be aware of these important considerations when using sliding scale insulin:
- Sliding scale insulin alone is often ineffective for optimal glycemic control and should be combined with basal insulin when appropriate 2
- Traditional sliding scale regimens are widely variable in effectiveness and prone to monitoring and documentation deficiencies 3
- Hypoglycemia risk increases with sliding scale insulin, particularly in older adults 1
- Humalog has a faster onset and shorter duration than regular human insulin, which affects timing of administration relative to meals 4, 5
- For patients requiring >20 units of prandial insulin daily, Humalog 200 U/ml formulation may be more convenient 4
Special Populations
For older adults or those with complex medical needs:
- Consider higher glucose targets (90-150 mg/dL) to avoid hypoglycemia 1
- In hospitalized patients, basal-bolus insulin regimens with supplemental sliding scale may be more effective than sliding scale alone 1
- For patients on enteral/parenteral nutrition, add 1 unit of insulin per 10-15g of carbohydrate in addition to sliding scale coverage 1
- For patients with mild diabetic ketoacidosis, consider a priming dose of 0.4-0.6 units/kg followed by 0.1 unit/kg/hr before transitioning to sliding scale 1
Remember that sliding scale insulin should ideally be part of a comprehensive insulin regimen that includes basal insulin coverage to achieve optimal glycemic control and reduce complications 1, 2.