What is the starting dose of Humalog (insulin lispro) for a type 2 diabetic patient?

Starting Dose of Humalog Insulin for Type 2 Diabetic Patients

The recommended starting dose of Humalog (insulin lispro) for type 2 diabetic patients is 4 units per meal, 0.1 units/kg per meal, or 10% of the basal insulin dose per meal if the patient is already on basal insulin. 1

Initial Insulin Therapy Approach

• Basal insulin is typically the first insulin regimen initiated in type 2 diabetes, starting at 10 units per day or 0.1-0.2 units/kg/day, depending on the degree of hyperglycemia 1
• When adding mealtime (prandial) insulin such as Humalog to the regimen, the recommended starting dose is:
  • 4 units per meal, OR
  • 0.1 units/kg per meal, OR
  • 10% of the basal insulin dose per meal 1
• If A1C is <8% when starting mealtime insulin, consider decreasing the basal insulin dose by the same amount as the starting mealtime dose 1

Titration and Adjustment

• After initiating Humalog, doses should be adjusted based on self-monitoring of blood glucose (SMBG) results 1
• Educating and involving patients in insulin self-management improves glycemic control 1
• Dose titration should occur over days to weeks as needed, based on blood glucose patterns 1
• Self-titration algorithms based on SMBG can improve glycemic control in patients initiating insulin therapy 1

Considerations for Humalog Administration

• Humalog is a rapid-acting insulin analog with a quick onset of action after dosing 1
• Humalog should be administered just before meals due to its rapid onset of action 1
• For hyperglycemic patients, administering Humalog 15 minutes before meals may provide better postprandial glucose control 2
• Comprehensive education regarding blood glucose monitoring, diet, and hypoglycemia management is critically important for any patient using insulin 1

Special Considerations

• If transitioning from other insulin regimens to Humalog, dose adjustments may be necessary 1
• When initiating mealtime insulin like Humalog, metformin therapy should typically be continued 1
• Other oral agents may be discontinued on an individual basis to avoid unnecessarily complex regimens 1
• Sulfonylureas, DPP-4 inhibitors, and GLP-1 receptor agonists are typically discontinued when more complex insulin regimens beyond basal insulin are used 1

Common Pitfalls to Avoid

• Avoid using insulin as a threat or describing it as a sign of personal failure or punishment 1
• Don't underestimate the importance of patient education on self-monitoring of blood glucose, diet, and hypoglycemia management 1
• Be aware that cost considerations are important when selecting insulin products due to substantial price increases over the past decade 1
• Recognize that the progressive nature of type 2 diabetes should be regularly and objectively explained to patients 1