What is the typical dosing regimen for Humalog (insulin lispro) in type 2 diabetes patients?

Humalog (Insulin Lispro) Dosing for Type 2 Diabetes

For patients with type 2 diabetes requiring prandial insulin control, Humalog (insulin lispro) is typically initiated at 4 units or 10% of the basal insulin dose before the largest meal, with subsequent dose adjustments based on blood glucose monitoring. 1

Initial Dosing Approach

• When adding prandial insulin to a basal insulin regimen, start with a single injection of Humalog before the largest meal or the meal with the greatest postprandial glucose excursion 1
• Initial dose should be 4 units or 10% of the basal insulin dose 1
• Administer Humalog 0-2 minutes before meals due to its rapid-acting profile 2
• Continue metformin therapy when initiating insulin, but consider discontinuing other oral agents to avoid unnecessarily complex regimens 1

Intensification of Insulin Therapy

• If HbA1c remains above target with basal insulin plus a single Humalog injection, advance to a basal-bolus regimen with multiple daily injections of Humalog before meals 1
• Titrate prandial insulin doses based on pre-meal blood glucose levels with a target of 90-150 mg/dL (5.0-8.3 mmol/L) 1
• When significant prandial insulin is added, particularly with evening meals, consider decreasing the basal insulin dose to avoid hypoglycemia 1

Premixed Humalog Options

• Alternatively, premixed formulations may be used:
  • Humalog Mix75/25 (75% insulin lispro protamine/25% insulin lispro) twice daily before breakfast and dinner 3
  • Humalog Mix50/50 (50% insulin lispro protamine/50% insulin lispro) may provide better postprandial control for carbohydrate-rich meals 4
  • Initial dosing of premixed insulin is typically administered twice daily before breakfast and dinner 1

Dose Adjustments

• Titrate doses based on self-monitoring of blood glucose or HbA1c 1
• If 50% of pre-meal glucose readings are above target: increase dose by 2 units 1
• If more than 2 pre-meal glucose readings per week are <80 mg/dL (<4.4 mmol/L): decrease dose by 2 units 1
• Patients with type 2 diabetes generally require higher daily doses (≥1 unit/kg) than those with type 1 diabetes 1

Special Considerations

• People with type 2 diabetes have lower rates of hypoglycemia compared to those with type 1 diabetes when using insulin lispro 1
• Humalog offers greater flexibility in meal planning compared to premixed insulins due to its rapid onset of action 1
• Regular monitoring of blood glucose is essential for dose adjustments 1
• For patients who struggle with complex regimens, consider simplified approaches such as using Humalog Mix75/25 twice daily 5, 6

Potential Pitfalls and Caveats

• Watch for signs of overbasalization when adding prandial insulin: basal dose >0.5 units/kg, high bedtime-morning glucose differential (>50 mg/dL), or hypoglycemia 1
• When intensifying to multiple daily Humalog injections, sulfonylureas, DPP-4 inhibitors, and GLP-1 receptor agonists are typically discontinued 1
• Cost considerations may impact adherence; discuss with patients as Humalog may be more expensive than human regular insulin 1
• For older adults, consider simplified regimens and higher glycemic targets to reduce hypoglycemia risk 1