Humalog (Insulin Lispro) Sliding Scale Dosing Strategy
The typical sliding scale dosing strategy for Humalog (insulin lispro) involves administering 2 units for blood glucose >250 mg/dL and 4 units for blood glucose >350 mg/dL before meals, with adjustments based on individual response and glycemic targets. 1
Basic Principles of Prandial Insulin Dosing
- Initial prandial insulin dosing typically starts at 4 units per dose, 0.1 units/kg, or 10% of the basal insulin dose 1
- When adding prandial insulin to a regimen, consider reducing the basal insulin dose by 4 units or 10% if A1C is <8% to prevent hypoglycemia 1
- Prandial insulin is usually initiated with one dose at the largest meal or the meal with the greatest postprandial glucose excursion 1
Standard Sliding Scale Protocol
- For premeal glucose >250 mg/dL: Add 2 units of Humalog (insulin lispro) 1
- For premeal glucose >350 mg/dL: Add 4 units of Humalog (insulin lispro) 1
- Titrate the dose by increasing 1-2 units or 10-15% twice weekly based on glucose response 1
- For hypoglycemic events, determine the cause and reduce the corresponding dose by 10-20% if no clear reason is identified 1
Considerations for Different Patient Populations
Older Adults
- In older adults, a simplified sliding scale may be more appropriate with lower targets (90-150 mg/dL) to reduce hypoglycemia risk 1
- For frail elderly patients, consider discontinuing sliding scale when not needed daily to reduce medication burden 1
- Avoid using rapid-acting insulin at bedtime in older adults to prevent nocturnal hypoglycemia 1
Intensification Strategy
- If initial prandial dosing is insufficient, consider stepwise addition of additional prandial insulin injections (progressing from one to three meals) 1
- When advancing to multiple daily injections, maintain metformin while considering discontinuation of other oral agents to avoid unnecessarily complex regimens 1
Monitoring and Adjustment
- Assess blood glucose values every 2 weeks and adjust doses if 50% of premeal values are above target 1
- Decrease dose if more than 2 premeal glucose values per week are below target range 1
- For patients requiring >20 units of prandial insulin per day, consider Humalog 200 U/mL formulation for reduced injection volume 2
Common Pitfalls to Avoid
- Using sliding scale insulin alone without basal insulin can lead to a 3-fold higher risk of hyperglycemic episodes 3
- Sliding scales that are not individualized or adjusted based on patterns may lead to glucose variability 3
- Failure to adjust the sliding scale based on meal content and timing can result in postprandial hyperglycemia or delayed hypoglycemia 4
- Overreliance on sliding scale without addressing underlying basal insulin needs may worsen overall glycemic control 3
Special Situations
- During Ramadan or other fasting periods, consider adjusting the Humalog dose to match the timing and size of meals 1, 5
- For patients transitioning from oral agents to insulin therapy, Humalog Mix formulations (premixed insulin with fixed ratios of rapid and intermediate-acting components) may provide better postprandial control than human insulin mixtures 4, 6