Insulin Lispro (Humalog) One-Time Dosing Recommendations
The recommended one-time dose of insulin lispro (Humalog) is 4 units per meal, 0.1 units/kg per meal, or 10% of the basal insulin dose per meal. 1, 2
Initial Dosing Guidelines
- For patients starting mealtime insulin lispro, the initial dose should be 4 units, 0.1 units/kg body weight, or 10% of the basal insulin dose per meal 1, 2
- Insulin lispro should be administered 15 minutes or less before meals for optimal glycemic control 2, 3
- If the patient's A1C is <8% when starting mealtime bolus insulin, consider decreasing the basal insulin dose by the same amount as the starting mealtime dose 1
- For patients with significant hyperglycemia, administering lispro insulin 15-30 minutes before meals may improve postprandial glucose excursion 3
Dosing Considerations Based on Patient Factors
- For patients requiring large doses of insulin, concentrated formulations such as U-200 lispro (200 units/mL) are available for more comfortable administration 1
- When initiating insulin lispro in combination with other antihyperglycemic medications, metformin should typically be continued while other oral agents may be discontinued to avoid unnecessarily complex regimens 1
- In elderly patients with type 2 diabetes, insulin lispro has been shown to provide better metabolic control with fewer hypoglycemic episodes compared to regular insulin 4
Administration Timing
- Unlike regular human insulin which requires administration 30-45 minutes before meals, insulin lispro should be administered immediately before or within 15 minutes of starting a meal 5, 6
- For hyperglycemic patients, administering lispro 15 minutes before meals has shown better postprandial glucose control than injection at mealtime 3
- Insulin lispro has a faster onset of action (5 minutes), earlier peak effect (1-2 hours), and shorter duration of action (3-4 hours) compared to regular human insulin 2, 6
Common Pitfalls and Caveats
- Patients must understand the rapid onset of lispro to avoid rapid hypoglycemia 2
- Insulin lispro is contraindicated in patients with hypersensitivity to the medication 2
- When switching from regular insulin to lispro, patients should be aware of the different timing requirements to avoid dosing errors 6
- For patients with type 2 diabetes, if basal insulin has been titrated to an acceptable fasting blood glucose level but A1C remains above target, adding mealtime insulin lispro is an appropriate step 1
Monitoring and Adjustment
- Self-monitoring of blood glucose is essential when initiating insulin lispro therapy to assess effectiveness and adjust dosing as needed 1
- Postprandial glucose levels at 1-2 hours after meals should be monitored to evaluate the effectiveness of the insulin lispro dose 7
- Dose adjustments should be made based on patterns of blood glucose readings rather than single values 1