What is the typical starting dose for a Humalog (insulin lispro) infusion?

Humalog (Insulin Lispro) Infusion Starting Dose

The typical starting dose for a Humalog (insulin lispro) infusion is 0.5 units/kg/day, which can be adjusted based on the patient's metabolic stability and clinical condition. 1

Dosing Guidelines for Humalog Infusions

• For metabolically stable patients with type 1 diabetes, the American Diabetes Association recommends starting with 0.5 units/kg/day as a typical dose 1
• The total insulin dose range generally falls between 0.4 to 1.0 units/kg/day, with higher amounts required during puberty, pregnancy, and medical illness 1
• For patients with severe hyperglycemia (>300 mg/dL or 16.6 mmol/L), or those using high doses of insulin at home (>0.6 units/kg/day), a more complex regimen may be indicated 1
• In critically ill patients requiring insulin infusion therapy, Humalog has demonstrated a faster blood glucose drop during infusion compared to regular insulin at the same dose 2

Pharmacokinetic Profile of Humalog

• Humalog (insulin lispro) is a rapid-acting insulin analog with onset of action within 5 minutes 1
• Peak action occurs at 1-2 hours after administration 1, 3
• Duration of action is typically 3-4 hours 1, 3
• This rapid onset and shorter duration make Humalog particularly suitable for continuous subcutaneous insulin infusion (insulin pumps) 1, 3

Adjusting Humalog Infusion Rates

• Insulin requirements should be individualized based on blood glucose monitoring results 1
• For patients with mild hyperglycemia (<200 mg/dL), consider lower doses with correction doses of rapid-acting insulin before meals or every 6 hours 1
• For moderate hyperglycemia (201-300 mg/dL), start at 0.2-0.3 units/kg/day 1
• In patients at risk for hypoglycemia (elderly, frail, acute kidney injury), reduce the starting dose to 0.15 units/kg/day 1

Clinical Considerations

• Humalog infusions have been shown to have less profound carryover effect on blood glucose after discontinuation compared to regular insulin, making it potentially preferable for use in critically ill patients 2
• Continuous glucose monitoring should be considered for patients on insulin infusions to detect and prevent hypoglycemic episodes 1
• The American Diabetes Association recommends rapid-acting insulin analogs like Humalog for continuous subcutaneous insulin infusion to reduce hypoglycemia risk 1
• When transitioning from intravenous to subcutaneous insulin, consider that Humalog has a quicker blood glucose rise after discontinuation compared to regular insulin 2

Common Pitfalls and Caveats

• Avoid excessive insulin dosing, as Humalog's rapid onset can cause a quick onset of hypoglycemia, giving patients less time to recognize symptoms 1
• Weight-based dosing requires higher amounts immediately following presentation with ketoacidosis 1
• Regular monitoring of blood glucose is essential, optimally four times daily, with target blood glucose of 180-200 mg/dL when using insulin infusions 1
• Addition of regular insulin to the infusion solution may be required if blood glucose exceeds target levels 1