Can Humalog (insulin lispro) be administered intravenously (IV)?

Intravenous Administration of Humalog (Insulin Lispro)

Yes, Humalog (insulin lispro) can be administered intravenously (IV), particularly in critical care settings where continuous intravenous insulin infusion is the most effective method for achieving glycemic targets. 1

Clinical Settings for IV Insulin Administration

Critical Care Setting

• Continuous intravenous insulin infusion is the recommended method for achieving glycemic targets and avoiding hypoglycemia in critically ill patients 1
• IV insulin infusions should be administered using validated written or computerized protocols that allow for predefined adjustments in the infusion rate based on glycemic fluctuations 1
• For diabetic ketoacidosis (DKA) and hyperglycemic hyperosmolar state (HHS) management, continuous IV insulin infusion is given for correction of hyperglycemia, hyperketonemia, and acid-base disorders 1

Monitoring Requirements

• More frequent blood glucose testing ranging from every 30 minutes to every 2 hours is the required standard for safe use of intravenous insulin 1
• Intravenous insulin infusions should be administered based on validated protocols that account for glycemic fluctuations and insulin dose 1

Transitioning from IV to Subcutaneous Insulin

When transitioning from IV to subcutaneous insulin administration:

• Subcutaneous insulin should be given 1-2 hours before intravenous insulin therapy is discontinued 1
• Converting to basal insulin at 60-80% of the daily infusion dose has been shown to be effective 1
• A practical approach is to administer half of the 24-hour IV insulin requirement as basal insulin and divide the other half into three doses of rapid-acting insulin for meals 1

Advantages of Insulin Lispro

Humalog (insulin lispro) has specific properties that make it suitable for IV use:

• It is a recombinant human insulin analogue that differs from human insulin only by the transposition of two amino acids 2
• It has a faster onset of action and shorter duration of activity than regular human insulin 3
• The time-action profile mimics the physiological response of endogenous human insulin 2

Important Considerations and Precautions

• Safety standards that prohibit the sharing of insulin delivery devices, lancets, and needles are mandatory 1
• Inpatient glucose targets of 7.8-10 mmol/L (140-180 mg/dL) are recommended for most critically ill patients 1
• For specific patients such as those with acute cardiac or neurologic events, tighter glucose targets of 6.1-7.8 mmol/L (110-140 mg/dL) may be appropriate if achievable without significant hypoglycemia 1

Risk Management

• Hospital-related hypoglycemia is associated with higher mortality 1
• A standardized hospital-wide and nurse-initiated hypoglycemia treatment protocol should be in place to immediately address hypoglycemia 1
• Potential triggers for hypoglycemia include sudden reduction of corticosteroid dose, reduced oral intake, inappropriate timing of insulin in relation to meals, and unexpected interruption of feeding 1

Special Situations

• In cases of β-blocker overdose with refractory shock, high-dose IV insulin (with glucose supplementation) may be considered as a therapeutic option 1
• The protocol for this use involves IV administration of 1 U/kg regular insulin as a bolus, accompanied by 0.5 g/kg dextrose, followed by continuous infusions 1

By following established protocols and maintaining appropriate monitoring, Humalog can be safely and effectively administered intravenously in appropriate clinical settings, particularly for critically ill patients requiring tight glycemic control.