From the Guidelines
To adjust Basaglar insulin when Humalog sliding scale is not controlling blood glucose, adjust the Basal rates based on overnight glucose levels, and consider adjusting the Correction insulin by modifying the Insulin Sensitivity Factor (ISF) and/or target glucose levels, as recommended by the most recent guidelines 1. When using Basaglar insulin, a long-acting basal insulin, in conjunction with Humalog, a rapid-acting insulin, it's essential to understand the roles of each in glucose management. Basaglar provides 24-hour background insulin coverage, while Humalog is used for mealtime coverage to manage short-term glucose rises. If the Humalog sliding scale is not effectively controlling blood glucose levels, it may indicate a need to adjust the basal insulin dose. The most recent guidelines suggest adjusting basal insulin based on overnight glucose levels, as these levels best reflect the adequacy of basal insulin coverage 1. Key considerations for adjusting Basaglar include:
- Monitoring fasting morning glucose levels to guide adjustments, as these levels are most reflective of basal insulin adequacy.
- Adjusting the basal rate if glucose levels are consistently out of target range overnight.
- Considering adjustments to the Correction insulin dose by modifying the ISF and/or target glucose levels if correction doses are not effectively bringing glucose levels into range.
- Always taking Basaglar at the same time each day for consistent coverage.
- Contacting a healthcare provider before making significant insulin adjustments, especially if experiencing frequent hypoglycemia or if glucose levels remain consistently above target despite adjustments. This approach is supported by the most recent and highest quality evidence, which emphasizes the importance of basal-bolus insulin regimens over sliding-scale insulin for effective glucose control in hospitalized patients and those with established insulin requirements 1.
From the FDA Drug Label
During changes to a patient's insulin regimen, increase the frequency of blood glucose monitoring [see Warnings and Precautions (5. 2)]. Dosage adjustments may be needed with changes in physical activity, changes in meal patterns (i.e., macronutrient content or timing of food intake), during acute illness, or changes in renal or hepatic function. Dosage adjustments should only be made under medical supervision with appropriate glucose monitoring [see Warnings and Precautions (5.2)].
The adjustment of Basaglar insulin when Humolog sliding scale does not control blood glucose should be made under medical supervision with increased frequency of blood glucose monitoring.
- Dosage adjustments may be needed based on the patient's metabolic needs, blood glucose monitoring results, and glycemic control goal.
- The patient's insulin regimen may need to be changed, which can affect glycemic control and predispose to hypoglycemia 2.
From the Research
Adjusting Basaglar Insulin with Humolog Sliding Scale
When the Humolog sliding scale does not control blood glucose, several options can be considered to adjust Basaglar insulin:
- Alternative insulin regimens: Studies have shown that alternative insulin regimens, such as adding a GLP-1 receptor agonist to basal insulin, can be effective in controlling blood glucose levels 3.
- Supplemental insulin: A proactive approach to managing diabetes using supplemental insulin, given in conjunction with basal insulin, can be a more effective and safer means of improving glycemic control 4.
- 70/30 insulin algorithm: A 70/30 insulin algorithm has been shown to be superior to traditional sliding scale insulin dosing for glycemic control in hospitalized patients with type 2 diabetes 5.
- Comparison of basal insulin formulations: Comparison of insulin lispro protamine suspension versus insulin glargine once daily added to oral antihyperglycaemic medications and exenatide in type 2 diabetes has shown that both formulations can be effective, but with some differences in terms of efficacy and safety 6.
Considerations for Adjusting Basaglar Insulin
When adjusting Basaglar insulin, the following considerations should be taken into account:
- GLP-1 receptor agonists: GLP-1 receptor agonists can be an attractive option for the treatment of type 2 diabetes, as they effectively lower A1C and weight while having a low risk of hypoglycemia 7.
- Individualized treatment: Each patient may require an individualized treatment approach, taking into account their specific needs and medical history.
- Monitoring and adjustment: Regular monitoring of blood glucose levels and adjustment of the insulin regimen as needed is crucial to achieve optimal glycemic control.