When to Hold Humalog for Low Blood Glucose
Hold Humalog when blood glucose is ≤70 mg/dL (3.9 mmol/L) until blood glucose recovers to normal levels. 1
Critical Blood Glucose Thresholds
Hypoglycemia Alert Value (Level 1):
- Blood glucose ≤70 mg/dL (3.9 mmol/L) requires immediate action 1
- Hold all rapid-acting insulin (including Humalog) until blood glucose recovers 1
- Treat with 15-20 grams of fast-acting carbohydrate 1
Clinically Significant Hypoglycemia (Level 2):
- Blood glucose <54 mg/dL (3.0 mmol/L) indicates serious hypoglycemia 1
- Requires immediate treatment and insulin dose reduction by 10-20% 1
Treatment Protocol When Holding Humalog
Immediate Management:
- Administer 15-20 grams of glucose (preferred) or any carbohydrate containing glucose 1
- Recheck blood glucose after 15 minutes 1
- Repeat treatment if blood glucose remains <70 mg/dL 1
- Once blood glucose normalizes, consume a meal or snack to prevent recurrence 1
Insulin Adjustment After Hypoglycemia:
- Review and modify the treatment regimen whenever blood glucose <70 mg/dL occurs 1
- Reduce insulin dose by 10-20% if hypoglycemia occurs without clear cause 1, 2
- Document all hypoglycemic episodes in the medical record 1
Special Considerations for Sick Days
During Acute Illness:
- Hold Humalog (and other sulfonylureas/meglitinides) only if blood glucose is low 1
- Resume insulin once blood glucose recovers and patient is eating normally 1
- If blood glucose is elevated during illness, increase basal and bolus insulin by 10-20% instead 1
Preventing Future Hypoglycemia
High-Risk Situations Requiring Vigilance:
- Fasting for tests or procedures 1
- Delayed or missed meals 1
- During or after exercise 1
- During sleep (nocturnal hypoglycemia) 1
- While driving 1
Patient Education Requirements:
- Patients should carry fast-acting glucose at all times 1
- Glucagon should be prescribed for all patients at increased risk 1
- Caregivers and family members must know how to administer glucagon 1
- Raise glycemic targets for several weeks after severe hypoglycemia to reverse hypoglycemia unawareness 1
Common Pitfalls to Avoid
- Never administer Humalog when blood glucose is ≤70 mg/dL - this will worsen hypoglycemia 1
- Do not use protein-rich foods to treat hypoglycemia - use 15-20 grams of pure glucose or fast-acting carbohydrates instead 1
- Do not delay treatment - hypoglycemia should be treated immediately when blood glucose ≤70 mg/dL 1
- Do not resume Humalog until blood glucose has normalized and patient has consumed food 1