From the Guidelines
If someone has hypoglycemia in the morning, you should not give the normal Lantus dose without adjustment, instead consider reducing the Lantus dose by 10-20% after discussing with a healthcare provider. Morning hypoglycemia often indicates that the current basal insulin dose is too high for the patient's needs during overnight hours. Lantus is a long-acting insulin that works for approximately 24 hours to provide baseline insulin coverage, and excessive amounts can lead to low blood sugar, particularly during periods of fasting like overnight 1. The patient should check blood glucose more frequently after any dose adjustment and keep fast-acting carbohydrates (like juice or glucose tablets) available to treat hypoglycemia. Some key points to consider when adjusting the Lantus dose include:
- Determining the cause of hypoglycemia and lowering the dose by 10-20% if no clear reason is found 1
- Assessing the adequacy of insulin dose at every visit and considering clinical signals to evaluate for overbasalization and need to consider adjunctive therapies 1
- Maintaining a log of blood glucose readings and hypoglycemic episodes to share with the healthcare provider, who may need to adjust the timing of the Lantus injection or recommend splitting the dose between morning and evening
- Addressing other factors like evening exercise, alcohol consumption, or insufficient bedtime snacks may also help prevent morning hypoglycemia.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Hypoglycemia Management
- Hypoglycemia is a common issue in patients with type 1 and 2 diabetes, and it can be a major limiting factor in achieving glycemic control 2.
- The American Diabetes Association recommends a management protocol for hypoglycemia, including a clear prevention and treatment plan 2.
Lantus Dose Adjustment
- There is no direct evidence to suggest that the Lantus dose should be adjusted in the morning if someone has hypoglycemia.
- However, studies have shown that insulin glargine (Lantus) has a reduced risk of hypoglycemia compared to NPH insulin, particularly nocturnal hypoglycemia 3, 4.
- One study found that using insulin glargine at high dosages for basal-bolus insulin therapy in patients with type 2 diabetes can help achieve strict glycemic control with minimal risk of nocturnal hypoglycemia 5.
Considerations for Hypoglycemia Risk
- Patients with type 2 diabetes who are at risk of hypoglycemia may benefit from using second-generation basal insulin analogues, which have been shown to reduce rates of hypoglycemia events 6.
- Continuous glucose monitoring (CGM) should be considered for individuals with increased risk for hypoglycemia, impaired hypoglycemia awareness, frequent nocturnal hypoglycemia, and a history of severe hypoglycemia 2.
- Optimizing insulin doses and carbohydrate intake, as well as a short warm-up before or after physical activity sessions, may help avoid hypoglycemia 2.