Is administering a large dose of Lantus (insulin glargine) dangerous?

From the Guidelines

Administering Lantus in large amounts can be dangerous and potentially life-threatening due to the risk of severe hypoglycemia. Lantus is a long-acting insulin used to control blood sugar in people with diabetes, and taking too much can cause symptoms such as confusion, dizziness, sweating, shakiness, extreme hunger, and in severe cases, seizures, loss of consciousness, or even death 1. The appropriate dose of Lantus varies by individual and should be determined by a healthcare provider based on factors like weight, blood sugar levels, diet, and activity level.

Key Considerations

• Typical basal insulin doses for patients not using insulin pumps range from 16 to 24 units of glargine (Lantus) once daily 1.
• Lantus slowly releases insulin over 24 hours, causing more physiologic basal insulin levels, which reduces the risk of hypoglycemia compared to intermediate-acting insulins 1.
• If someone has taken too much Lantus, seeking immediate medical attention is crucial.
• For mild hypoglycemia, consuming 15-20 grams of fast-acting carbohydrates can help raise blood sugar levels temporarily while waiting for medical help.

Important Precautions

• Lantus doses should never be adjusted without medical supervision, as insulin requirements can change based on various factors including illness, stress, and changes in diet or activity.
• Patients using Lantus should learn the signs and symptoms of hypoglycemia and how to manage the condition to minimize risks associated with insulin therapy 1.

From the FDA Drug Label

The FDA drug label does not answer the question.

From the Research

Lantus Administration and Safety

• The administration of Lantus (insulin glargine) in large amounts may pose certain risks, although the provided studies do not directly address the dangers of large doses 2, 3, 4, 5, 6.
• Insulin glargine is a long-acting, human insulin analogue designed to provide a relatively constant basal level of circulating insulin with no pronounced peak 2.
• Studies have shown that insulin glargine achieves equivalent glycaemic control to NPH insulin, with a lower risk of hypoglycaemia, especially nocturnal episodes 2, 3.
• The risk of severe hypoglycaemia and severe nocturnal hypoglycaemia is reduced with insulin glargine compared to NPH insulin 3.
• In patients with type 2 diabetes, once-daily insulin glargine reduces the risk of hypoglycaemia compared to NPH insulin, facilitating more aggressive insulin treatment to achieve target HbA(1c) levels 3.

Glycemic Control and Lantus

• A study using continuous glucose monitoring found that Lantus-treated patients had lower 24h mean blood glucose, 24h mean amplitude of glycemic excursion, and 24h standard deviation of blood glucose compared to Basalin-treated patients 4.
• Lantus may be a better choice than Basalin for patients with well-controlled type 2 diabetes, with lower mean blood glucose and glycemic variability 4.
• Initiation of once-daily glargine therapy in patients suboptimally controlled on oral antidiabetic agents results in significant reduction of HbA(1c) with a low risk of hypoglycaemia 5.

Adverse Effects of Lantus

• Common adverse effects of insulin glargine include injection site reaction and hypoglycaemia 6.
• A case report described a patient who experienced nausea and emesis after initiation of insulin glargine, which subsided after switching to insulin detemir and resumed after re-trial of insulin glargine 6.
• The relationship between insulin glargine and nausea is not well-established, and further investigation is warranted 6.