What is the administration and dosing protocol for Glargine (insulin glargine) insulin, such as Lantus (insulin glargine) or Toujeo (insulin glargine), in patients with hyperglycemia?

From the Guidelines

Insulin glargine should be administered as a once-daily subcutaneous injection, with dose adjustments made by increasing the dose by 1–2 units or 10–15% twice weekly, as needed, to achieve target blood glucose levels. The starting dose for insulin-naïve type 2 diabetes patients is usually 10 units or 0.1-0.2 units/kg body weight daily, preferably at the same time each day 1. For type 1 diabetes patients, glargine typically provides 50-60% of the total daily insulin requirement, with the remainder covered by rapid-acting insulin.

Key Administration and Dosing Considerations

• Dose adjustments should be made based on fasting blood glucose levels, aiming for target levels of 80-130 mg/dL.
• Glargine should be injected into the abdomen, thigh, or upper arm using proper rotation technique.
• The medication should be stored in a refrigerator before opening and can be kept at room temperature for up to 28 days after first use.
• Patients should be educated about hypoglycemia symptoms and management.
• Insulin glargine works by providing a steady, peakless insulin level over approximately 24 hours (up to 36 hours for Toujeo), mimicking basal insulin secretion and helping maintain consistent blood glucose control between meals and overnight 1.

Special Considerations

• Clinicians should be aware of the potential for overbasalization with insulin therapy, and clinical signals that may prompt evaluation of overbasalization include basal dose greater than 0.5 units/kg, high bedtime–morning or postprandial glucose differential, hypoglycemia, and high variability 1.
• Consideration of cost is an important component of effective management, and human insulin (NPH and regular) may be the appropriate choice of therapy for many individuals with type 2 diabetes, particularly those with cost concerns 1.

From the Research

Administration and Dosing Protocol for Glargine Insulin

The administration and dosing protocol for Glargine insulin, such as Lantus or Toujeo, in patients with hyperglycemia is as follows:

• Insulin glargine is a long-acting, human insulin analogue that provides a relatively constant basal level of circulating insulin with no pronounced peak 2.
• It is typically administered as a single daily dose, usually at bedtime, but can be given in the morning or at any other time convenient for the patient 3.
• The dose of insulin glargine should be adjusted according to the blood glucose level as part of an aggressive regimen to achieve near normoglycaemia without incurring episodes of hypoglycaemia 2.
• In patients with type 1 diabetes, insulin glargine should be used in combination with short-acting insulin analogues 2.
• In patients with type 2 diabetes, insulin glargine can be added to oral hypoglycaemic agents if they are failing to control blood glucose levels 2.

Dosing Frequency

• Insulin glargine is usually administered once daily, but in some cases, such as in labile type 1 diabetes or obese, insulin-resistant patients, it may be given in two daily injections 3.
• The dosing frequency may need to be adjusted based on individual patient needs and response to treatment.

Benefits of Insulin Glargine

• Insulin glargine has been shown to reduce the risk of hypoglycemia, particularly nocturnal hypoglycemia, compared to NPH insulin 2, 3, 4, 5, 6.
• It provides a steady time-action profile over 24 hours without a pronounced peak, making it a useful addition to the armamentarium of insulin therapy 5, 6.
• Patients have reported greater treatment satisfaction with insulin glargine compared to NPH insulin 6.