From the Guidelines
Glargine is not recommended for daytime coverage of blood glucose due to its long-acting nature and potential for prolonged hypoglycemia. Instead, for daytime mealtime coverage, rapid-acting insulins like insulin lispro, aspart, or glulisine are more appropriate as they have a quick onset and short duration that better matches carbohydrate intake during meals. If basal insulin coverage is needed, glargine can be administered once daily, often at bedtime, at a dose individualized to the patient's weight and insulin sensitivity, typically starting at 0.1-0.2 units/kg per day or 10 units per day, as suggested by the 2025 standards of care in diabetes 1. Key considerations for glargine dosing include:
- Starting dose: 0.1-0.2 units/kg per day or 10 units per day
- Titration: increase by 2 units every 3 days to reach FPG goal without hypoglycemia
- Monitoring: assess adequacy of insulin dose at every visit and consider clinical signals to evaluate for overbasalization. Using glargine for meal coverage would risk prolonged hypoglycemia due to its extended duration of action and would not provide the rapid response needed to address post-meal glucose excursions.
From the FDA Drug Label
- 2 General Dosing Instructions Administer Insulin Glargine subcutaneously once daily at any time of day but at the same time every day. Individualize and adjust the dosage of Insulin Glargine based on the patient's metabolic needs, blood glucose monitoring results and glycemic control goal.
The recommended dose of glargine (insulin glargine) for daytime coverage is not explicitly stated in the FDA drug label.
- Key points:
- Administer Insulin Glargine subcutaneously once daily at any time of day but at the same time every day.
- Individualize and adjust the dosage of Insulin Glargine based on the patient's metabolic needs, blood glucose monitoring results, and glycemic control goal.
- In patients with type 1 diabetes, Insulin Glargine must be used concomitantly with short-acting insulin.
- The FDA label does not provide a specific dose for daytime coverage, and any adjustments should be made under medical supervision with appropriate glucose monitoring 2 2.
From the Research
Recommended Dose of Glargine for Daytime Coverage
- The recommended dose of glargine (insulin glargine) for daytime coverage is not explicitly stated as glargine is typically used for basal insulin coverage, which is usually administered at bedtime to cover the body's insulin needs during the night and early morning hours 3, 4.
- However, the initial dose of basal insulin, including glargine, is usually started at a conservative dose of 10 units/day or 0.1-0.2 units/kg/day, and then titrated based on the patient's self-measured fasting plasma glucose levels to achieve an individualized target, usually 80-130 mg/dL 3.
- The dose of basal insulin, including glargine, can be increased as required up to approximately 0.5-1.0 units/kg/day in some cases, but overbasalization should be avoided 3.
- It's worth noting that glargine is a long-acting insulin analog that provides 24-hour basal insulin coverage when administered once daily, and its activity profile lacks a pronounced peak, which makes it suitable for basal insulin coverage 4, 5.
Titration and Administration
- A simple rule for titrating the dose of glargine is to gradually increase the initial dose by 1 unit per day (for glargine 100 units/mL) or 2-4 units once or twice per week (for glargine 100 and 300 units/mL) until fasting plasma glucose levels remain consistently within the target range 3.
- Glargine can be administered at any time of the day, but it is usually administered at bedtime to provide basal insulin coverage during the night and early morning hours 4, 5.