From the Guidelines
The recommended weight-based starting dose of insulin glargine is 0.1 to 0.2 units per kilogram of body weight once daily. This dose range is supported by recent guidelines, including the 2021 American Diabetes Association standards of medical care in diabetes 1. For insulin-naïve patients, starting at the lower end of this range (0.1 units/kg/day) is often preferred to minimize the risk of hypoglycemia. The dose should be administered at the same time each day, with evening administration being common practice.
- Key factors to consider when determining the starting dose include the patient's body weight and degree of hyperglycemia.
- Insulin requirements vary significantly between individuals based on factors such as insulin sensitivity, degree of insulin deficiency, concurrent medications, and overall health status.
- After initiation, the dose should be titrated based on fasting blood glucose levels, typically adjusting by 2-4 units every 3-7 days until target glucose levels are achieved, as suggested by the 2017 American Diabetes Association standards of medical care in diabetes 1.
- Patients should be educated about proper injection technique, rotation of injection sites, recognition and management of hypoglycemia, and the importance of consistent carbohydrate intake.
- Insulin glargine works as a long-acting basal insulin that provides relatively peakless coverage for approximately 24 hours by slowly releasing from a subcutaneous depot.
From the FDA Drug Label
2.3 Initiation of Insulin Glargine-yfgn Therapy Recommended Starting Dosage in Patients with Type 2 Diabetes The recommended starting dosage of Insulin Glargine-yfgn in patients with type 2 diabetes who are not currently treated with insulin is 0.2 units/kg or up to 10 units once daily.
The recommended weight-based starting dose of insulin glargine is 0.2 units/kg or up to 10 units once daily for patients with type 2 diabetes who are not currently treated with insulin 2.
From the Research
Weight-Based Starting Dose of Insulin Glargine
The recommended weight-based starting dose of insulin glargine can vary depending on the patient population and specific clinical context.
- For hospitalized patients with type 2 diabetes, a study published in 2014 3 used an initial dose of 0.2 U/kg, with titration by increments of 0.1 U/kg daily.
- In pediatric patients newly diagnosed with type 1 diabetes, a retrospective chart review published in 2019 4 found that initial insulin glargine doses were similar among all weight groups, with a median dose of approximately 0.3 U/kg.
- However, there is no direct evidence from the provided studies to support a specific weight-based starting dose for all patients.
Factors Influencing Dosing
Several factors can influence the dosing of insulin glargine, including:
- Patient weight and body mass index (BMI)
- Fasting blood glucose levels
- Presence of comorbidities, such as renal or hepatic dysfunction
- Concomitant use of other medications, such as oral antidiabetic drugs
Clinical Trials and Studies
Various clinical trials and studies have investigated the efficacy and safety of insulin glargine in different patient populations, including:
- A phase 2 trial published in 2019 5 comparing oral basal insulin with subcutaneous insulin glargine in patients with type 2 diabetes
- A review of titration algorithms for insulin glargine published in 2007 6
- An updated review of insulin glargine published in 2003 7 discussing its use in the management of diabetes mellitus
These studies provide valuable insights into the use of insulin glargine in different clinical contexts, but may not directly address the question of a weight-based starting dose.