Is it safe to discontinue Lantus (insulin glargine) after a 6‑unit dose at 8 pm and start Jardiance (empagliflozin) at 2 pm today given a fasting blood glucose of 68 mg/dL?

Do Not Discontinue Lantus and Start Jardiance Today

You should NOT discontinue Lantus and start Jardiance today given your fasting blood glucose of 68 mg/dL this morning. This fasting glucose indicates you are already experiencing hypoglycemia, and abruptly stopping basal insulin without a clear alternative glucose-lowering strategy in place creates significant risk for both severe hypoglycemia (if residual insulin effect persists) and dangerous hyperglycemia (once the insulin wears off).

Why This Is Unsafe

Immediate Hypoglycemia Risk

• Your fasting BG of 68 mg/dL suggests your current 6-unit Lantus dose may already be too high or you have other contributing factors (inadequate food intake, increased activity, illness)
• Lantus has a duration of action of approximately 24 hours 1, meaning the dose from 8 pm last night is still active in your system until approximately 8 pm tonight
• Starting Jardiance (empagliflozin) at 2 pm today does nothing to address acute hypoglycemia risk — SGLT2 inhibitors work by causing urinary glucose loss, not by providing glucose 2

Jardiance Is Not a Substitute for Insulin

• Jardiance is an SGLT2 inhibitor that works through an insulin-independent mechanism by blocking glucose reabsorption in the kidney 3
• Jardiance cannot replace basal insulin's role in preventing hyperglycemia and ketoacidosis, particularly if you have significant insulin deficiency
• If you have type 1 diabetes, Jardiance is contraindicated entirely 2

Sick Day Guidance Supports Caution

Current consensus guidelines on medication management during metabolic stress recommend:

• Holding SGLT2 inhibitors during illness or metabolic instability due to ketoacidosis risk 4
• Adjusting insulin doses (not stopping them) when blood glucose is low 4
• Your fasting BG of 68 mg/dL represents metabolic instability that requires insulin dose adjustment, not medication switching

What You Should Do Instead

Immediate Actions (Today)

1. Do NOT take your Lantus dose tonight — your fasting BG of 68 mg/dL indicates overbasalization 5
2. Do NOT start Jardiance today — wait until your glucose control is stable
3. Monitor your blood glucose every 4-6 hours while awake 4
4. Consume adequate carbohydrates to prevent further hypoglycemia while residual Lantus is active
5. Contact your healthcare provider today to discuss:
   • Why your fasting glucose was 68 mg/dL (dose too high? inadequate food? illness?)
   • Whether you truly need basal insulin or if you can transition to oral agents alone
   • The appropriate timing and sequence for any medication changes

Proper Medication Transition Strategy

If your provider determines you can safely discontinue Lantus:

1. Reduce the Lantus dose by 10-20% initially rather than stopping abruptly, especially given your hypoglycemia risk 5
2. Wait 24-48 hours after the last Lantus dose before starting Jardiance to allow insulin clearance
3. Ensure fasting blood glucose is stable in the 100-180 mg/dL range before introducing Jardiance
4. Start Jardiance only after confirming you don't have type 1 diabetes and have adequate beta-cell function 2

Critical Safety Concerns

Signs You Need Emergency Care

Seek immediate medical attention if you develop 4:

• Blood glucose below 54 mg/dL or recurrent readings below 70 mg/dL
• Confusion, difficulty thinking clearly, or loss of consciousness
• Inability to eat or drink normally
• Blood glucose persistently above 250 mg/dL after stopping insulin

Common Pitfall to Avoid

The most dangerous mistake is assuming one diabetes medication can simply replace another without understanding their different mechanisms. Lantus provides 24-hour basal glucose control through insulin action 1. Jardiance causes glucose loss in urine but provides no insulin effect 2. Stopping insulin without a plan risks diabetic ketoacidosis if you have significant insulin deficiency, or severe hyperglycemia requiring hospitalization.

Why Your Current Situation Requires Caution

Your fasting BG of 68 mg/dL suggests possible overbasalization — using more basal insulin than clinically necessary 5. This often indicates:

• Insufficient mealtime coverage (if you have type 1 diabetes or advanced type 2)
• Excessive basal insulin dose for your current needs
• Changes in diet, activity, or other medications affecting glucose

This clinical picture requires systematic evaluation and dose adjustment, not abrupt medication switching.