From the Guidelines
The initial dose of insulin glargine should be 10 units or 0.1 to 0.2 units/kg of body weight once daily, as this approach has been shown to be safe and effective in achieving target fasting glucose levels 1. When determining the initial dose of insulin glargine, several factors should be considered, including the patient's degree of hyperglycemia, weight, and other health conditions.
- Insulin glargine is typically administered subcutaneously, not intravenously, and the injection site should be rotated to prevent lipodystrophy.
- Dosage adjustments are typically made in increments of 1-2 units every 3-7 days based on blood glucose monitoring results, with the goal of achieving target fasting glucose levels.
- Lower initial doses may be appropriate for elderly patients, those with renal or hepatic impairment, or patients at higher risk for hypoglycemia.
- Insulin glargine provides a relatively peakless, long-acting basal insulin coverage for approximately 24 hours, helping to control blood glucose levels throughout the day and night. The most recent and highest quality study, published in 2018, recommends starting with 10 units per day or 0.1–0.2 units/kg/day of basal insulin, depending on the degree of hyperglycemia 1.
- This approach is consistent with previous studies, which have also recommended starting with a dose of 10 units or 0.1 to 0.2 units/kg of body weight once daily 1.
- It is essential to consider the cost-effectiveness of different antihyperglycemic agents, as there have been substantial increases in the price of insulin over the past decade 1.
From the FDA Drug Label
2.3 Initiation of Insulin Glargine-yfgn Therapy
Recommended Starting Dosage in Patients with Type 1 Diabetes The recommended starting dosage of Insulin Glargine-yfgn in patients with type 1 diabetes is approximately one-third of the total daily insulin requirements. 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 initial dose of insulin glargine is approximately one-third of the total daily insulin requirements for patients with type 1 diabetes, and 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.
- For type 1 diabetes: one-third of the total daily insulin requirements
- For type 2 diabetes: 0.2 units/kg or up to 10 units once daily
From the Research
Initial Dose of Insulin Glargine
The initial dose of insulin glargine can vary depending on the patient's specific needs and the treatment regimen.
- In a study published in 2014 3, the initial dose of insulin glargine was 0.2 U/kg.
- Another study from 2000 4 determined the initial doses of insulin glargine based on the previous NPH total daily dose.
- A review of dosing strategies for insulin glargine in type 2 diabetes published in 2007 5 discussed various titration algorithms but did not specify a standard initial dose, suggesting that dosing should be individualized and titrated according to fasting blood glucose levels.
Factors Influencing Initial Dose
The initial dose may be influenced by several factors, including:
- Patient's weight, as seen in the weight-based regimen 3
- Previous insulin dose, if the patient is transitioning from another insulin therapy 4
- Fasting blood glucose levels, which guide the titration of the insulin dose 5
Titration Regimens
Different titration regimens may be used to adjust the dose of insulin glargine, including: