From the Guidelines
The starting dose of insulin glargine can be estimated based on body weight, typically ranging from 0.1–0.2 units/kg/day, with individualized titration over days to weeks as needed, as recommended by the most recent guidelines 1. When initiating insulin glargine therapy, it is essential to consider the degree of hyperglycemia and the patient's overall health status.
- The dose can be adjusted gradually, usually by 1-2 units every 3-7 days, based on fasting blood glucose readings.
- Insulin glargine works as a long-acting basal insulin analog that provides relatively peakless insulin coverage for approximately 24 hours by slowly releasing from a subcutaneous depot.
- Patients should be educated about proper injection technique, rotation of injection sites, recognition and management of hypoglycemia, and the importance of consistent carbohydrate intake to optimize safety and efficacy of insulin therapy. The most recent guidelines from 2022 1 emphasize the importance of individualized titration and awareness of the potential for overbasalization with insulin therapy, which may prompt reevaluation to further individualize therapy.
- Clinical signals that may indicate overbasalization include basal dose greater than 0.5 units/kg, high bedtime-morning or post-preprandial glucose differential, hypoglycemia, and high variability.
- By following these guidelines and considering the patient's specific needs, clinicians can optimize the starting dose of insulin glargine and minimize the risk of adverse effects, ultimately improving morbidity, mortality, and quality of life outcomes 1.
From the FDA Drug Label
- 3 Initiation of Insulin Glargine Therapy Recommended Starting Dosage in Patients with Type 1 Diabetes The recommended starting dosage of Insulin Glargine 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 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 starting dose of Insulin Glargine is:
- For patients with Type 1 Diabetes: approximately one-third of the total daily insulin requirements.
- For patients with Type 2 Diabetes who are not currently treated with insulin: 0.2 units/kg or up to 10 units once daily 2.
From the Research
Insulin Glargine Starting Dose
- The starting dose of Insulin Glargine can vary depending on the patient's condition and the specific treatment regimen 3, 4, 5, 6, 7.
- A study published in 2012 suggested that a starting dose of 0.15 U/kg/day is applicable to most patients, but some patients may require a lower starting dose, such as those with retinopathy or impaired renal function 5.
- Another study published in 2020 compared a higher starting dose of 0.3 U/kg/day to a standard starting dose of 0.2 U/kg/day in overweight or obese Chinese patients with type 2 diabetes, and found that the higher dose was as safe as the standard dose and achieved self-monitored fasting blood glucose targets earlier 7.
- The American Diabetes Association recommends that the starting dose of Insulin Glargine be individualized based on the patient's specific needs and circumstances, and that the dose be titrated to achieve a target glycated hemoglobin (HbA1c) level 3, 4, 6.
- The following factors can influence the starting dose of Insulin Glargine:
Dosing Regimens
- Insulin Glargine can be administered once daily, at any time of day, but is typically given at bedtime 3.
- The dose can be titrated based on the patient's self-monitored blood glucose levels, with the goal of achieving a target HbA1c level 3, 4, 6.
- Some patients may require twice-daily injections of Insulin Glargine, particularly those with labile type 1 diabetes or obese, insulin-resistant patients 3.