From the Guidelines
The recommended titration schedule for increasing Lantus (insulin glargine) dosage is to increase by 2 units every 3 days to reach the target fasting plasma glucose (FPG) goal without hypoglycemia, as suggested by the most recent guidelines 1. When adjusting the Lantus dosage, it is essential to monitor blood glucose levels closely and watch for signs of hypoglycemia. The American Diabetes Association recommends setting an FPG target and choosing an evidence-based titration algorithm, such as increasing the dose by 2 units every 3 days 1. Some key points to consider when titrating Lantus dosage include:
- Starting with a dose of 10 units per day or 0.1-0.2 units/kg per day 1
- Assessing the adequacy of the insulin dose at every visit and considering clinical signals to evaluate for overbasalization and the need for adjunctive therapies 1
- Lowering the dose by 10-20% if hypoglycemia occurs without a clear reason 1 It is crucial to consult with a healthcare provider before making any changes to the Lantus dosage, as they can provide personalized guidance based on individual factors such as insulin sensitivity, weight, diet, activity level, and other medications being taken.
From the Research
Recommended Titration Schedule for Lantus (Insulin Glargine)
- The recommended titration schedule for increasing Lantus (insulin glargine) dosage is to increase the insulin dose by 2 IU every 3 days in the absence of blood glucose <4.0 mmol/L (<72 mg/dL) 2.
- This titration schedule is based on the results of the AT.LANTUS study, which showed that patient-managed titration with this schedule resulted in greater reductions in HbA1c compared to clinic-managed titration 2.
- The study also found that the patient-managed titration schedule was associated with a higher proportion of patients achieving an HbA1c target of <7% without nocturnal hypoglycemia 2.
Key Considerations
- The titration schedule should be individualized based on the patient's response to treatment and their blood glucose levels 2.
- The patient's ability and willingness to manage their own titration schedule should also be taken into account 2.
- The use of a simple titration regimen, such as the one described above, can help to overcome barriers to insulin therapy, including fear of hypoglycemia and weight gain 3.