From the Guidelines
Lantus (insulin glargine) 20 units twice daily is not a standard dosing regimen, but it may be safe for some patients under medical supervision with regular blood glucose monitoring. The safety of this regimen depends on the individual's insulin sensitivity, overall insulin requirements, meal patterns, physical activity levels, and other medications they may be taking. According to the American Diabetes Association standards of medical care in diabetes 1, basal insulin may be initiated at 10 units or 0.1 to 0.2 units/kg of body weight, and adjustment of both basal and prandial insulins should be based on self-monitoring of blood glucose levels. Some patients, particularly those requiring higher total daily insulin doses or those who experience blood glucose fluctuations with once-daily dosing, may benefit from splitting the dose into twice-daily administration. However, patients should never adjust their insulin regimen without consulting their healthcare provider, as inappropriate insulin dosing can lead to dangerous hypoglycemia or persistent hyperglycemia. The most recent guidelines from the American Diabetes Association 1 emphasize the importance of individualizing insulin therapy and considering factors such as cost, convenience, and patient preferences when selecting an insulin regimen. In general, concentrated insulin preparations, such as U-300 glargine, may be suitable for patients who require higher doses of basal insulin per volume, but these products may be more expensive than traditional insulins. Ultimately, the decision to use Lantus 20 units twice daily should be made on a case-by-case basis, taking into account the individual patient's needs and circumstances, and under the guidance of a healthcare provider. Key considerations include:
- Regular blood glucose monitoring to ensure appropriate glycemic control
- Individualized insulin therapy based on patient-specific factors
- Medical supervision to minimize the risk of hypoglycemia or hyperglycemia
- Patient education on insulin dosing, blood glucose monitoring, and hypoglycemia recognition and treatment.
From the Research
Safety of Lantus 20 Units Twice a Day
- The safety of Lantus (insulin glargine) 20 units twice a day is not directly addressed in the provided studies, but we can look at the general safety profile of insulin glargine and its use in various dosing regimens 2, 3, 4, 5, 6.
- Insulin glargine is a long-acting insulin analogue that provides a relatively constant basal level of circulating insulin with no pronounced peak, and it is generally well-tolerated with a lower risk of hypoglycemia compared to NPH insulin 2, 3.
- A study found that twice-daily injection with insulin glargine can be beneficial in patients who experience hypoglycemia despite titration of once-daily glargine, and it may be a valuable option in the management of diabetic patients 4.
- Another study compared insulin glargine with intermediate-acting insulin as the basal component of multiple daily injection regimens for adolescents with type 1 diabetes mellitus, and found that insulin glargine is well-tolerated and may be more efficacious than NPH/Lente in those with elevated A1C 5.
- A retrospective study evaluated the safety and efficacy of twice/day insulin glargine in critically ill patients, and found that it reduced the rate of predose hyperglycemia without increasing the risk of hypoglycemia 6.
Dosing Regimen Considerations
- The dosing regimen of Lantus 20 units twice a day is not a standard recommended regimen, as insulin glargine is typically administered once daily 2, 3.
- However, some studies suggest that twice-daily injection with insulin glargine can be beneficial in certain patients, such as those who experience hypoglycemia despite titration of once-daily glargine 4, or critically ill patients 6.
- It is essential to individualize insulin treatment and adjust the dose of insulin glargine according to the blood glucose level as part of an aggressive regimen to achieve near normoglycaemia without incurring episodes of hypoglycaemia 2.
Key Findings
- Insulin glargine is a safe and effective basal insulin analogue with a lower risk of hypoglycemia compared to NPH insulin 2, 3.
- Twice-daily injection with insulin glargine can be beneficial in certain patients, such as those who experience hypoglycemia despite titration of once-daily glargine, or critically ill patients 4, 6.
- Individualization of insulin treatment and adjustment of the dose of insulin glargine according to the blood glucose level is crucial to achieve near normoglycaemia without incurring episodes of hypoglycaemia 2.