From the Guidelines
The initial dosage for insulin glargine is typically 10 units once daily, administered subcutaneously at the same time each day, as recommended by the most recent guidelines 1. When initiating insulin glargine, it is essential to consider the patient's individual needs and adjust the dosage accordingly. For insulin-naïve patients with type 2 diabetes, starting with 0.1 to 0.2 units/kg of body weight is another appropriate approach, as suggested by previous guidelines 1. Key points to consider when initiating insulin glargine include:
- Administering the insulin subcutaneously at the same time each day
- Rotating injection sites to prevent lipohypertrophy
- Monitoring for hypoglycemia, especially when initiating therapy
- Adjusting the dosage gradually, typically by 1-2 units every 3-7 days based on fasting blood glucose levels, with a target of 80-130 mg/dL, as recommended by the latest guidelines 1 It is crucial to prioritize the patient's safety and well-being, and to adjust the treatment plan as needed to minimize the risk of hypoglycemia and other adverse effects. By following the most recent guidelines and considering the individual patient's needs, healthcare providers can help patients with type 2 diabetes achieve optimal glycemic control and improve their overall quality of life.
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 dosage for 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
Initial Dosage for Insulin Glargine
The initial dosage for insulin glargine can vary depending on the patient's specific needs and medical history.
- For patients previously receiving twice-daily isophane insulin (NPH), the recommended initial dosage of insulin glargine is 20% less than the total daily dose of NPH insulin 3.
- In clinical trials, the starting dose of insulin glargine was significantly greater in patients who achieved target HbA1c levels (<7%) compared to those who did not, with a starting dose of 0.142 U/kg/day 4.
- The dosage of insulin glargine can be adjusted based on the patient's fasting plasma glucose (FPG) levels, with a goal of achieving an FPG level of 110 mg/dL or below 4.
- Insulin glargine is typically administered once daily at bedtime, and the dosage can be titrated to achieve optimal glycemic control 5, 6, 3.
Factors to Consider When Determining Initial Dosage
When determining the initial dosage of insulin glargine, several factors should be considered, including:
- The patient's current HbA1c level and FPG level
- The patient's medical history, including any previous insulin therapy
- The patient's renal and hepatic function
- The presence of any comorbidities, such as hypertension or hyperlipidemia
- The patient's lifestyle and dietary habits 7, 6, 3.
Clinical Trials and Studies
Clinical trials have shown that insulin glargine is effective in improving glycemic control in patients with type 1 and type 2 diabetes mellitus, with a lower incidence of hypoglycemia compared to NPH insulin 4, 5, 6.
- A study published in the journal Diabetes Technology & Therapeutics found that insulin glargine was effective in achieving target HbA1c levels in Japanese patients with type 2 diabetes mellitus 4.
- Another study published in the journal Drugs found that insulin glargine was as effective as NPH insulin in improving glycemic control in patients with type 1 diabetes mellitus, with a lower incidence of hypoglycemia 5.
- A randomized trial published in the journal Diabetic Medicine found that adding insulin glargine to the treatment regimen of patients with type 2 diabetes mellitus was more effective than conventional therapy with oral agents in achieving target HbA1c levels 7.