From the Guidelines
Insulin glargine therapy should be initiated at a dose of 10 units per day or 0.1-0.2 units/kg per day, with a goal of achieving a target fasting plasma glucose (FPG) level. The initial dose should be individualized based on the patient's specific needs and clinical characteristics, such as body weight and glycemic control goals 1.
Key Principles for Initiating Insulin Glargine Therapy
- Start with a dose of 10 units per day or 0.1-0.2 units/kg per day
- Set an FPG goal and choose an evidence-based titration algorithm, such as increasing the dose by 2 units every 3 days to reach the FPG goal without hypoglycemia
- Assess the adequacy of the insulin dose at every visit and consider clinical signals to evaluate for overbasalization and the need for adjunctive therapies
- If hypoglycemia occurs, determine the cause and lower the dose by 10-20% if no clear reason is found
Titration and Monitoring
- Titrate the dose based on fasting blood glucose readings, aiming for a target of 80-130 mg/dL (4.4-7.2 mmol/L)
- Monitor blood glucose levels more frequently during initiation and dose adjustments to minimize the risk of hypoglycemia
- Educate patients about hypoglycemia recognition and management
Clinical Considerations
- Consider the patient's type of diabetes, as insulin glargine typically provides 40-50% of the total daily insulin requirement as basal insulin in patients with type 1 diabetes
- When transitioning from twice-daily NPH insulin, reduce the initial glargine dose by about 20% to avoid hypoglycemia
- Insulin glargine should be administered at the same time each day to maintain consistent blood glucose control, as it has a duration of action of approximately 24 hours with no pronounced peak 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 principles for initiating insulin glargine therapy include:
- Individualized dosing: The dosage of Insulin Glargine-yfgn should be individualized based on the patient’s metabolic needs, blood glucose monitoring results, and glycemic control goal.
- Starting dosage:
- For patients with type 1 diabetes, the recommended starting dosage is approximately one-third of the total daily insulin requirements.
- For patients with type 2 diabetes who are not currently treated with insulin, the recommended starting dosage is 0.2 units/kg or up to 10 units once daily.
- Close medical supervision: Any changes to a patient’s insulin regimen should be made under close medical supervision with increased frequency of blood glucose monitoring 2.
From the Research
Principles for Initiating Insulin Glargine
The principles for initiating insulin glargine therapy involve several key considerations, including:
- The patient's type of diabetes, as insulin glargine can be used in both type 1 and type 2 diabetes 3
- The patient's current treatment regimen, as insulin glargine can be used as a single daily dose or in combination with other insulins or oral glucose-lowering agents 4, 5
- The patient's lifestyle and preferences, as insulin glargine can be administered at bedtime or in the morning 3
- The need for dose titration, as insulin glargine doses may need to be adjusted based on the patient's fasting plasma glucose levels 6, 4
Dosing and Titration
The dosing and titration of insulin glargine involve:
- Starting with a single daily dose, typically administered at bedtime 3, 6
- Titrating the dose based on the patient's fasting plasma glucose levels, with a goal of achieving a level of 4.0-5.5 mmol/l 6, 4
- Adjusting the dose as needed to achieve optimal glycemic control, while minimizing the risk of hypoglycemia 6, 4
Benefits and Considerations
The benefits and considerations of initiating insulin glargine therapy include:
- Improved glycemic control, with reduced fasting plasma glucose levels and HbA1c levels 6, 4, 5
- Reduced risk of hypoglycemia, compared to other insulins such as NPH insulin 7, 6
- Increased treatment satisfaction, with improved quality of life and reduced symptoms of diabetes 4, 5
- Potential for weight gain, as insulin glargine can increase insulin levels and promote weight gain 5