From the Guidelines
Insulin glargine should not be administered twice daily to improve mid-day glucose levels as a standard practice, as its duration of action is 20-24 hours and it is typically given once daily, usually at bedtime 1.
Administration Considerations
- However, in some patients, glargine may not last 24 hours, and dividing the dose into two daily injections has been suggested based on anecdotal experience 1.
- The 2023 standards of care in diabetes also mention that insulin detemir or insulin glargine may require twice-daily dosing in multiple daily injection (MDI) regimens, but this is not specifically recommended for improving mid-day glucose levels 1.
Key Points
- Insulin glargine is a long-acting peakless insulin with a duration of action of 20-24 hours 1.
- It is usually given at bedtime, but administration at other times of the day may result in similar levels of coverage and glycemic control 1.
- MDI regimens with insulin glargine typically involve once-daily dosing, with mealtime and correction insulin administered separately 1.
From the Research
Administration of Insulin Glargine
- Insulin glargine is typically recommended as a once-daily basal insulin 2, 3
- However, some studies have explored the use of twice-daily insulin glargine administration to improve glycemic control 4, 5
Efficacy of Twice-Daily Insulin Glargine
- A case report and review of the literature found that twice-daily administration of insulin glargine resulted in the resolution of hypoglycemia in a patient who experienced significant morning hypoglycemia despite titration of insulin dose 4
- A study investigating glucose control in patients with type 2 diabetes based on frequency of insulin glargine administration found a mean decrease in %A1c of 0.52+/-0.12 (p=0.14) with twice-daily administration, indicating clinical relevance 5
Comparison with Once-Daily Administration
- A post hoc analysis of the EDITION 1 and EDITION 2 trials found that switching from twice-daily basal insulin to once-daily insulin glargine 300 U/mL or insulin glargine 100 U/mL resulted in similar glycated haemoglobin change from baseline to Month 6 6
- Most clinical trials have demonstrated that insulin glargine once daily improves glycemic control at least as effectively as NPH insulin given once or twice daily 2, 3