What is the appropriate dosing for Lantu?

Lantu (Insulin Glargine) Dosing Guidelines

For type 1 diabetes, Lantu (insulin glargine) should be dosed at 16-24 units once daily as basal insulin, with dose adjustments based on blood glucose monitoring. 1

Initial Dosing

Lantu is a long-acting basal insulin that provides steady insulin levels over 24 hours with no peak action time. The appropriate dosing follows these principles:

• Starting dose for adults with type 1 diabetes: 16-24 units once daily 1
• Administration timing: Can be given at any consistent time of day
• Transition from other insulin regimens:
  • When switching from intermediate-acting insulin (NPH): Use the same total daily dose
  • When switching from twice-daily NPH: Reduce total daily dose by 20% to start

Dose Adjustments

Blood glucose monitoring should guide dose adjustments:

• Target: Fasting blood glucose between 100-140 mg/dL
• Adjustment frequency: Typically every 3-7 days based on patterns
• Adjustment amount:
  • Increase by 2-4 units if fasting glucose consistently >140 mg/dL
  • Decrease by 2-4 units if fasting glucose <100 mg/dL or hypoglycemic episodes occur

Special Populations

Renal Impairment

• Patients with renal insufficiency may require dose reduction due to decreased insulin clearance
• Monitor blood glucose more frequently in these patients

Hepatic Impairment

• Use with caution in patients with liver disease
• More frequent monitoring of blood glucose is recommended

During Hospitalization

If a patient on Lantu requires hospitalization:

• For minor procedures: Continue Lantu at usual dose
• For major surgery or emergency procedures: Discontinue Lantu and switch to intravenous insulin 1
• When transitioning back to Lantu:
  • Connect pump and infuse basal rate for at least 2 hours before stopping IV insulin
  • Or replace with equivalent subcutaneous injection in 2 divided doses 12 hours apart 1

Advantages of Lantu

Lantu offers several benefits over intermediate-acting insulins:

• More consistent absorption
• No peak action time, reducing hypoglycemia risk
• Studies show symptomatic hypoglycemia is less common with glargine compared to NPH insulin (39.9% vs 49.2% over one month) 1

Important Considerations

Hypoglycemia Prevention

• Always carry rapid-acting insulin for meal coverage and corrections
• Learn to recognize hypoglycemia symptoms (blood glucose <100 mg/dL)
• Keep glucose tablets or other fast-acting carbohydrates available

Monitoring

• Regular blood glucose monitoring is essential
• Fingertip testing is more reliable than alternative sites, especially after meals or exercise 1
• Consider continuous glucose monitoring systems for detecting unrecognized hypoglycemic episodes

Common Pitfalls to Avoid

1. Inconsistent timing: Administering Lantu at different times each day can lead to variable glucose control
2. Inappropriate dose adjustments: Making large dose changes or adjusting too frequently
3. Failure to adjust for activity: Not reducing dose before planned exercise
4. Ignoring patterns: Not recognizing consistent high or low glucose trends
5. Equipment issues: Not checking meter accuracy when readings seem inconsistent with symptoms

By following these guidelines, patients can achieve optimal glycemic control while minimizing the risk of hypoglycemia with Lantu insulin therapy.