What is the starting dose of Lantus (insulin glargine) for a patient with Type 2 diabetes mellitus?

Starting Dose of Lantus (Insulin Glargine) for Type 2 Diabetes

The recommended starting dose of Lantus (insulin glargine) for patients with type 2 diabetes who are not currently treated with insulin is 0.2 units/kg of body weight or up to 10 units once daily. 1

Initial Dosing Guidelines

Basal insulin therapy with Lantus can be initiated using the following approach:

• Starting dose options:
  • 10 units once daily 2
  • 0.1-0.2 units/kg of body weight once daily 2, 1

For example:

• A 70 kg patient would start with 7-14 units (at 0.1-0.2 units/kg)
• For most patients, the simpler approach of starting with 10 units is appropriate

Administration Considerations

• Administer Lantus subcutaneously once daily at any time of day, but at the same time every day 1
• Common injection sites include abdominal area, thigh, or deltoid 1
• Rotate injection sites within the same region to reduce the risk of lipodystrophy 1
• Lantus should not be diluted or mixed with any other insulin or solution 1

Titration Protocol

After initiating Lantus, dose adjustments should be made based on blood glucose monitoring:

• Increase dose by 2-4 units every 3-7 days until target fasting blood glucose is achieved 2, 3
• Target fasting blood glucose: <100 mg/dL (5.5 mmol/L) 2
• If hypoglycemia occurs, determine the cause and reduce dose by 10-20% 3
• Watch for signs of overbasalization if basal dose exceeds 0.5 units/kg/day 2

Combination Therapy

When initiating Lantus in type 2 diabetes:

• Continue metformin and potentially other oral antidiabetic medications 2, 3
• Basal insulin is typically used with metformin and perhaps one additional noninsulin agent 2
• Consider GLP-1 receptor agonists before adding prandial insulin if further glycemic control is needed 3

Special Considerations

• Severe hyperglycemia: Consider starting insulin therapy immediately when blood glucose levels are ≥300-350 mg/dL or HbA1c levels are 10-12%, especially if symptomatic 2
• Elderly patients or those with renal impairment: Consider starting with lower doses (0.1 units/kg/day) to minimize hypoglycemia risk 3
• Switching from other insulin regimens:
  • When switching from twice-daily NPH insulin to once-daily Lantus, the recommended starting Lantus dosage is 80% of the total NPH dosage 1
  • When switching from once-daily NPH insulin to once-daily Lantus, the recommended starting Lantus dosage is the same as the NPH dosage 1

Common Pitfalls to Avoid

1. Delayed dose titration: Timely dose titration after insulin initiation is crucial for achieving glycemic targets 2
2. Using insulin as a threat: Avoid describing insulin therapy as a sign of personal failure or punishment 2
3. Overbasalization: Watch for signs such as basal dose >0.5 units/kg, high bedtime-morning glucose differential (≥50 mg/dL), or hypoglycemia 2
4. Inadequate monitoring: During changes to insulin regimen, increase the frequency of blood glucose monitoring 1
5. Mixing insulins: Do not dilute or mix Lantus with any other insulin or solution 1

Remember that insulin therapy needs to be individualized based on the patient's metabolic needs, blood glucose monitoring results, and glycemic control goals, with adjustments made under medical supervision.