Can Basaglar (insulin glargine) and Lantus (insulin glargine) be given together?

Administering Basaglar and Lantus Together

Basaglar and Lantus should not be administered together as they are both insulin glargine products with identical active ingredients, which would result in unnecessary duplication of therapy and increased risk of hypoglycemia.

Rationale for Not Combining These Insulins

Basaglar and Lantus are both insulin glargine formulations that:

• Contain the same active ingredient (insulin glargine)
• Have similar pharmacokinetic profiles with long-acting, peakless activity over 24 hours
• Serve the same clinical purpose as basal insulin

Clinical Evidence

The American Diabetes Association guidelines make no recommendation for using two identical basal insulin products concurrently 1. Using two long-acting insulin glargine products together would essentially be doubling the same medication, which:

1. Increases the risk of hypoglycemia
2. Makes dose titration more complex and potentially dangerous
3. Does not provide any additional therapeutic benefit over using a single product at the appropriate dose

Appropriate Insulin Regimen Options

If a patient requires intensification of insulin therapy, there are several evidence-based approaches:

1. Optimize Single Basal Insulin First

• Titrate a single basal insulin (either Basaglar OR Lantus) to the appropriate dose based on fasting blood glucose targets 2
• Starting doses typically range from 0.1-0.2 units/kg/day with individualized titration over time 1

2. Add Prandial Insulin When Basal Is Insufficient

• If basal insulin alone is insufficient, add prandial insulin rather than a second basal insulin 2
• Begin with one dose of rapid-acting insulin with the largest meal 2
• Progress to a full basal-bolus regimen if needed

3. Consider GLP-1 Receptor Agonist

• For patients with type 2 diabetes needing intensification beyond basal insulin, adding a GLP-1 receptor agonist may be preferred over adding prandial insulin 2

Switching Between Insulin Glargine Products

If transitioning between Basaglar and Lantus is necessary:

• Use the same dose when switching between these products as they have similar pharmacokinetic properties 3, 4
• Some studies suggest potential differences in glycemic control between Basaglar and Lantus, with one study showing slightly better glycemic control with Lantus 5, but another showing non-inferiority of Basaglar 4
• Monitor blood glucose closely after switching to ensure equivalent glycemic control

Potential Pitfalls and Safety Considerations

1. Hypoglycemia risk: Combining two basal insulins significantly increases the risk of hypoglycemia, especially nocturnal hypoglycemia 2

2. Medication errors: Using two similar products increases the risk of dosing errors and confusion

3. Cost implications: Using two identical products increases costs without clinical benefit 3

4. Insulin stacking: The overlapping effect of two long-acting insulins could lead to prolonged hypoglycemia that is difficult to manage

Special Considerations

For patients requiring very high insulin doses:

• Consider using a more concentrated insulin formulation (e.g., insulin glargine U-300) rather than adding a second basal insulin 1
• Evaluate for insulin resistance and address underlying causes
• Consider split dosing of a single basal insulin product if 24-hour coverage is inadequate with once-daily dosing

Remember that the goal of insulin therapy is to mimic physiologic insulin secretion as closely as possible, which is best achieved through appropriate combinations of basal and prandial insulins rather than duplicating the same type of insulin.