What is the recommended use and dosage of Toujeo (insulin glargine) for patients with diabetes mellitus?

Toujeo (Insulin Glargine) Dosing and Administration Guidelines

Toujeo (insulin glargine 300 U/mL) should be administered once daily at the same time each day, with a recommended starting dose of 0.2 units/kg or up to 10 units for insulin-naïve type 2 diabetes patients, and approximately one-third of the total daily insulin requirements for type 1 diabetes patients.

Dosing Recommendations

Initial Dosing

• Type 2 Diabetes (insulin-naïve):

  • Start with 0.2 units/kg or up to 10 units once daily 1
  • For elderly patients or those with poor oral intake: Consider lower starting dose of 0.1-0.15 units/kg/day 2

• Type 1 Diabetes:

  • Start with approximately one-third of the total daily insulin requirements
  • Must be used with short-acting insulin to cover mealtime needs 1

Dose Adjustments

• Adjust dose every 3 days based on fasting glucose patterns until target range is achieved (typically 80-130 mg/dL) 3
• Dose adjustments based on fasting blood glucose (FBG):
  • FBG ≥180 mg/dL: Increase by 6-8 units
  • FBG 140-179 mg/dL: Increase by 4 units
  • FBG 120-139 mg/dL: Increase by 2 units
  • FBG 100-119 mg/dL: Maintain or increase by 0-2 units
  • FBG <100 mg/dL: Decrease by 2-4 units
  • Any hypoglycemia (<70 mg/dL): Decrease by 10-20% 3

Administration Guidelines

• Administer subcutaneously into the abdominal area, thigh, or deltoid 1
• Rotate injection sites within the same region to reduce risk of lipodystrophy 1
• Administer at the same time every day, but timing can be flexible if needed 4
• Never administer intravenously or via an insulin pump 1
• Do not dilute or mix with any other insulin or solution 1

Special Considerations

Switching from Other Insulin Therapies

• When switching from:
  • Lantus (insulin glargine 100 U/mL): Daily insulin requirement may be slightly higher with Toujeo 4
  • Once-daily NPH insulin: Use same dosage as NPH that is being discontinued 1
  • Twice-daily NPH insulin: Use 80% of the total NPH dosage 1

Clinical Advantages of Toujeo

• More stable and prolonged pharmacokinetic profile than insulin glargine 100 U/mL, with glucose-lowering activity exceeding 24 hours 5
• Lower risk of nocturnal hypoglycemia compared to insulin glargine 100 U/mL in insulin-experienced type 2 diabetes patients 5
• More reproducible glycemic control due to flatter and longer profile with less variability 4

Monitoring

• Increase frequency of blood glucose monitoring during changes to insulin regimen 1
• Target fasting blood glucose: 80-130 mg/dL 3
• Evaluate HbA1c every 3 months to assess overall glycemic control, with a target HbA1c <7.0% 3

Precautions and Warnings

• Never share Toujeo SoloStar prefilled pens, insulin syringes, or needles between patients 1
• Hypoglycemia is the most common adverse reaction; severe hypoglycemia can cause seizures and may be life-threatening 1
• Changes in insulin regimen may affect glycemic control and predispose to hypoglycemia or hyperglycemia 1
• Use with caution in patients with renal or hepatic impairment, as dosage adjustments may be needed 1

Basal-Bolus Regimen Implementation

• For optimal glycemic control in type 1 diabetes, use a basal-bolus approach with Toujeo as the basal insulin and rapid-acting insulin before meals 2
• For type 2 diabetes patients requiring more intensive control:
  • Half of total daily insulin dose as basal insulin (Toujeo)
  • Half as rapid-acting insulin divided before meals 2
  • For patients at higher risk of hypoglycemia, consider a basal-plus approach with correction doses only 2

Toujeo offers effective glycemic control with the advantages of once-daily dosing, reduced risk of nocturnal hypoglycemia, and a more stable pharmacokinetic profile compared to traditional basal insulins 5, 4.