Is 3 units of Lantus (insulin glargine) a typical dose?

Is Three Units of Lantus a Typical Dose?

No, three units of Lantus (insulin glargine) is an unusually low dose for most adult patients with diabetes. The typical starting dose for insulin glargine in adults with type 2 diabetes is 0.2 units/kg or up to 10 units once daily 1.

Typical Insulin Glargine Dosing

Starting Doses

• Type 2 diabetes: 0.2 units/kg or up to 10 units once daily 1
• Type 1 diabetes: Approximately one-third of the total daily insulin requirements 1

Dose Titration

The FDA-approved label for insulin glargine recommends individualizing and adjusting dosage based on:

• Patient's metabolic needs
• Blood glucose monitoring results
• Glycemic control goals 1

Titration algorithms typically recommend:

• If 50% of fasting finger-stick glucose values are over goal: Increase dose by 2 units
• If >2 fasting finger-stick values/week are <80 mg/dL: Decrease dose by 2 units 2

More specific titration guidance suggests:

• 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

Special Populations Where Lower Doses May Be Appropriate

While 3 units is generally considered a low dose, there are specific situations where such a low dose might be used:

1. Initial insulin therapy: When first introducing insulin to insulin-sensitive patients
2. Elderly patients: Older adults may require lower insulin doses and more conservative glycemic targets 2
3. Renal impairment: Patients with kidney disease may need lower insulin doses due to decreased insulin clearance 3
4. Children: Pediatric patients may require lower doses based on weight
5. Insulin-sensitive patients: Some patients may be particularly sensitive to insulin effects

Clinical Implications of Very Low Doses

Using a dose as low as 3 units of insulin glargine may:

• Be insufficient to provide adequate basal insulin coverage for most adults
• Not effectively control fasting blood glucose levels
• Be difficult to accurately administer with standard insulin pens (most dial in 1-unit increments) 1

Practical Considerations

If a patient is prescribed 3 units of Lantus:

• Verify the prescription is correct
• Consider whether the patient has special circumstances warranting such a low dose
• Monitor blood glucose closely to ensure adequate glycemic control
• Be prepared to titrate the dose upward if glycemic targets are not met

Conclusion

Three units of Lantus is an unusually low dose for most adult patients with diabetes. Standard starting doses are typically higher (0.2 units/kg or up to 10 units daily), with subsequent titration based on blood glucose response. If a patient is prescribed such a low dose, careful monitoring and dose adjustment will likely be necessary to achieve glycemic targets.