What are the initial dosing parameters for patients starting Lantus (insulin glargine) for the first time?

Initial Dosing Parameters for Lantus (Insulin Glargine)

For patients with type 2 diabetes starting Lantus (insulin glargine) for the first time, the recommended starting dosage is 0.2 units/kg or up to 10 units once daily. 1

Starting Dose Calculation

• Type 2 diabetes patients not currently on insulin:

  • 0.2 units/kg or up to 10 units once daily 1
  • Example: For a 70 kg patient: 0.2 × 70 = 14 units (round to nearest whole unit)

• Type 1 diabetes patients:

  • Approximately one-third of the total daily insulin requirements 1
  • Must be used with short-acting insulin for meal coverage 1

Administration Guidelines

• Timing: Administer once daily at any time of day, but at the same time every day 1, 2

  • Morning or bedtime administration produces equivalent glycemic control 2
  • Flexibility in timing can improve adherence

• Injection site:

  • Subcutaneous injection into abdomen, thigh, or deltoid 1
  • Rotate injection sites within the same region to reduce risk of lipodystrophy 1

Dose Titration Algorithm

• Frequency: Adjust dose every 3 days based on fasting blood glucose patterns 3
• Target: Fasting blood glucose 80-130 mg/dL without hypoglycemia 4, 3

Fasting Blood Glucose (mg/dL)	Dose Adjustment
≥180	Increase by 6-8 units
140-179	Increase by 4 units
120-139	Increase by 2 units
100-119	Maintain or increase by 0-2 units
<100	Decrease by 2-4 units
Any hypoglycemia (<70)	Decrease by 10-20%

Special Populations Requiring Dose Adjustment

• Renal impairment: For eGFR <60 mL/min/1.73m², consider reduced starting dose of 0.114 units/kg 5
• Retinopathy: Consider reduced starting dose of 0.120 units/kg 5
• Women: May require slightly lower starting dose of 0.135 units/kg 5
• Patients on sulfonylureas: Consider reduced starting dose of 0.132 units/kg 5

Monitoring Parameters

• Blood glucose monitoring:

  • Increase frequency during initiation and dose adjustments 1
  • Monitor fasting blood glucose daily during titration
  • Check for nocturnal hypoglycemia (particularly important with bedtime dosing)

• HbA1c monitoring:

  • Evaluate every 3 months to assess overall glycemic control 3
  • Target HbA1c <7% to decrease microvascular complications

Concomitant Medications

• Type 2 diabetes:

  • Maintain metformin when initiating Lantus 4
  • Consider discontinuing sulfonylureas, DPP-4 inhibitors when more complex insulin regimens are used 4

• Type 1 diabetes:

  • Must use with short-acting insulin for meal coverage 1

Important Precautions

• Hypoglycemia risk:

  • Increased risk during initial titration period
  • Educate patients on hypoglycemia recognition and management
  • Ensure patients carry quick-acting carbohydrates 3

• Dose adjustments:

  • Make only under medical supervision with appropriate glucose monitoring 1
  • Adjust dosage with changes in physical activity, meal patterns, during acute illness, or changes in renal/hepatic function 1

• Never share: Lantus SoloStar prefilled pens, insulin syringes, or needles between patients 1

By following these parameters for initiating Lantus therapy, you can optimize glycemic control while minimizing the risk of hypoglycemia in patients starting insulin glargine for the first time.