What is the initial dose of Lantus (insulin glargine) for a type 2 diabetic patient?

Initial Dosing of Lantus (Insulin Glargine) for Type 2 Diabetes

The recommended starting dose of Lantus (insulin glargine) for a type 2 diabetic patient is 0.1-0.2 units/kg/day or 10 units once daily. 1, 2

Dosing Algorithm

Initial Dosing

• For insulin-naïve type 2 diabetic patients:
  • Start with 10 units once daily OR
  • Calculate dose as 0.1-0.2 units/kg/day 1, 2
• Example: For a 70 kg patient, initial dose would be 7-14 units

Timing of Administration

• Lantus can be administered at any time of day, but should be given at the same time each day 2
• Morning or bedtime administration both provide similar glycemic control 3

Dose Titration

• Adjust dose every 3 days based on fasting blood glucose (FBG) patterns 4:
  • 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%

Special Considerations

Concomitant Medications

• Lantus is typically prescribed with metformin and sometimes one additional non-insulin agent 1
• When starting Lantus, continue metformin therapy 1
• Consider reducing dose of sulfonylureas to minimize hypoglycemia risk 1

Dose Adjustments for Special Populations

• Lower starting doses may be needed for:
  • Patients with retinopathy (0.12 units/kg/day)
  • Patients with eGFR <60 mL/min/1.73 m² (0.114 units/kg/day)
  • Women (0.135 units/kg/day)
  • Patients on sulfonylureas (0.132 units/kg/day) 5

Switching from Other Insulin Regimens

• When switching from once-daily NPH insulin to Lantus, use the same dose 2
• When switching from twice-daily NPH insulin to once-daily Lantus, use 80% of the total NPH dose 2

Monitoring and Safety

Blood Glucose Monitoring

• Increase frequency of blood glucose monitoring during initiation and dose adjustments 2
• Target fasting blood glucose: 80-130 mg/dL 4
• Target HbA1c: <7% 1

Hypoglycemia Risk

• Lantus has lower risk of nocturnal hypoglycemia compared to NPH insulin 6, 7
• Watch for signs of overbasalization (high bedtime-morning glucose differential ≥50 mg/dL) 1

Injection Technique

• Administer subcutaneously into abdomen, thigh, or deltoid 2
• Rotate injection sites within the same region to reduce risk of lipodystrophy 2
• Never share insulin pens, syringes, or needles between patients 2

Common Pitfalls to Avoid

1. Delayed Titration: Timely dose adjustment is crucial for achieving glycemic targets 1
2. Overbasalization: Watch for signs such as basal dose >0.5 units/kg or high bedtime-morning glucose differential 1
3. Inadequate Education: Ensure patients understand self-monitoring, hypoglycemia recognition, and proper injection technique 1
4. Failure to Individualize: While standard starting doses are recommended, consider patient-specific factors like renal function and concomitant medications 5
5. Inappropriate Timing: Although Lantus can be given at any time of day, consistency in timing is important 2, 3

By following these guidelines, clinicians can effectively initiate Lantus therapy in type 2 diabetic patients to improve glycemic control while minimizing the risk of hypoglycemia.