What is the starting dose of Lantus (insulin glargine) for a 111.13 kg patient?

Starting Dose of Lantus (Insulin Glargine) for a 111.13 kg Patient

For a patient weighing 111.13 kg, the recommended starting dose of Lantus (insulin glargine) would be 22.2 units once daily (calculated as 0.2 units/kg × 111.13 kg).

Dosing Calculation Based on Weight

The FDA-approved prescribing information for insulin glargine (Lantus) provides clear guidance for initial dosing in patients with diabetes 1:

• For patients with type 2 diabetes who are not currently on insulin: 0.2 units/kg or up to 10 units once daily
• For patients with type 1 diabetes: approximately one-third of the total daily insulin requirements

Using the weight-based calculation for this 111.13 kg patient:

• Type 2 diabetes: 0.2 units/kg × 111.13 kg = 22.2 units
• Type 1 diabetes: If using the typical range of 0.4-1.0 units/kg/day for total insulin requirements 2, then:
  • Total daily insulin: 44.5-111.1 units
  • Basal insulin (one-third): 14.8-37.0 units

Administration Guidelines

• Administer subcutaneously once daily at the same time each day
• Inject into the abdominal area, thigh, or deltoid
• Rotate injection sites within the same region to reduce risk of lipodystrophy
• Do not mix with other insulins or administer intravenously

Titration and Monitoring

After initiating Lantus at 22.2 units daily:

• Increase dose by 2 units every 3 days until fasting glucose target is reached without hypoglycemia 3
• For significant hyperglycemia (>200 mg/dL), a 4-unit increase may be appropriate 3
• Monitor fasting blood glucose daily during titration
• If hypoglycemia occurs, determine the cause; if no clear reason, lower dose by 10-20% 3

Special Considerations

• Type 1 diabetes: Lantus must be used concomitantly with short-acting insulin 1
• Switching from other insulins:
  • From once-daily NPH: Use same dosage as NPH
  • From twice-daily NPH: Use 80% of total NPH dosage
  • From Toujeo (insulin glargine 300 units/mL): Use 80% of Toujeo dosage 1

Potential Pitfalls

1. Hypoglycemia risk: Higher insulin doses increase risk of hypoglycemia, especially in patients with renal impairment or irregular eating patterns 3

2. Inadequate postprandial control: Lantus provides basal insulin coverage but does not address postprandial glucose excursions; short-acting insulin may be needed for meals 2, 1

3. Injection technique: Poor technique can lead to variable absorption and unpredictable glucose control

4. Once-daily limitations: Some patients may benefit from twice-daily dosing if they experience hypoglycemia or inadequate 24-hour coverage with once-daily dosing 4

By following these guidelines and carefully monitoring the patient's response, the starting dose of 22.2 units of Lantus can be safely initiated and then adjusted to achieve optimal glycemic control.