What is the typical starting dose of Lantus (insulin glargine) for nighttime administration?

Lantus (Insulin Glargine) Nighttime Dosing

For patients with type 2 diabetes who are not currently on insulin, the recommended starting dose of Lantus (insulin glargine) is 0.2 units/kg or up to 10 units once daily at bedtime. 1

Initial Dosing Guidelines

• Type 2 Diabetes (insulin-naïve patients):

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

• Type 1 Diabetes:

  • Approximately one-third of total daily insulin requirements 1
  • Typical starting dose range: 0.4-1.0 units/kg/day of total insulin, with about 0.2-0.3 units/kg as basal insulin 2
  • Must be used with short-acting insulin to cover mealtime needs 1

Titration Algorithm

• Increase dose by 2 units every 3 days until fasting glucose target is reached without hypoglycemia 2
• For persistent hyperglycemia:
  • Increase by 2-4 units or 5-10% of current dose 2
  • For significant hyperglycemia (>200 mg/dL), increase by 4 units (or 25%) 2

Administration Timing

• Administer at the same time every night for consistency 1
• While typically given at bedtime, morning administration is equally effective with similar rates of nocturnal hypoglycemia 3

Monitoring and Adjustment

• Check blood glucose before breakfast daily during titration 2
• Target fasting glucose levels:
  • 90-150 mg/dL for older adults 2
  • <100 mg/dL (5.5 mmol/L) for optimal HbA1c control 4
• If hypoglycemia occurs, reduce dose by 10-20% 2

Practical Formula for Dose Calculation

A simplified formula derived from clinical data 5:

• Optimal daily dose = starting dose (0.15 × weight in kg) + incremental dose (baseline HbA1c - target HbA1c + 2)

Important Considerations

• Rotate injection sites within the same region (abdomen, thigh, or deltoid) to reduce risk of lipodystrophy 1
• Visually inspect Lantus for clarity and absence of particles before administration 1
• Never share insulin pens, syringes, or needles between patients 1
• Lantus cannot be mixed in the same syringe with other insulins 6
• Patients with renal impairment or retinopathy may require lower starting doses (0.114-0.120 units/kg/day) 5

Common Pitfalls to Avoid

1. Using sliding scale insulin alone without adequate basal insulin coverage 2
2. Failing to adjust doses during periods of illness, changes in physical activity, or meal patterns 1
3. Injecting into areas of lipodystrophy, which can lead to unpredictable absorption 1
4. Not monitoring for nocturnal hypoglycemia, which occurs less frequently with Lantus compared to NPH insulin but remains a risk 6, 7

Remember that while Lantus provides basal insulin coverage, it does not address postprandial hyperglycemia, which may require additional short-acting insulin at mealtimes 6.