What adjustments should be made to my Lantus (Insulin Glargine) regimen of 15 units QAM and 10 units QHS, with MSSI, for optimal glucose control?

Optimizing Lantus (Insulin Glargine) Regimen with MSSI

Your current Lantus regimen of 15 units QAM and 10 units QHS should be simplified to a single daily dose of 20 units in the morning to improve glucose control and reduce hypoglycemia risk.

Current Regimen Assessment

• Split-dosing of basal insulin (Lantus) is generally not necessary due to its 24-hour duration of action 1, 2
• Your current regimen (15 units morning, 10 units bedtime) totals 25 units daily but may be causing:
  • Potential overlap in insulin action leading to hypoglycemia risk 1
  • Unnecessary complexity in your insulin management 3

Recommended Adjustments

Consolidate to Once-Daily Dosing

• Convert to a single morning dose of approximately 20 units (80% of your current total daily dose) 3, 1
• Morning administration provides more consistent coverage throughout the day 4
• Once-daily dosing at the same time each day improves adherence and glucose stability 1

Titration Protocol

• Monitor fasting blood glucose (FBG) daily 3
• Adjust dose by 2 units every 3 days until reaching target FBG of 90-150 mg/dL 3
• If experiencing hypoglycemia (glucose <70 mg/dL), reduce dose by 10-20% 3

Mealtime Insulin Considerations (MSSI)

• Continue your mealtime short-acting insulin (MSSI) with meals 3
• Consider adjusting mealtime insulin if:
  • Post-meal glucose consistently exceeds 180 mg/dL 3
  • Large glucose excursions occur between meals 3
• Typical starting dose for mealtime insulin is 4 units or 10% of basal dose per meal 3

Monitoring Recommendations

• Check blood glucose before meals and at bedtime 3
• Assess for patterns of hypoglycemia, especially overnight 5, 6
• Evaluate for "overbasalization" signs: elevated bedtime-to-morning glucose differential, hypoglycemia, or high glucose variability 3

Special Considerations

• If simplifying from split-dose to once-daily dosing doesn't provide adequate control, consider:
  • Adding a GLP-1 receptor agonist before increasing insulin doses 3
  • Adjusting timing of the single daily dose (morning vs. evening) 4
  • Evaluating for dawn phenomenon (early morning glucose rise) 3

Hypoglycemia Prevention

• Be vigilant about recognizing hypoglycemia symptoms 1
• Keep rapid-acting carbohydrates available for treating low blood glucose 3
• Avoid alcohol consumption which can increase hypoglycemia risk 1

Remember that insulin glargine (Lantus) should be clear and colorless before injection, and should be administered subcutaneously into the abdomen, thigh, or upper arm with rotation of injection sites 1.