Recommended Starting Dose for Insulin Glargine in Type 2 Diabetes
The recommended starting dose for insulin glargine in patients with type 2 diabetes who are not currently treated with insulin is 0.2 units/kg or up to 10 units once daily. 1
Initial Dosing Guidelines
- Basal insulin alone is the most convenient initial insulin regimen for type 2 diabetes patients, beginning at 10 units per day or 0.1-0.2 units/kg/day, depending on the degree of hyperglycemia 2
- The FDA-approved insulin glargine label specifically recommends a starting dose of 0.2 units/kg or up to 10 units once daily for insulin-naïve type 2 diabetes patients 1
- Insulin glargine should be administered subcutaneously once daily at any time of day, but at the same time every day to maintain consistent blood glucose control 1
- Basal insulin is typically prescribed in conjunction with metformin and sometimes one additional noninsulin agent 2
Dose Titration and Adjustment
- After initiating insulin glargine, the dose should be individualized and adjusted based on the patient's metabolic needs, blood glucose monitoring results, and glycemic control goals 1
- Equipping patients with an algorithm for self-titration of insulin doses based on self-monitoring of blood glucose improves glycemic control 2
- Dose titration should occur over days to weeks as needed, with adjustments made based on fasting blood glucose patterns 2
- Dosage adjustments may be needed with changes in physical activity, meal patterns, during acute illness, or changes in renal or hepatic function 1
Special Considerations
- For overweight or obese patients with type 2 diabetes, research suggests that a higher starting dose of 0.3 units/kg may be as safe as the standard 0.2 units/kg dose, with faster achievement of glycemic targets 3
- Patients with retinopathy or reduced renal function (eGFR<60 mL/min/1.73 m²) may require lower starting doses (approximately 0.12 units/kg/day) 4
- Women and patients taking sulfonylureas may benefit from slightly reduced starting doses (approximately 0.13-0.14 units/kg/day) 4
- When switching from other insulin therapies to insulin glargine, dose adjustments are recommended to lower the risk of hypoglycemia 1:
Monitoring and Safety
- Comprehensive education regarding self-monitoring of blood glucose, diet, and the avoidance and appropriate treatment of hypoglycemia are critically important for any patient using insulin 2
- During changes to a patient's insulin regimen, increase the frequency of blood glucose monitoring to reduce the risk of hypoglycemia or hyperglycemia 1
- The principal action of basal insulin is to restrain hepatic glucose production and limit hyperglycemia overnight and between meals 2
- Long-acting basal analogs like insulin glargine have been demonstrated to reduce the risk of symptomatic and nocturnal hypoglycemia compared with NPH insulin 2, 5
Common Pitfalls to Avoid
- Avoid using insulin as a threat or describing it as a sign of personal failure or punishment; the progressive nature of type 2 diabetes should be regularly and objectively explained to patients 2
- Be aware of the potential for overbasalization with insulin therapy (using higher than necessary doses of basal insulin) 2
- Clinical signals of overbasalization include high bedtime-morning glucose differential (≥50 mg/dL), hypoglycemia, and high glucose variability 2
- Cost considerations are important when selecting insulin products due to substantial price increases over the past decade 2
By following these guidelines for initiating insulin glargine therapy in type 2 diabetes, clinicians can help patients achieve optimal glycemic control while minimizing the risk of adverse effects such as hypoglycemia.