Starting Dose of Lantus (Insulin Glargine) for Insulin-Naive Patients
The recommended starting dose of Lantus (insulin glargine) for insulin-naive patients is 0.1-0.2 units/kg/day, typically administered once daily at the same time each day.
Dosing Guidelines Based on Patient Type
Type 1 Diabetes
- Starting dose ranges from 0.4 to 1.0 units/kg/day of total insulin, with 0.5 units/kg/day being typical for metabolically stable patients 1
- Higher weight-based dosing is required immediately following presentation with ketoacidosis 1
- Lantus provides basal insulin coverage, but rapid-acting insulin will be needed at mealtimes to control postprandial glucose 1
Type 2 Diabetes
- Starting dose is lower: 0.1-0.2 units/kg/day for insulin-naive patients 2, 3
- Can be used as add-on therapy to oral medications in a basal-supported oral therapy (BOT) regimen 4
- A simplified formula derived from clinical data suggests: optimal daily dose = starting dose (0.15 × weight in kg) + incremental dose (baseline HbA1c - target HbA1c + 2) 4
Dose Titration and Adjustment
Titration Algorithm
- Increase dose by 2-4 units every 3-4 days until fasting blood glucose reaches target range (80-130 mg/dL) 2, 3
- If fasting glucose is ≥180 mg/dL, consider increasing by 4 units 2
- If fasting glucose is between 140-180 mg/dL, increase by 2 units 3
- Titration can be either physician-managed or patient-managed with proper education 3
Special Populations Requiring Dose Adjustment
- Patients with retinopathy: consider lower starting dose of 0.12 units/kg/day 4
- Patients with eGFR <60 mL/min/1.73m²: consider lower starting dose of 0.114 units/kg/day 4
- Women may require slightly lower starting dose (0.135 units/kg/day) 4
- Patients taking sulfonylureas may need reduced starting dose (0.132 units/kg/day) to avoid hypoglycemia 4
Administration and Clinical Considerations
Administration
- Administer once daily at the same time each day for consistent glycemic control 5
- Can be given at bedtime, morning, or any consistent time that works for the patient 5
- In some insulin-resistant patients, splitting into two daily doses may be more effective 5
Benefits and Monitoring
- Lantus has a lower risk of hypoglycemia, especially nocturnal hypoglycemia, compared to NPH insulin 6, 7
- Studies show 26% reduction in nocturnal hypoglycemia and 46% reduction in severe hypoglycemia compared to NPH insulin 6
- Monitor for injection site pain, which may be more common than with NPH insulin but is typically mild 7
Common Pitfalls to Avoid
Overbasalization: Using higher than necessary basal insulin doses, which can mask insufficient mealtime insulin coverage 1
- Signs include high bedtime-to-morning glucose differential (≥50 mg/dL), hypoglycemia, and high glucose variability
Inadequate titration: Failure to adjust doses based on glucose monitoring can lead to suboptimal glycemic control 3
Mixing with other insulins: Lantus should not be mixed in the same syringe with other insulins as it may coprecipitate 5
Inconsistent timing: Administering Lantus at different times each day can lead to variable glycemic control 5