What is the starting dose of Lantus (insulin glargine)?

Starting Dose of Lantus (Insulin Glargine)

The recommended starting dose of Lantus (insulin glargine) is 0.1-0.2 units/kg/day for patients with type 2 diabetes and 0.4-0.5 units/kg/day for patients with type 1 diabetes who are metabolically stable. 1, 2

Type 1 Diabetes Starting Dose

• For patients with type 1 diabetes, the American Diabetes Association recommends a starting insulin dose based on weight, with doses ranging from 0.4 to 1.0 units/kg/day of total insulin 1
• The typical starting dose for metabolically stable type 1 diabetes patients is 0.5 units/kg/day 1
• Higher weight-based dosing may be required immediately following presentation with diabetic ketoacidosis 1

Type 2 Diabetes Starting Dose

• For patients with type 2 diabetes, the recommended starting dose is lower at 0.1-0.2 units/kg/day 2
• This lower starting dose helps minimize the risk of hypoglycemia while initiating basal insulin therapy 3
• Once-daily administration can be given either in the morning or at bedtime with similar glycemic efficacy 4

Dose Titration Algorithm

• After initiating Lantus, the dose should be titrated by 2-4 units every 3-4 days until the target fasting blood glucose is reached 2, 3
• A common titration algorithm increases the dose by:
  • 2 units if fasting glucose is ≥5.6-<6.7 mmol/L (≥100-<120 mg/dL)
  • 4 units if fasting glucose is ≥6.7-<7.8 mmol/L (≥120-<140 mg/dL)
  • 6-8 units if fasting glucose is ≥7.8 mmol/L (≥140 mg/dL) 3
• Titration should be done cautiously to avoid hypoglycemia, particularly nocturnal hypoglycemia 5

Special Considerations

• Lower starting doses (0.12-0.13 units/kg/day) should be considered for patients with diabetic retinopathy, renal impairment (eGFR<60 mL/min/1.73m²), women, and patients taking sulfonylureas 6
• For elderly patients or those at high risk for hypoglycemia, consider starting at the lower end of the dosing range (0.1 units/kg/day) 3
• When transitioning from an insulin pump to Lantus injections, the 24-hour basal dose from the pump can be used to calculate the Lantus dose, typically given in two divided doses 12 hours apart 1

Practical Formula for Dose Calculation

• A simplified formula for calculating the optimal Lantus dose is: Starting dose (0.15 × weight in kg) + incremental dose (baseline HbA1c - target HbA1c + 2) 6
• This formula provides a pragmatic approach to both initiating and titrating insulin glargine therapy 6

Advantages of Lantus Over NPH Insulin

• Lantus has been shown to reduce the risk of overall symptomatic hypoglycemia by 11% and nocturnal hypoglycemia by 26% compared to NPH insulin 5
• The risk of severe hypoglycemia is reduced by 46% with Lantus compared to NPH insulin 5
• These benefits allow for more aggressive insulin titration to achieve target HbA1c levels 5

Remember that while these are evidence-based starting doses, close monitoring of blood glucose levels and appropriate dose adjustments are essential for optimal glycemic control and minimizing hypoglycemia risk.