From the Guidelines
The starting dose of Lantus (insulin glargine) is typically 10 units once daily for adults with type 2 diabetes who are insulin-naïve, as recommended by the American Diabetes Association standards of medical care in diabetes 1.
Key Considerations
- For patients with type 1 diabetes, the initial dose is usually calculated as 0.1 to 0.2 units/kg of body weight administered once daily, as stated in the evidence from the Annals of Internal Medicine 1.
- Lantus should be injected subcutaneously at the same time each day, preferably in the evening or at bedtime, to maintain consistent blood glucose control over 24 hours.
- The dose should be individualized based on the patient's blood glucose monitoring results, with adjustments typically made in 1-2 unit increments every 3-7 days until target glucose levels are achieved.
- Patients should be aware that hypoglycemia is the most common side effect, and they should monitor their blood glucose regularly, especially when starting insulin therapy.
Important Details
- Lantus works by providing a steady, basal insulin level throughout the day, mimicking the body's natural background insulin production to help control blood glucose between meals and overnight.
- The American Diabetes Association recommends that insulin therapy should not be delayed in patients not achieving glycemic goals, and that timely dose titration is important, based on self-monitoring of blood glucose levels 1.
- Basal insulin may be initiated at 10 units or 0.1 to 0.2 units/kg of body weight, and is typically used with metformin and perhaps 1 additional noninsulin agent, as stated in the evidence from the Annals of Internal Medicine 1.
From the Research
Starting Dose of Lantus (Insulin Glargine)
- The starting dose of Lantus (insulin glargine) can be determined based on the patient's weight and individual needs 2, 3, 4, 5.
- A common starting dose is 0.1-0.2 units/kg/day or 10 units/day, which can be titrated thereafter based on the patient's self-measured fasting plasma glucose levels 5.
- Another study suggests a starting dose of 0.15 units/kg/day, which can be adjusted based on the patient's response to treatment 2, 4.
- For patients with specific medical conditions, such as renal or hepatic impairment, the starting dose may need to be lowered to 0.2 U/kg/day 6.
- The dose of basal insulin should be increased as required up to approximately 0.5-1.0 units/kg/day in some cases, but overbasalization should be avoided 5.
Factors Affecting Starting Dose
- Patient's weight and body mass index (BMI) can affect the starting dose of Lantus (insulin glargine) 3, 4.
- Presence of medical conditions such as retinopathy, renal impairment, or hepatic impairment may require adjustments to the starting dose 4, 6.
- Use of other medications, such as sulfonylureas, may also affect the starting dose of Lantus (insulin glargine) 4.
- Individual patient characteristics, such as age, sex, and lifestyle, should also be considered when determining the starting dose of Lantus (insulin glargine) 5.