What are the typical dosing regimens for Lantus (insulin glargine) and regular insulin (human insulin) in patients requiring insulin therapy?

Lantus (Insulin Glargine) and Regular Insulin Dosing Regimens

For patients requiring insulin therapy, basal insulin (Lantus) should typically be initiated at 10 units or 0.1-0.2 units/kg body weight once daily, while regular insulin should be dosed before meals based on carbohydrate intake and pre-meal glucose levels as part of a basal-bolus regimen. 1

Basal Insulin (Lantus) Dosing

• Lantus (insulin glargine) is a long-acting basal insulin that provides relatively uniform insulin coverage throughout the day and night with no pronounced peak 2
• Initial dosing for insulin-naive patients should be 10 units or 0.1-0.2 units/kg body weight once daily 1
• For patients with type 2 diabetes, Lantus is typically used with metformin and possibly one additional non-insulin agent 1
• Dose titration is crucial for achieving glycemic targets - adjust dose by 2-4 units every 3 days based on fasting blood glucose levels 3
• Target fasting blood glucose should be <5.5 mmol/L (100 mg/dL) to achieve HbA1c <7% 3
• For patients already on higher doses of insulin at home (≥0.6 units/kg/day), a 20% reduction in total daily insulin dose is recommended during hospitalization to prevent hypoglycemia 1

Regular Insulin (Human Insulin) Dosing

• Regular human insulin is a short-acting insulin typically used for prandial (mealtime) coverage 1
• When used as part of a basal-bolus regimen, regular insulin should be administered 30 minutes before meals 1
• Regular insulin has a slower onset and longer duration compared to rapid-acting insulin analogs, making its pharmacokinetic profile less ideal for precise mealtime coverage 1
• Typical starting dose for prandial insulin is calculated as half of the total daily insulin requirement, divided into three doses before meals 1

Combined Insulin Regimens

• For a basal-bolus regimen, the total daily insulin dose typically ranges from 0.3-0.5 units/kg for insulin-naive patients 1
• Half of the total daily insulin dose should be allocated to basal insulin (Lantus) and half to prandial insulin (regular insulin divided into three doses before meals) 1
• Lower doses are recommended for patients at higher risk of hypoglycemia (older patients >65 years, those with renal failure, and those with poor oral intake) 1
• For patients with severe hyperglycemia (blood glucose ≥16.7-19.4 mmol/L or HbA1c 10-12%), especially with symptoms, basal insulin plus mealtime insulin is the preferred initial regimen 1

Special Considerations

• Lantus has been shown to reduce the risk of nocturnal hypoglycemia compared to NPH insulin 4, 5
• A basal-plus approach (basal insulin with one prandial dose at the largest meal) may be preferred for patients with mild hyperglycemia or those with decreased oral intake 1
• Sliding scale insulin alone (correctional insulin) is not recommended as the sole therapy for patients with diabetes as it treats hyperglycemia after it has occurred rather than preventing it 1
• Premixed insulin formulations (70/30) have been associated with higher rates of hypoglycemia and are generally not recommended in the hospital setting 1

Dose Adjustment and Monitoring

• Adjustment of both basal and prandial insulins should be based on self-monitoring of blood glucose (SMBG) levels 1
• When basal insulin has been titrated to appropriate fasting blood glucose levels but HbA1c remains above target, consider adding prandial insulin coverage 1
• Patient education regarding glucose monitoring, insulin injection technique, insulin storage, and recognition/treatment of hypoglycemia is essential for successful insulin therapy 1