What is the initial dosing for Lantus (insulin glargine) in patients requiring insulin therapy?

Initial Dosing for Lantus (Insulin Glargine) in Patients Requiring Insulin Therapy

For patients requiring insulin therapy, the recommended initial dose of Lantus (insulin glargine) is 10 units or 0.1-0.2 units/kg of body weight once daily. 1

Dosing Guidelines by Patient Type

Type 2 Diabetes Patients

• Start with 10 units or 0.1-0.2 units/kg of body weight once daily 1, 2
• Typically used with metformin and possibly one additional non-insulin agent 1
• Consider higher starting doses (basal-bolus regimen) when:
  • HbA1c ≥ 9% 1
  • Blood glucose levels ≥ 300-350 mg/dL 1
  • HbA1c 10-12% with symptomatic or catabolic features 1

Type 1 Diabetes Patients

• Higher weight-based dosing is required (0.4-1.0 units/kg/day of total insulin) 2
• 0.5 units/kg/day is typical for metabolically stable patients 2
• Higher doses are needed immediately following ketoacidosis 2

Dose Titration

• Increase dose by 10-15% or 2-4 units once or twice weekly until fasting blood glucose target is met 1, 2
• If fasting glucose ≥180 mg/dL, consider increasing the dose by 4 units 2
• Timely dose titration is important for achieving glycemic goals 1

Administration Considerations

• Lantus is administered as a once-daily subcutaneous injection 3, 4
• Can be given at any time of day, but should be consistent from day to day 3
• In some cases (e.g., labile type 1 diabetes or obese insulin-resistant patients), dividing into two daily doses may be more effective 3

Important Clinical Considerations

• Lantus provides basal insulin coverage only and does not treat postprandial hyperglycemia 2, 3
• Rapid-acting insulin at mealtimes is needed to control postprandial glucose excursions in most patients 1, 2
• Insulin glargine has a lower risk of hypoglycemia, particularly nocturnal hypoglycemia, compared to NPH insulin 5, 6
• The smooth 24-hour time-action profile of insulin glargine allows for once-daily dosing in most patients 7, 4

Common Pitfalls to Avoid

• Delaying insulin therapy in patients not achieving glycemic goals 1
• Overbasalization (using higher than necessary basal insulin doses) can mask insufficient mealtime insulin coverage 2
• Signs of overbasalization include high bedtime-to-morning glucose differential (≥50 mg/dL), hypoglycemia, and high glucose variability 2
• Not adjusting doses based on self-monitoring of blood glucose levels 1

Special Populations

• For patients on enteral/parenteral feeding requiring insulin, basal insulin needs are typically 30-50% of the total daily insulin requirement 1
• In the absence of previous insulin dosing, a reasonable starting point for these patients is 5 units of NPH/detemir insulin every 12 hours or 10 units of insulin glargine every 24 hours 1