Can Lantus (insulin glargine) be administered twice daily (BID)?

Lantus (Insulin Glargine) Can Be Administered Twice Daily

Yes, insulin glargine (Lantus) can be administered twice daily in certain clinical situations, particularly when once-daily dosing does not provide adequate 24-hour coverage. 1

Evidence Supporting Twice-Daily Lantus Administration

• Basal insulin regimens using insulin glargine can be administered once or twice daily according to the 2018 American Diabetes Association (ADA) and European Association for the Study of Diabetes (EASD) consensus report 1
• While insulin glargine is designed to provide relatively constant basal insulin levels over 24 hours, clinical experience has shown that in some patients it may not last the full 24 hours, necessitating divided dosing 2
• In hospital settings, basal-bolus regimens that include basal insulin (such as glargine) given once or twice daily along with rapid-acting insulin have shown better glycemic control than sliding scale insulin alone 1

Clinical Scenarios Where Twice-Daily Lantus May Be Appropriate

• In patients with labile type 1 diabetes, insulin glargine is often most effective when given as two daily injections 2
• In obese, insulin-resistant patients requiring high volumes of insulin, administering insulin glargine in two separate doses may be more effective 2
• When a patient's blood glucose monitoring shows a pattern suggesting the insulin effect is waning before the next scheduled dose 1
• When basal insulin doses exceed 0.5 units/kg/day, which may indicate overbasalization and the need to reevaluate the insulin regimen 1

Considerations When Using Twice-Daily Lantus

• When splitting the total daily dose of glargine into two injections, the total NPH dose should typically be reduced to about 80% of the current dose when converting from NPH insulin 1
• Monitoring for hypoglycemia is essential, as basal-bolus regimens have a higher risk of hypoglycemia compared to sliding scale insulin therapy 1
• Patients should maintain consistent timing of injections to ensure stable insulin levels 3
• Regular blood glucose monitoring is crucial to evaluate the effectiveness of the regimen and make appropriate adjustments 1

Benefits of Twice-Daily Lantus in Specific Populations

• In adolescents with type 1 diabetes, insulin glargine (whether once or twice daily) may be more efficacious than NPH/Lente insulin in those with elevated A1C levels 4
• For patients with significant dawn phenomenon (early morning rise in blood glucose), twice-daily dosing may provide better coverage 1
• Patients with high insulin requirements may benefit from divided doses to improve absorption and reduce injection site discomfort 2

Potential Drawbacks

• Increased number of injections may reduce patient adherence 1
• Higher cost compared to once-daily dosing 1
• Potential for medication errors with multiple daily injections 1

Remember that insulin regimens should be tailored to the individual patient's needs, with consideration of their glucose patterns, lifestyle, and risk of hypoglycemia 1, 3.