What is the recommended use and dosage of Lantus (insulin glargine) for managing diabetes mellitus?

Lantus (Insulin Glargine) Recommended Use and Dosage for Diabetes Mellitus

Insulin glargine (Lantus) should be administered once daily at any time of day (but at the same time every day) as a subcutaneous injection at a starting dose of 0.2 units/kg or up to 10 units for type 2 diabetes, and approximately one-third of total daily insulin requirements for type 1 diabetes. 1

General Administration Guidelines

• Administer Lantus subcutaneously into the abdominal area, thigh, or deltoid, rotating injection sites within the same region to reduce the risk of lipodystrophy 1
• Do not administer intravenously or via an insulin pump 1
• Do not dilute or mix Lantus with any other insulin or solution 1
• Visually inspect Lantus for particulate matter and discoloration prior to administration - only use if solution is clear and colorless 1

Dosing for Type 1 Diabetes

• The recommended starting dose is approximately one-third of the total daily insulin requirements 1
• Must be used concomitantly with short-acting insulin to satisfy mealtime insulin requirements 1, 2
• Typical total daily insulin requirements range from 0.4 to 1.0 units/kg/day, with approximately 50% as basal insulin and 50% as prandial insulin 2
• Lantus provides stable basal insulin levels over 24 hours with no pronounced peak, making it more physiologic than intermediate-acting insulins 2

Dosing for Type 2 Diabetes

• For insulin-naïve patients: Start with 0.2 units/kg or up to 10 units once daily 1
• When adding to oral agents: Lantus can be added when oral hypoglycemic agents are failing 3
• For patients switching from NPH insulin once daily: Use the same dosage of Lantus as the previous NPH dose 1
• For patients switching from NPH insulin twice daily: Use 80% of the total previous NPH dosage 1

Advantages of Lantus Over Other Insulins

• Lantus has no pronounced peak action time, reducing the risk of hypoglycemia compared to NPH insulin 2, 4
• It provides a relatively constant basal level of circulating insulin over 24 hours 3
• Studies show significantly lower rates of symptomatic hypoglycemia with Lantus compared to NPH insulin (39.9% vs 49.2% over one month) 2
• Risk of severe hypoglycemia is reduced by 46% and severe nocturnal hypoglycemia by 59% compared to NPH insulin 4

Monitoring and Dose Adjustments

• Individualize and adjust dosage based on the patient's metabolic needs, blood glucose monitoring results, and glycemic control goals 1
• Increase frequency of blood glucose monitoring during changes to insulin regimen 1
• Dosage adjustments may be needed with changes in physical activity, meal patterns, during acute illness, or with changes in renal or hepatic function 1
• Make dosage adjustments under medical supervision with appropriate glucose monitoring 1

Common Pitfalls and Precautions

• Never share Lantus SoloStar prefilled pens, insulin syringes, or needles between patients due to risk of blood-borne pathogen transmission 1
• Changes in insulin regimen (including switching to Lantus) may affect glycemic control and predispose to hypoglycemia or hyperglycemia - close monitoring is essential during transitions 1
• Repeated injections into areas of lipodystrophy can result in hyperglycemia 1
• Lantus does not treat postprandial hyperglycemia - short-acting insulin at mealtimes is needed to control glucose surges after meals 5
• In some patients with labile type 1 diabetes, Lantus may be more effective when given as two daily injections 5

By following these guidelines, Lantus can provide effective glycemic control with reduced risk of hypoglycemia compared to traditional intermediate-acting insulins in both type 1 and type 2 diabetes.