What is the typical starting dose of Lantus (insulin glargine) for patients requiring insulin therapy?

Typical Starting Dose of Lantus (Insulin Glargine) for Patients Requiring Insulin Therapy

For patients with type 2 diabetes, the recommended starting dose of Lantus is 0.1-0.2 units/kg of body weight or up to 10 units once daily. 1, 2, 3

Starting Dose by Diabetes Type

Type 1 Diabetes

• The starting total daily insulin dose typically ranges from 0.4 to 1.0 units/kg of body weight 1, 2
• A typical starting dose for metabolically stable patients is 0.5 units/kg of body weight 1, 4
• Higher weight-based starting doses may be needed for patients presenting with diabetic ketoacidosis 1, 2
• Approximately one-third of the total daily insulin requirements should be provided as basal insulin (Lantus), with the remainder covered by short-acting insulin 3

Type 2 Diabetes

• For insulin-naive patients with type 2 diabetes, start with 0.1-0.2 units/kg or up to 10 units once daily 1, 3
• When transitioning from oral medications to insulin therapy, 5 units of Lantus nightly may be appropriate 1
• Consider higher starting doses for patients with HbA1c ≥ 9%, blood glucose levels ≥ 300-350 mg/dL, or HbA1c 10-12% with symptomatic features 1

Dose Titration

• After initiating Lantus, increase the dose by 2-4 units every 3-4 days until the target fasting blood glucose is reached 1, 2
• For fasting glucose ≥180 mg/dL, consider increasing the dose by 4 units 1
• Most patients can be taught to uptitrate their own insulin dose, typically adding 1-2 units (or 5-10% for higher doses) once or twice weekly if fasting glucose levels remain above target 1

Special Populations and Considerations

Switching from Other Insulin Therapies

• When switching from once-daily NPH insulin to once-daily Lantus, use the same dosage 3
• When switching from twice-daily NPH insulin to once-daily Lantus, start with 80% of the total NPH dosage 3
• When switching from TOUJEO (insulin glargine 300 units/mL) to Lantus (100 units/mL), start with 80% of the TOUJEO dosage 3

Patients on Enteral/Parenteral Feeding

• For patients on enteral/parenteral feeding requiring insulin, a reasonable starting point is 10 units of insulin glargine every 24 hours 1
• Basal insulin needs are typically 30-50% of the total daily insulin requirement for these patients 1

Common Pitfalls to Avoid

• Delaying insulin therapy in patients not achieving glycemic goals 1
• Not adjusting doses based on self-monitoring of blood glucose levels 1
• Overbasalization (using higher than necessary basal insulin doses), which can mask insufficient mealtime insulin coverage 1
• Failure to recognize that insulin requirements may change with weight changes, illness, or changes in physical activity 1

Administration Timing

• Lantus can be administered at any time of day, but should be given at the same time every day for consistent glycemic control 5
• Studies have shown similar efficacy whether administered at breakfast, dinner, or bedtime, though morning administration may be associated with fewer nocturnal hypoglycemic events 5

Remember that Lantus provides basal insulin coverage only and does not treat postprandial hyperglycemia. For patients with type 1 diabetes and some with type 2 diabetes, rapid-acting insulin will be needed at mealtimes to control glucose surges after meals 6.