Maximum Dose of Insulin Toujeo (Insulin Glargine)
There is no specific maximum dose limit for Insulin Toujeo (insulin glargine 300 U/mL), as dosing should be individualized based on the patient's insulin requirements, which may be significantly higher in insulin-resistant patients with type 2 diabetes.
Dosing Considerations for Insulin Toujeo
- Insulin Toujeo is a concentrated insulin (300 U/mL) that allows higher doses of basal insulin administration per volume used compared to standard U-100 insulin formulations 1, 2
- Initial dosing for basal insulin therapy typically starts at 0.1-0.2 units/kg/day with individualized titration over days to weeks as needed 1
- Patients with type 2 diabetes generally require higher daily doses (approximately 1 unit/kg) compared to those with type 1 diabetes due to insulin resistance 1
Pharmacological Properties of Toujeo
- Toujeo (insulin glargine 300 U/mL) has a more stable and prolonged pharmacokinetic/pharmacodynamic profile than insulin glargine 100 U/mL, with glucose-lowering activity exceeding 24 hours 3
- U-300 glargine has a longer duration of action than U-100 glargine but modestly lower efficacy per unit administered, which may necessitate higher doses 1
- When switching from other basal insulins to Toujeo, dose adjustments and reinforced blood glucose monitoring may be required as the daily insulin requirement is typically slightly higher with insulin glargine 300 U/mL 2
Practical Dosing Considerations
- For insulin-resistant patients who require large doses, Toujeo may be more convenient (fewer injections to achieve target dose) and comfortable (less volume to inject) 1
- In obese, insulin-resistant patients requiring high volumes of insulin, it may be beneficial to administer insulin glargine in two separate doses 4
- Clinical signals that may prompt evaluation of overbasalization include basal dose greater than 0.5 units/kg, high bedtime-morning glucose differential, hypoglycemia, and high variability 1
Special Populations
- For older adults, insulin regimens may need simplification, with consideration for reducing the dose when hypoglycemia occurs 1
- In patients with type 2 diabetes, the combination of basal insulin and GLP-1 RA may allow for lower insulin doses while providing potent glucose-lowering actions with less weight gain and hypoglycemia 1
Important Safety Considerations
- Titration should be based on home glucose monitoring or A1C, with consideration given to decreasing basal insulin when significant additions to prandial insulin doses are made 1
- Monitor for hypoglycemia, which is a key concern with insulin therapy, though Toujeo has been associated with a lower risk of nocturnal hypoglycemia compared to insulin glargine 100 U/mL in some patient populations 3
- Regular monitoring of blood glucose is essential when using high doses of insulin to minimize the risk of hypoglycemia 1