Recommended Dosing for Lantus (Insulin Glargine)
For patients with diabetes requiring insulin therapy, the recommended starting dose of Lantus (insulin glargine) is 0.2 units/kg or up to 10 units once daily for type 2 diabetes, and approximately one-third of the total daily insulin requirements for type 1 diabetes. 1
Initial Dosing Guidelines
Type 1 Diabetes
- The recommended starting dose is approximately one-third of the total daily insulin requirements 1
- Total daily insulin requirements typically range from 0.4 to 1.0 units/kg/day, with 0.5 units/kg/day being typical for metabolically stable patients 2, 3
- Must be used with short-acting, premeal insulin to satisfy the remainder of daily insulin requirements 1
- Higher doses may be required during puberty, menses, and medical illness 2
Type 2 Diabetes
- The recommended starting dose is 0.2 units/kg or up to 10 units once daily 1
- For insulin-naive patients, starting with 0.1-0.2 units/kg/day is appropriate 3
- Most patients can be taught to uptitrate their own insulin dose by adding 1-2 units (or 5-10% for higher doses) once or twice weekly if fasting glucose levels remain above target 3
Dose Titration
- Increase the dose by 2-4 units every 3-4 days until fasting blood glucose reaches target range (80-130 mg/dL) 3, 4
- If fasting glucose is ≥180 mg/dL, consider increasing the dose by 4 units 3, 4
- The American Diabetes Association recommends increasing the basal insulin dose by 10-15% or 2-4 units once or twice weekly until fasting blood glucose target is met 2
Administration Timing
- Administer subcutaneously once daily at any time of day, but at the same time every day 1
- Studies show that morning, dinner, or bedtime administration are all effective with similar glycemic control 5
- Morning administration may result in fewer nocturnal hypoglycemic events compared to dinner or bedtime dosing 5, 6
Special Populations and Situations
- For patients on enteral/parenteral feeding requiring insulin, a reasonable starting point is 10 units of insulin glargine every 24 hours 3
- For patients with higher risk of hypoglycemia (elderly, renal impairment), consider using the lower end of the dosing range 3
- For patients with retinopathy or eGFR <60 mL/min/1.73 m², a lower starting dose of approximately 0.12 units/kg/day may be appropriate 7
Common Pitfalls to Avoid
- Delaying insulin therapy in patients not achieving glycemic goals can be harmful 3
- Not adjusting doses based on self-monitoring of blood glucose levels can lead to poor glycemic control 3
- Overbasalization (using higher than necessary basal insulin doses) can mask insufficient mealtime insulin coverage 3
- Failure to recognize that insulin requirements may change with weight changes, illness, or changes in physical activity 3
Switching from Other Insulin Therapies
- When switching from once-daily NPH insulin to once-daily Lantus, use the same dosage 1
- When switching from twice-daily NPH insulin to once-daily Lantus, use 80% of the total NPH dosage 1
- When switching from TOUJEO (insulin glargine 300 units/mL) to Lantus (100 units/mL), use 80% of the TOUJEO dosage 1
Lantus provides consistent, 24-hour basal insulin coverage with reduced risk of hypoglycemia compared to NPH insulin, particularly nocturnal hypoglycemia (26% reduction in nocturnal and 46% reduction in severe hypoglycemia) 8.