Initial Lantus Dosing for a 155-pound Patient
For a patient weighing 155 pounds (70.3 kg), the recommended starting dose of Lantus (insulin glargine) is 0.1-0.2 units/kg/day, which equals approximately 7-14 units once daily. 1, 2
Dosing Calculation
- The FDA-approved starting dose for insulin-naive type 2 diabetes patients is 0.2 units/kg or up to 10 units once daily 2
- For a 155-pound (70.3 kg) patient:
- At 0.1 units/kg: 7 units
- At 0.2 units/kg: 14 units
- The American Diabetes Association recommends starting with 10 units per day or 0.1-0.2 units/kg/day 3
Administration Guidelines
- Administer Lantus subcutaneously once daily at any time of day, but at the same time every day 2
- Inject into the abdominal area, thigh, or deltoid, and rotate injection sites within the same region to reduce the risk of lipodystrophy 2
- For type 2 diabetes, Lantus is usually prescribed in conjunction with metformin and sometimes one additional non-insulin agent 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) 1
- If fasting glucose is ≥180 mg/dL, consider increasing the dose by 4 units 1
- Equipping patients with an algorithm for self-titration of insulin doses based on self-monitoring of blood glucose improves glycemic control 3
Important Considerations
- For type 1 diabetes patients, Lantus must be used concomitantly with short-acting insulin 2
- Lantus provides basal insulin coverage but does not treat postprandial hyperglycemia; supplemental short-acting insulin at mealtimes may be needed 4
- During changes to insulin regimen, increase the frequency of blood glucose monitoring 2
- In obese, insulin-resistant patients, it may be better to administer insulin glargine in two separate doses due to high volumes of injected insulin required 4
Common Pitfalls to Avoid
- Delaying insulin therapy in patients not achieving glycemic goals can be harmful 1
- Not adjusting doses based on self-monitoring of blood glucose levels can lead to poor glycemic control 1
- Overbasalization (using higher than necessary basal insulin doses) 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
By starting with 10 units daily (or 0.1-0.2 units/kg/day) and carefully titrating the dose based on blood glucose monitoring, most patients can achieve optimal glycemic control while minimizing the risk of hypoglycemia.