What is the recommended dosage and administration of Lantus (insulin glargine) for diabetes management?

Lantus (Insulin Glargine) Dosing and Administration for Diabetes Management

The recommended starting dosage of Lantus (insulin glargine) is 0.2 units/kg or up to 10 units once daily for insulin-naive patients with type 2 diabetes, and approximately one-third of the total daily insulin requirements for patients with type 1 diabetes. 1

Initial Dosing Recommendations

• For type 2 diabetes patients not currently on insulin therapy, start with 10 units or 0.1-0.2 units/kg of body weight once daily 2, 1
• For type 1 diabetes patients, 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, with approximately 50% as basal insulin (Lantus) 3, 2
• For patients transitioning from NPH insulin once daily to Lantus, the recommended starting Lantus dosage is the same as the dosage of NPH that is being discontinued 1
• For patients transitioning from twice-daily NPH insulin to once-daily Lantus, the recommended starting Lantus dosage is 80% of the total NPH dosage that is being discontinued 1, 4

Administration Guidelines

• Administer Lantus subcutaneously once daily at any time of day, but at the same time every day to maintain stable blood glucose levels 5, 1
• Inject into the abdominal area, thigh, or deltoid, and rotate 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, 6

Dose Titration

• Increase the dose by 2-4 units every 3-4 days until fasting blood glucose reaches target range (80-130 mg/dL) 2, 7
• If fasting glucose is ≥180 mg/dL, consider increasing the dose by 4 units 2
• More aggressive titration can be used: increase by 0-2,4, or 6-8 units if mean fasting plasma glucose over the previous 3 days is ≥100-<120, ≥120-<140, ≥140-<180, or ≥180 mg/dL, respectively 7
• Patient self-titration (increasing insulin dose by 2 units every 3 days) has shown greater reductions in HbA1c compared to clinic-managed titration in some studies 7

Special Populations and Considerations

• For patients on enteral/parenteral feeding requiring insulin, a reasonable starting point is 10 units of insulin glargine every 24 hours 2
• For patients with higher risk of hypoglycemia, use the lower end of the dosing range (0.1 units/kg/day) 2
• In hospitalized elderly patients with diabetes, the starting insulin total daily dose should be reduced to 0.1–0.15 units/kg/day, given mainly as basal insulin 3
• For patients requiring high doses of insulin (>0.5 units/kg/day) with A1C remaining above target, consider advancing to combination injectable therapy with GLP-1 receptor agonists or multiple insulin doses 5

Important Clinical Considerations

• In patients with type 1 diabetes, Lantus must be used concomitantly with short-acting insulin to control postprandial glucose 1, 6
• Lantus provides a peakless profile with duration of action up to 24 hours, resulting in more stable glycemic control and fewer episodes of nocturnal hypoglycemia compared to NPH insulin 8, 6
• For patients experiencing hypoglycemia despite titration of once-daily Lantus, consider splitting the dose into a twice-daily regimen 9
• Increase the frequency of blood glucose monitoring during changes to insulin regimen to reduce the risk of hypoglycemia or hyperglycemia 1
• Concentrated formulations (U-300 glargine) are available for patients requiring larger doses, offering longer duration of action than U-100 formulations 5

Common Pitfalls to Avoid

• Delaying insulin therapy in patients not achieving glycemic goals can be harmful 2
• Not adjusting doses based on self-monitoring of blood glucose levels can lead to poor glycemic control 2
• Overbasalization (using higher than necessary basal insulin doses) can mask insufficient mealtime insulin coverage 5
• Failing to recognize that insulin requirements may change with weight changes, illness, or changes in physical activity 2
• Mixing Lantus with other insulins in the same syringe, which can alter its pharmacokinetic profile 1, 6