How often can I increase the dose of Lantus (insulin glargine)?

Lantus (Insulin Glargine) Dose Titration Guidelines

When initiating Lantus (insulin glargine), you should increase the dose by 2 units every 3 days until you reach your fasting plasma glucose target without experiencing hypoglycemia. 1

Initial Dosing

• Start with 10 units per day or 0.1-0.2 units/kg per day if you are insulin-naïve 1, 2
• Administer at the same time each day for consistent blood glucose control 2
• Can be given in the morning or at bedtime, depending on your preference and schedule 3

Titration Schedule

• Increase dose by 2 units every 3 days to reach your fasting plasma glucose goal without hypoglycemia 1, 4
• For higher starting blood glucose levels (≥180 mg/dL), consider increasing by 4 units every 3-4 days 2
• If hypoglycemia occurs, determine the cause; if no clear reason is identified, lower the dose by 10-20% 1, 4

Monitoring Requirements

• Check fasting blood glucose levels regularly during the titration phase 4
• Set a fasting plasma glucose goal (typically 80-130 mg/dL) 1, 2
• Assess adequacy of insulin dose at every healthcare provider visit 1

Special Considerations

• For obese, insulin-resistant patients, two separate daily doses may be more effective due to high volumes of insulin required 3
• In labile type 1 diabetes, Lantus is often most effective when given as two daily injections 3
• Watch for signs of overbasalization (elevated bedtime-to-morning glucose differential ≥50 mg/dL, hypoglycemia, high glucose variability) 1, 2

Common Pitfalls to Avoid

• Delaying dose adjustments when glucose targets are not met (therapeutic inertia) 1, 4
• Continuing with the same dose after experiencing hypoglycemia (should reduce by 10-20% instead) 1, 4
• Not recognizing that insulin requirements may change with weight changes, illness, or changes in physical activity 2
• Lantus does not treat postprandial hyperglycemia; supplemental rapid-acting insulin may be needed at mealtimes 3

Benefits of Proper Titration

• Achieving target HbA1c levels with minimal risk of hypoglycemia 5
• Reduced risk of severe hypoglycemia compared to NPH insulin when properly titrated 5
• Better glycemic control with proper dose adjustment, as demonstrated in the AT.LANTUS study 6

Remember that consistent monitoring and timely dose adjustments are key to successful insulin therapy. Regular communication with your healthcare provider during the titration process is essential.