How to transition from Humalog (insulin lispro) 75/25 to Lantus (insulin glargine)?

Transitioning from Humalog 75/25 to Lantus (Insulin Glargine)

To transition from Humalog 75/25 to Lantus, calculate 75% of the total daily premixed insulin dose, start Lantus at 80% of this calculated amount as a once-daily injection, and monitor blood glucose levels frequently to adjust dosing. 1

Step-by-Step Transition Protocol

• Calculate the total daily dose of Humalog 75/25 currently being administered 1
• Determine the basal component by taking 75% of the total daily dose of premixed insulin 1
• Start Lantus at 80% of the calculated basal requirement (approximately 60% of the total daily premixed dose) to avoid hypoglycemia during transition 1
• Administer the first Lantus dose in the evening of the day you plan to discontinue premixed insulin, after giving the last dose of Humalog 75/25 in the morning of that day 1
• For patients who need prandial coverage, consider adding rapid-acting insulin before meals based on the remaining 25% of the original premixed dose 2, 1

Monitoring and Dose Adjustment

• Check blood glucose levels frequently during the transition period, especially fasting and 2-hour postprandial levels 1
• Target fasting blood glucose of 90-150 mg/dL for most patients 2, 1
• Adjust Lantus dose by 2 units every 3-4 days based on fasting glucose values 2, 1
• If 50% of fasting fingerstick glucose values are over the target, increase dose by 2 units 2
• If more than 2 fasting fingerstick values per week are below 80 mg/dL, decrease dose by 2 units 2

Clinical Benefits of Transition

• Lantus provides a relatively constant basal level of circulating insulin with no pronounced peak, unlike premixed insulins 3
• Once-daily Lantus achieves equivalent glycemic control to NPH insulin given once or twice daily, with significantly lower fasting blood glucose levels 3
• Lantus is associated with less hypoglycemia, especially nocturnal episodes, compared to NPH insulin 3
• Separating basal and bolus insulin components allows for more flexible dosing and better postprandial glucose control 1, 3

Special Considerations

• Do not use rapid-acting insulin at bedtime to avoid nocturnal hypoglycemia 2
• For patients with significant postprandial hyperglycemia, consider adding mealtime insulin or non-insulin agents 2
• Schedule follow-up within 2-4 weeks to assess glycemic control and make further adjustments 1
• Consider individual comorbidities (e.g., CKD, ASCVD, low body weight) when adjusting insulin regimens 2

Common Pitfalls and How to Avoid Them

• Hypoglycemia during transition: Start with 80% of the calculated basal dose and adjust gradually 1
• Inadequate postprandial coverage: Consider adding mealtime insulin or non-insulin agents if postprandial glucose remains elevated 2, 1
• Insufficient monitoring: Check blood glucose 4 times daily for the first week after transition 1
• Failure to adjust: Titrate Lantus dose every 3-4 days based on fasting glucose patterns 2, 1
• Forgetting to discontinue premixed insulin: Give the last dose of Humalog 75/25 in the morning and start Lantus that evening 1