From the Guidelines
No, insulin glargine (Lantus) is not typically administered twice daily, as it is designed for once-daily administration 1.
Administration Guidelines
- Insulin glargine is a long-acting insulin analog that can be administered once daily, with options including U100 or U300 formulations 1.
- The American Diabetes Association (ADA) and the European Association for the Study of Diabetes (EASD) recommend basal insulin as the preferred initial insulin formulation in patients with type 2 diabetes, with options including once- or twice-daily administration of intermediate-acting NPH or detemir insulin, and once-daily administration of glargine or degludec 1.
- Some multiple daily injection (MDI) regimens may require twice-daily dosing of insulin detemir or insulin glargine, but this is not the standard administration schedule for insulin glargine 1.
Key Considerations
- Long-acting insulin analogs, including glargine, have a modestly lower absolute risk for hypoglycemia compared with NPH insulin, but are more expensive 1.
- The choice of insulin regimen should be individualized based on patient factors, such as lifestyle, glucose control goals, and cost considerations 1.
From the Research
Administration of Insulin Glargine
- Insulin glargine is typically administered as a single daily dose, usually at nighttime 2, 3, 4, 5
- However, it can be given in the morning or at any other time convenient for the patient 2
- In some cases, such as labile type 1 diabetes or obese, insulin-resistant patients, insulin glargine may be administered in two separate doses 2
- A case report suggests that twice-daily injection with insulin glargine can be beneficial in resolving hypoglycemia in patients who experience significant morning hypoglycemia despite titration of insulin dose 6
Efficacy and Safety of Twice-Daily Administration
- Few studies have addressed the role of multiple daily injections of insulin glargine, but it remains a valuable option in the management of diabetic patients 6
- Prior studies using multiple daily injections with NPH insulin and Ultralente have demonstrated success 6
- Twice-daily administration of insulin glargine may result in a greater success in achieving glycemic targets, despite a slight increase in cost and inconvenience for the patient 6
Comparison with Other Insulin Therapies
- Insulin glargine has been compared to NPH insulin in several studies, with results showing that insulin glargine provides a lower frequency of hypoglycemic reactions and improved safety 2, 3, 4, 5
- Insulin glargine has also been shown to be effective in hospitalized and postsurgical patients due to its lack of pronounced insulin peaks and long duration of action 2