What is the standard initiating dose of Lantus (insulin glargine)?

Standard Initiating Dose of Lantus (Insulin Glargine)

For type 2 diabetes patients who are insulin-naive, start Lantus at 0.2 units/kg or up to 10 units once daily, administered at the same time each day. 1

Type 2 Diabetes Starting Dose

The FDA-approved dosing for insulin-naive type 2 diabetes patients is straightforward:

• Primary recommendation: 0.2 units/kg body weight OR up to 10 units once daily 1
• The American Diabetes Association guidelines support a starting range of 0.1-0.2 units/kg/day 2, 3, 4
• For a typical 50 kg patient, this translates to approximately 10 units once daily 4

Lantus should be administered subcutaneously once daily at any time of day, but consistently at the same time every day. 1

Dose Titration Algorithm

After initiation, systematic uptitration is essential to reach glycemic targets:

• Increase by 2-4 units every 3-4 days until fasting blood glucose reaches target range (80-130 mg/dL) 2, 3, 4
• More specifically:
  • If fasting glucose ≥180 mg/dL: increase by 4 units every 3 days 4
  • If fasting glucose 140-179 mg/dL: increase by 2 units every 3 days 4
• Alternative approach: increase by 10-15% of current dose once or twice weekly 4

Type 1 Diabetes Starting Dose

For type 1 diabetes, the approach differs significantly:

• Start with approximately one-third of total daily insulin requirements as basal insulin 1
• Total daily insulin requirements typically range from 0.4-1.0 units/kg/day, with 0.5 units/kg/day being typical for metabolically stable patients 3, 4
• The remaining two-thirds should be provided as short-acting, premeal insulin 1
• Higher doses (approaching 1.0 units/kg/day) may be required immediately following diabetic ketoacidosis 3

Special Considerations and Common Pitfalls

When to Use Higher Starting Doses

Consider more aggressive initial dosing in type 2 diabetes patients with:

• HbA1c ≥9% 4
• Blood glucose levels ≥300-350 mg/dL 4
• HbA1c 10-12% with symptomatic or catabolic features 4

In these cases, consider starting with 0.3-0.4 units/kg/day or a basal-bolus regimen from the outset 4.

Critical Pitfall: Overbasalization

Be vigilant for overbasalization when basal insulin exceeds 0.5 units/kg/day 2, 4:

• Clinical signals include:
  • Basal dose >0.5 units/kg/day 2
  • High bedtime-to-morning glucose differential (≥50 mg/dL) 2, 4
  • Hypoglycemia (aware or unaware) 2
  • High glucose variability 2

When basal insulin approaches 0.5-1.0 units/kg/day and A1C remains elevated despite controlled fasting glucose, add prandial insulin rather than continuing to escalate basal insulin 2, 4.

Administration Details

• Inject subcutaneously into the abdominal area, thigh, or deltoid 1
• Rotate injection sites within the same region to reduce risk of lipodystrophy 1
• Never administer intravenously or via insulin pump 1
• Do not dilute or mix with any other insulin or solution 1

Monitoring Requirements

• Daily fasting blood glucose monitoring is essential during titration 4
• Increase frequency of blood glucose monitoring during any insulin regimen changes 1
• Reassess every 3 days during active titration and every 3-6 months once stable 4

Switching from Other Insulins

When transitioning to Lantus from other basal insulins 1:

• From once-daily NPH: use the same dose
• From twice-daily NPH: use 80% of total NPH dose
• From TOUJEO (U-300 glargine): use 80% of TOUJEO dose