Semglee (Insulin Glargine) Dosing and Administration
Semglee should be administered as a once-daily subcutaneous injection at the same time each day, with initial dosing of 10 units daily or 0.1-0.2 units/kg/day for insulin-naive type 2 diabetes patients, and typical maintenance doses ranging from 0.4-1.0 units/kg/day, titrated by 10-15% or 2-4 units once or twice weekly based on fasting glucose targets. 1
Initial Dosing Strategy
For insulin-naive patients with type 2 diabetes:
- Start with 10 units once daily OR 0.1-0.2 units/kg/day 1
- Administer at a consistent time each day (morning, evening, or bedtime—patient's choice) 1, 2
- In metabolically stable patients, total daily insulin requirements typically start at 0.5 units/kg/day 1
For patients with type 1 diabetes:
- Basal insulin (including Semglee) typically comprises 40-60% of total daily insulin dose in multiple daily injection regimens 1
- Must be combined with rapid-acting insulin analogs for mealtime coverage 3, 4
Dose Titration Protocol
Increase dose by 10-15% or 2-4 units once or twice weekly until fasting blood glucose target is met 1
Critical escalation threshold:
- If basal insulin dose exceeds 0.5 units/kg/day and A1C remains above target, advance to combination injectable therapy with GLP-1 receptor agonists or add prandial insulin rather than continuing to escalate Semglee alone 1
- Type 2 diabetes patients often require ≥1 unit/kg/day due to insulin resistance 1
Administration Guidelines
Injection technique:
- Administer subcutaneously in the upper arm, anterior and lateral thigh, buttocks, or abdomen (excluding 2-inch radius around navel) 5
- Rotate injection sites within one anatomical area rather than rotating between different areas to minimize day-to-day absorption variability 5
- The abdomen has the fastest absorption rate, followed by arms, thighs, and buttocks 5
Critical mixing prohibition:
- Do not dilute or mix Semglee (insulin glargine) with any other insulin or solution due to its low pH 5, 1
- This is a non-negotiable safety requirement that distinguishes glargine from other insulins 5
Storage and Handling
- Refrigerate unopened vials; avoid extreme temperatures (<36°F or >86°F) 5
- Insulin in use may be kept at room temperature to reduce injection site irritation 5
- Inspect before each use—Semglee should appear clear; discard if clumping, frosting, precipitation, or color change occurs 5
- Replace vials that have been open >1 month, especially if stored at room temperature 5
Special Dosing Considerations
Twice-daily dosing may be required when:
- Once-daily administration fails to provide adequate 24-hour coverage 1
- Patients have persistent glycemic variability despite optimal once-daily titration 1
- High absolute doses exceed absorption capacity for single injection 1
- However, once-daily dosing remains the standard initial approach 1
Higher doses needed during:
- Puberty, pregnancy, and acute medical illness 1
- Obese, insulin-resistant patients may require split dosing due to high injection volumes 2
Concentrated formulations:
- U-300 glargine (Toujeo) available for patients requiring larger doses, providing longer duration than U-100 but requiring approximately 10-18% higher daily doses 1
- U-500 regular insulin indicated specifically for patients requiring >200 units daily 1
Monitoring Requirements
- Check fasting glucose to guide basal insulin titration 1
- Monitor glucose at baseline and with each treatment cycle 5
- Self-monitoring 4 or more times daily required when using multiple daily injection regimens 5
- Base dose adjustments on home glucose monitoring or A1C levels 1
Common Pitfalls to Avoid
Do not:
- Mix Semglee with other insulins in the same syringe 5
- Continue escalating basal insulin beyond 0.5 units/kg/day without adding GLP-1 agonist or prandial insulin 1
- Assume once-daily dosing will work for all patients—some require twice-daily administration 1
- Discontinue rapid-acting mealtime insulin when adjusting basal insulin—Semglee only addresses fasting/between-meal glucose 6
Key safety consideration: