What is the recommended usage and dosage of Lantus (insulin glargine) for patients with type 1 or type 2 diabetes?

Lantus (Insulin Glargine) Dosing and Administration

Recommended Dosage

For type 1 diabetes, start with approximately one-third of total daily insulin requirements as Lantus, with the remainder covered by short-acting insulin at meals; for type 2 diabetes, start with 0.2 units/kg or up to 10 units once daily. 1

Type 1 Diabetes Starting Dose

• Lantus comprises approximately one-third of total daily insulin requirements 1
• Must be used concomitantly with short-acting insulin for meal coverage 1
• In established multiple daily injection regimens, basal insulin typically represents 40-60% of total daily dose 2
• Total daily insulin requirements generally range from 0.4-1.0 units/kg/day 2

Type 2 Diabetes Starting Dose

• For insulin-naive patients: 0.2 units/kg or up to 10 units once daily 1
• Alternative starting approach: 0.1-0.2 units/kg/day 2
• Type 2 patients typically require higher doses (approximately ≥1 unit/kg/day) due to insulin resistance 2

Administration Guidelines

Timing and Technique

• Administer subcutaneously once daily at the same time every day 1
• Can be given at any time of day, though bedtime is traditional 1, 3
• Inject into abdominal area, thigh, or deltoid 1
• Rotate injection sites within the same region to reduce lipodystrophy risk 1

Critical Administration Rules

• Never dilute or mix with any other insulin or solution 1, 2
• Do not administer intravenously or via insulin pump 1
• Do not inject into areas of lipodystrophy or localized cutaneous amyloidosis 1

Dose Titration Strategy

Standard Titration Approach

• Increase dose by 10-15% or 2-4 units once or twice weekly until fasting blood glucose target is met 2
• Base adjustments on home glucose monitoring or A1C levels 2
• Increase blood glucose monitoring frequency during any regimen changes 1

When to Intensify Beyond Basal Insulin

• 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 2
• When fasting glucose is controlled but A1C remains elevated, add prandial coverage rather than continuing to escalate basal insulin 2

Switching from Other Insulins

From NPH Insulin

• Once-daily NPH to once-daily Lantus: use the same dose 1
• Twice-daily NPH to once-daily Lantus: use 80% of total NPH dose 1

From Toujeo (U-300 Glargine)

• Use 80% of the Toujeo dosage when switching to Lantus (U-100) 1

From Other Regimens

• Close medical supervision required with increased glucose monitoring 1
• Dosage adjustments recommended to lower hypoglycemia risk 1

Special Dosing Considerations

High-Dose Requirements

• Concentrated U-300 glargine formulation available for patients requiring larger doses 2
• U-300 requires approximately 10-18% higher daily doses compared to U-100 due to modestly lower per-unit efficacy 2
• U-500 regular insulin indicated specifically for patients requiring >200 units daily 2

Twice-Daily Dosing

• Consider splitting to twice-daily administration if once-daily dosing fails to provide 24-hour coverage 2
• Particularly useful for type 1 diabetes patients with persistent glycemic variability or those requiring high basal doses 2
• Allows independent titration of morning and evening doses for specific glucose patterns 2

Population-Specific Adjustments

• Puberty: requirements may increase to 1.5 units/kg/day due to hormonal influences 2
• Elderly hospitalized patients with reduced oral intake: start with 0.1-0.15 units/kg/day 2
• Higher doses needed during pregnancy and medical illness 2

Clinical Advantages

Pharmacokinetic Profile

• Onset of action approximately 1 hour 4
• Duration of action up to 24 hours 4
• Peakless profile providing relatively constant insulin levels throughout 24 hours 4, 5

Hypoglycemia Risk Reduction

• Significantly fewer nocturnal hypoglycemic events compared to NPH insulin 6, 7
• 26% reduction in overall nocturnal hypoglycemia risk versus NPH 7
• 46% reduction in severe hypoglycemia and 59% reduction in severe nocturnal hypoglycemia 7
• More consistent absorption than NPH insulin 4

Important Caveats

Cost Considerations

• WHO recommends human insulin (including NPH) as first-line therapy in resource-limited settings, reserving long-acting analogs like Lantus for patients with frequent severe hypoglycemia on human insulin 6
• The modest overall benefit from insulin analogs may be outweighed by large price differences in low-resource settings 6

Common Pitfalls to Avoid

• Never share Lantus SoloStar pens between patients, even with needle changes 1
• Patients repeatedly injecting into lipodystrophy areas may experience hyperglycemia; sudden site changes can cause hypoglycemia 1
• In some patients, Lantus may not last 24 hours—consider twice-daily dosing if this occurs 2
• When adding significant prandial insulin (especially with evening meal), consider decreasing basal insulin dose 2

Monitoring Requirements

• Close blood glucose monitoring essential when initiating or changing insulin regimens 2
• Hypoglycemia most common within first four weeks after switching to Lantus 3
• Supplemental short-acting insulin correction doses may be needed if basal insulin is reduced or held 2