What is the optimal timing for administering insulin glargine (Lantus)?

From the Guidelines

Lantus (insulin glargine) is best used once daily at the same time each day, typically at bedtime, as it provides steady coverage for approximately 24 hours with minimal peaks, helping to maintain baseline blood glucose levels 1. This long-acting insulin is effective in controlling blood glucose between meals and during sleep, making it an effective foundation for diabetes management. For most patients, evening administration (between dinner and bedtime) works well as it helps prevent overnight hypoglycemia and morning hyperglycemia. However, some patients may benefit from morning administration based on their individual glucose patterns. The standard starting dose for type 2 diabetes is typically 10 units daily, as recommended by the American Diabetes Association standards of medical care in diabetes 1. Lantus should be injected subcutaneously in the abdomen, thigh, or upper arm, with rotation of injection sites to prevent lipohypertrophy. It should not be mixed with other insulins in the same syringe. Key considerations in the management of diabetes, including the use of Lantus, involve individualizing the treatment plan, considering factors such as meal times, exercise, and the risk of hypoglycemia 1. In clinical practice, the goal is to achieve optimal blood glucose control while minimizing the risk of adverse effects, such as hypoglycemia, and improving the patient's quality of life. Given the most recent and highest quality evidence, the use of Lantus at bedtime is recommended as the initial approach for most patients, with adjustments made based on individual patient needs and response to therapy 1. This approach is supported by the pharmacologic properties of Lantus and clinical guidelines for the management of diabetes. In real-life clinical practice, the key to successful use of Lantus is careful patient selection, education, and monitoring, as well as ongoing adjustment of the treatment plan as needed to achieve optimal outcomes 1.

From the FDA Drug Label

Administer Insulin Glargine subcutaneously once daily at any time of day but at the same time every day. The best time to use Lantus (insulin glargine) is once daily at the same time every day. This allows for consistent glucose control and minimizes the risk of hypoglycemia or hyperglycemia.

• The exact time of day is not specified, but it should be the same time every day to maintain a consistent dosing schedule.
• Dosage adjustments may be needed based on individual patient factors, such as changes in physical activity, meal patterns, or renal or hepatic function 2.

From the Research

Best Time to Use Lantus

• Lantus (insulin glargine) is a long-acting, human insulin analogue that provides a relatively constant basal level of circulating insulin with no pronounced peak 3.
• It can be used once daily, at any time of day, but it is recommended to be used at the same time every day to maintain a consistent level of insulin in the body.
• The optimal time to use Lantus may vary depending on the individual's lifestyle and meal schedule, but it is often recommended to be used in the morning or at bedtime.

Benefits of Using Lantus

• Lantus has been shown to provide equivalent glycaemic control to NPH insulin given once or twice daily, with a lower risk of hypoglycaemia, especially nocturnal episodes 3, 4.
• It has also been shown to improve treatment satisfaction and quality of life in patients with type 1 and type 2 diabetes 3.
• Lantus can be used in combination with short-acting insulin analogues in patients with type 1 diabetes, and can be added to oral hypoglycaemic agents in patients with type 2 diabetes who are not achieving adequate glycaemic control 3.

Comparison with Other Insulin Regimens

• Lantus has been compared to other insulin regimens, including NPH insulin and premixed insulin analogues, and has been shown to have a more stable and predictable glucose-lowering effect 4, 5.
• A study comparing Lantus to metformin in patients with early type 2 diabetes found that Lantus provided better control of fasting plasma glucose and overall glucose load, and improved beta-cell function 6.
• Another study comparing Lantus to a premixed insulin analogue (Mix 75/25) found that Lantus was associated with a lower risk of hypoglycaemia, but a higher fasting blood glucose level 7.