Lantus Dose Adjustment Guidelines
Standard Titration Protocol
Increase Lantus by 2 units every 3 days if fasting glucose is 140-179 mg/dL, or by 4 units every 3 days if fasting glucose is ≥180 mg/dL, until you reach a target fasting glucose of 80-130 mg/dL. 1, 2, 3
Specific Titration Algorithm
Based on Fasting Glucose Values Over One Week:
If 50% or more of fasting glucose values exceed your goal: Increase by 2 units 1
If fasting glucose is 140-179 mg/dL: Increase by 2 units every 3 days 1, 2, 3
If fasting glucose is ≥180 mg/dL: Increase by 4 units every 3 days 1, 2, 3
If more than 2 fasting values per week are <80 mg/dL: Decrease by 2 units 1, 3
Alternative Titration Approach:
- Increase by 10-15% of current dose once or twice weekly until fasting blood glucose target is met 2
Critical Threshold to Recognize
Stop escalating basal insulin when your dose exceeds 0.5 units/kg/day. At this point, you should add prandial (mealtime) insulin rather than continuing to increase Lantus alone. 1, 2, 3 Continuing to increase basal insulin beyond 0.5-1.0 units/kg/day without addressing postprandial hyperglycemia leads to "overbasalization"—a dangerous pattern characterized by hypoglycemia, high glucose variability, and a bedtime-to-morning glucose differential ≥50 mg/dL. 2, 3
Monitoring Requirements
- Check fasting glucose daily during active titration 1, 3
- Reassess every 3 days during active dose adjustments 2, 3
- Reassess every 3-6 months once stable 2, 3
Special Considerations for Older Adults
For older adults with diabetes, the same 2-unit increment applies, but fasting glucose goals may be adjusted to 90-150 mg/dL based on overall health status and goals of care. 1
Common Pitfalls to Avoid
Do not wait longer than 3 days between adjustments in stable patients—this unnecessarily prolongs time to glycemic targets 2
Do not continue increasing Lantus indefinitely if postprandial glucose remains elevated—this indicates need for prandial insulin, not more basal insulin 2, 3
If hypoglycemia occurs without clear cause, immediately reduce the dose by 10-20% 2, 3