Should Lantus Be Held at Blood Glucose 95 mg/dL?
No, Lantus should not be held when blood glucose is 95 mg/dL—this is a normal fasting glucose level and basal insulin should be administered as scheduled. 1, 2, 3
Understanding Basal Insulin Function
Basal insulin like Lantus provides continuous background insulin coverage over 24 hours to suppress hepatic glucose production between meals and overnight 2, 3. The FDA label specifies that Lantus should be administered "once daily at any time of day but at the same time every day" 4. Skipping scheduled basal insulin doses leads to unstable blood glucose control and rebound hyperglycemia 3.
When to Actually Hold or Reduce Lantus
The critical threshold for concern is blood glucose below 100 mg/dL, not 95 mg/dL:
- Reassess the insulin regimen when blood glucose falls below 100 mg/dL (5.6 mmol/L), as this predicts hypoglycemia risk within 24 hours 1, 5
- Modify the regimen when blood glucose is <70 mg/dL (3.9 mmol/L), unless easily explained by factors like a missed meal 1, 5
- Reduce the dose by 10-20% immediately if hypoglycemia occurs without clear cause 1, 2
At 95 mg/dL, the patient is safely above these thresholds and within the target fasting glucose range of 80-130 mg/dL recommended by the American Diabetes Association 1, 2.
Clinical Context Matters
For hospitalized patients, guidelines recommend reassessing insulin when glucose falls below 100 mg/dL, but modification is only required at <70 mg/dL 1, 5. The basal-plus approach is preferred for patients with poor oral intake, using lower doses (0.1-0.25 units/kg/day) for high-risk patients 1, 5.
For outpatients, maintaining consistent basal insulin administration is crucial for stable glycemic control 3. The American Diabetes Association recommends titrating Lantus by 2-4 units every 3 days based on fasting glucose patterns, not holding doses for normal values 1, 2.
Common Pitfall to Avoid
Do not confuse basal insulin management with correction insulin. Basal insulin addresses baseline glucose control and should be given consistently, while correction (sliding scale) insulin addresses acute hyperglycemic excursions 2. Holding Lantus at 95 mg/dL represents a fundamental misunderstanding of basal insulin physiology and will result in deteriorating glycemic control 3.
If the patient experiences glucose <100 mg/dL repeatedly, the appropriate response is to reduce the Lantus dose by 2 units at the next scheduled administration, not to skip doses 2.