What is the optimal time to administer insulin glargine (Insulin Glargine)?

From the Guidelines

Insulin glargine should be administered at bedtime for optimal glycemic control.

Administration Timing

• The optimal time to administer insulin glargine is typically at bedtime, although administration at other times of the day may result in similar levels of coverage and glycemic control 1.
• Once daily administration of glargine is recommended, with a duration of action of 20-24 hours 1.

Dosage and Considerations

• The typical dose of glargine is 16 to 24 units once daily 1.
• In some patients, glargine may not last 24 hours, and dividing the dose into two daily injections may be necessary 1.
• Glargine has been approved for use in pediatric patients 6 years of age and older 1.

Benefits of Bedtime Administration

• Bedtime administration of glargine helps to maintain stable blood glucose levels during the night and between short-acting insulin doses 1.
• Glargine's peakless action profile reduces the risk of hypoglycemia compared to intermediate-acting insulins 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 optimal time to administer insulin glargine is once daily at the same time every day, but it can be given at any time of day.

• The key consideration is to administer it at the same time every day to maintain a consistent therapeutic effect.
• This allows for flexibility in the timing of administration, while also ensuring that the patient receives a consistent dose of insulin glargine each day 2.

From the Research

Optimal Time to Administer Insulin Glargine

The optimal time to administer insulin glargine is a topic of interest in the management of diabetes. Several studies have investigated the effects of administering insulin glargine at different times of the day.

• Insulin glargine can be administered at any time of day, but its pharmacodynamics differ depending on the time of administration 3.
• A study found that administering insulin glargine in the evening resulted in lower glucose infusion rates in the first 12 hours, while morning administration resulted in lower glucose infusion rates in the second 12 hours 3.
• Another study suggested that administering insulin glargine at bedtime may lead to hyperglycemia in the early part of the night, which can be improved by giving insulin glargine at lunchtime or dinnertime 4.
• A case report found that a twice-daily regimen of insulin glargine was effective in resolving morning hypoglycemia in a patient with type 2 diabetes 5.
• A pooled analysis of two prospective observational studies found that iGlarLixi (insulin glargine 100 U/mL plus lixisenatide) was effective and safe regardless of its daily administration time, but pre-breakfast injection resulted in more effective glycemic control 6.

Administration Timing and Glycemic Control

The timing of insulin glargine administration can affect glycemic control.

• A study found that pre-breakfast injection of iGlarLixi resulted in a numerically greater reduction in HbA1c levels compared to pre-lunch, pre-dinner, or changed injection time 6.
• Another study found that administering insulin glargine at lunchtime or dinnertime resulted in improved blood glucose control compared to bedtime administration 4.
• The pharmacokinetics and pharmacodynamics of insulin glargine are similar regardless of the time of administration, but the impact of circadian changes in insulin sensitivity can affect glycemic control 3.

Clinical Implications

The optimal time to administer insulin glargine may vary depending on individual patient factors, such as lifestyle and meal times.

• Healthcare providers should consider the timing of insulin glargine administration when developing treatment plans for patients with diabetes 7, 3, 5, 6, 4.
• Further research is needed to fully understand the effects of insulin glargine administration timing on glycemic control and patient outcomes.