Recommended Lantus Dose for Procedure
For a patient on 20 units of Lantus undergoing EGD and colonoscopy, reduce the evening dose to 15 units (75% of usual dose) the night before the procedure. 1
Evidence-Based Dosing Recommendation
The American Diabetes Association guidelines specifically address perioperative basal insulin management and recommend a 25% dose reduction for long-acting insulin analogs given the evening before surgery to achieve target perioperative glucose levels while minimizing hypoglycemia risk. 1
Key Rationale
A recent study demonstrated that a 25% reduction in insulin dose given the evening before surgery was more likely to achieve perioperative blood glucose levels in the target range with decreased hypoglycemia risk compared to the usual insulin dose. 1
For longer-acting basal analogs like Lantus (insulin glargine), the timing does not need to change—continue the usual evening administration time. 1
The patient will be NPO (nothing by mouth) and undergoing bowel preparation, which significantly reduces carbohydrate intake and increases hypoglycemia risk if the full basal dose is administered. 1
Monitoring Requirements
Monitor blood glucose at least every 4-6 hours while NPO. 1
Dose with short-acting insulin as needed for hyperglycemia during the fasting period. 1
Target perioperative glucose range is 80-180 mg/dL (4.4-10.0 mmol/L), as tighter control does not improve outcomes and increases hypoglycemia risk. 1
Important Caveats
Do not withhold the basal insulin entirely—patients still require basal insulin coverage even when fasting, but at a reduced dose to account for decreased caloric intake. 1
The 60-80% dosing range mentioned in guidelines applies to situations where patients are completely NPO for extended periods; the 75% dose (25% reduction) is specifically supported by recent evidence for the evening before procedures. 1
Resume the usual 20-unit dose the evening after the procedure once the patient resumes normal eating. 1