When to withhold insulin glargine (Lantus)?

From the Guidelines

Insulin glargine (Lantus) should be withheld in cases of overbasalization, which can be identified by clinical signals such as high bedtime-to-morning or preprandial-to-postprandial glucose differential (e.g., bedtime-to-morning glucose differential $50 mg/dL [$2.8 mmol/L]), hypoglycemia (aware or unaware), and high glucose variability 1.

Key Considerations

• Basal dose exceeding 0.5 units/kg/day is a sign of potential overbasalization, and a thorough reevaluation of the glucose-lowering treatment plan should occur promptly 1.
• Simplification of the insulin regimen may be necessary in older adults with type 2 diabetes, especially when the current regimen is beyond their self-management abilities, to reduce hypoglycemia and disease-related distress without worsening glycemic control 1.
• In stable patients, the focus should be on preventing hypoglycemia and managing hyperglycemia, while in patients with organ failure, preventing hypoglycemia is of greatest significance, and in dying patients, discontinuation of all medications may be a reasonable approach for those with type 2 diabetes 1.

Clinical Decision-Making

When evaluating the need to withhold insulin glargine, clinicians should consider the individual's overall clinical picture, including their glucose monitoring data, hypoglycemia risk, and self-management abilities. By taking a patient-centered approach and carefully assessing these factors, clinicians can make informed decisions about when to withhold insulin glargine and adjust the treatment plan accordingly.

From the FDA Drug Label

Do not use Insulin Glargine if you: are having an episode of low blood sugar (hypoglycemia) have an allergy to insulin glargine or any of the ingredients in Insulin Glargine.

Insulin glargine (Lantus) should be withheld in the following situations:

• Hypoglycemia: If the patient is having an episode of low blood sugar.
• Allergy: If the patient has a known allergy to insulin glargine or any of the ingredients in Insulin Glargine 2.

From the Research

When to Withhold Insulin Glargine (Lantus)

There are several scenarios where insulin glargine may need to be withheld or its administration adjusted:

• Hypoglycemia: Insulin glargine should be withheld or its dose adjusted if the patient is experiencing hypoglycemia, particularly nocturnal hypoglycemia 3.
• Changing treatment regimens: When changing from one insulin regimen to another, insulin glargine may need to be withheld or its dose adjusted to prevent hypoglycemia or hyperglycemia 4, 5.
• Pregnancy: Although insulin glargine is used in pregnant diabetic women, there is no definitive study to confirm its benefits, and its use should be carefully monitored 4.
• Concomitant use with other insulins: Insulin glargine should not be mixed with other insulins in the same syringe, as it may coprecipitate with supplementary short-acting insulins 4.
• Dose titration: Insulin glargine dose may need to be adjusted based on the patient's blood glucose levels, and withholding or reducing the dose may be necessary to prevent hypoglycemia 5, 6.
• Switching to a twice-daily regimen: In some cases, switching to a twice-daily regimen of insulin glargine may be necessary to achieve better glycemic control or to prevent hypoglycemia 3.