What is the recommended starting dose of Glargine (insulin glargine) for a 62kg patient with diabetes?

Glargine Dosing for a 62kg Patient

For a 62kg patient with type 2 diabetes, start with 10 units of insulin glargine once daily, or alternatively use 0.1-0.2 units/kg/day (6-12 units), administered at the same time each day. 1, 2

Initial Dosing Strategy

The FDA-approved starting dose for insulin-naive patients with type 2 diabetes is 0.2 units/kg or up to 10 units once daily, which translates to approximately 12 units for a 62kg patient using weight-based dosing, or the simpler fixed dose of 10 units. 2 However, the American Diabetes Association guidelines support a starting range of 0.1-0.2 units/kg/day, giving flexibility between 6-12 units for this patient. 1

Choosing Between Fixed and Weight-Based Dosing

• For patients with mild-to-moderate hyperglycemia (HbA1c <9%), start with the fixed dose of 10 units once daily. 1
• For patients with more severe hyperglycemia (HbA1c ≥9% or fasting glucose ≥300 mg/dL), consider the higher end of the weight-based range (0.2 units/kg = 12 units) or even 0.3-0.4 units/kg/day (19-25 units) as part of a basal-bolus regimen. 1

Dose Titration Protocol

Increase the dose by 2-4 units every 3 days until fasting blood glucose reaches 80-130 mg/dL. 1 The specific titration schedule depends on fasting glucose levels:

• If fasting glucose is 140-179 mg/dL: increase by 2 units every 3 days 1
• If fasting glucose is ≥180 mg/dL: increase by 4 units every 3 days 1
• If hypoglycemia occurs without clear cause: reduce the dose by 10-20% immediately 1

Alternative Weight-Based Titration

A user-friendly weight-based titration approach involves increasing the dose by 0.1 units/kg (approximately 6 units for this patient) daily until target is reached, which achieved faster glycemic control in hospitalized patients compared to traditional algorithms. 3 However, this more aggressive approach should be reserved for inpatient settings with close monitoring.

Critical Threshold: When to Stop Escalating Basal Insulin

When basal insulin exceeds 0.5 units/kg/day (31 units for a 62kg patient) and approaches 1.0 units/kg/day (62 units), add prandial insulin rather than continuing to escalate basal insulin alone. 1 This prevents "overbasalization," which causes:

• Bedtime-to-morning glucose differential ≥50 mg/dL 1
• Increased hypoglycemia risk 1
• High glucose variability 1
• Suboptimal glycemic control despite high basal doses 1

Foundation Therapy Requirements

Continue metformin at maximum tolerated dose (up to 2000-2500 mg daily) when initiating insulin glargine, unless contraindicated. 1 This combination provides superior glycemic control with reduced insulin requirements and less weight gain compared to insulin alone. 1

Administration Guidelines

• Administer subcutaneously once daily at the same time each day 2
• Inject into the abdominal area, thigh, or deltoid, rotating sites within the same region 2
• Do not dilute or mix with any other insulin or solution 2
• Do not administer intravenously or via insulin pump 2

Special Considerations for This Patient

If Patient Has Renal Impairment

For patients with eGFR <60 mL/min/1.73 m², consider a lower starting dose of approximately 0.11-0.12 units/kg/day (7 units for a 62kg patient). 4

If Patient Is Elderly (>65 years)

Use lower starting doses of 0.1-0.25 units/kg/day (6-16 units) to prevent hypoglycemia, particularly if oral intake is poor. 1

If Patient Is Overweight/Obese

A higher starting dose of 0.3 units/kg/day (19 units for a 62kg patient) is safe and achieves glycemic targets faster without increased hypoglycemia risk. 5 This approach reduced time to reach fasting glucose targets by approximately 1 week compared to standard dosing. 5

Monitoring Requirements

• Daily fasting blood glucose monitoring is essential during titration 1
• Assess adequacy of insulin dose at every clinical visit 1
• Check HbA1c every 3 months during intensive titration 1

Common Pitfalls to Avoid

• Never delay insulin initiation in patients not achieving glycemic goals with oral medications alone 1
• Never discontinue metformin when starting insulin unless contraindicated 1
• Never continue escalating basal insulin beyond 0.5-1.0 units/kg/day without addressing postprandial hyperglycemia with prandial insulin or GLP-1 receptor agonist 1
• Never use sliding scale insulin as monotherapy—it is explicitly condemned by all major diabetes guidelines 1