Insulin Glargine Dosing Frequency
Insulin glargine is administered once daily at the same time each day. 1
Standard Dosing Schedule
- Administer insulin glargine subcutaneously once daily at any time of day, but at the same consistent time every day 1
- The once-daily dosing provides approximately 24 hours of basal insulin coverage without pronounced peaks 2, 3
- Patients can choose morning, evening, or any convenient time, but must maintain consistency 4
When Twice-Daily Dosing May Be Required
While once-daily administration is standard, specific clinical situations warrant twice-daily dosing:
- Type 1 diabetes patients with inadequate 24-hour coverage from once-daily dosing 5, 6
- Patients experiencing persistent nocturnal hypoglycemia with morning hyperglycemia despite dose titration 7
- Type 1 diabetes with high glycemic variability or refractory glycemic patterns 7
- Obese, insulin-resistant patients requiring high volumes of insulin (>0.5 units/kg/day) 4
The 2025 American Diabetes Association guidelines explicitly recognize that insulin glargine may require twice-daily dosing when once-daily administration fails to provide 24-hour coverage 7. However, twice-daily dosing should only be considered after proper once-daily dose titration has been attempted and failed 7.
Administration Guidelines
- Rotate injection sites within the same region (abdominal area, thigh, or deltoid) to reduce risk of lipodystrophy 1
- Do not administer intravenously, via insulin pump, or mix with other insulins 1
- For type 1 diabetes, insulin glargine must be used concomitantly with short-acting insulin at mealtimes 1
Common Pitfall to Avoid
Do not assume twice-daily dosing is needed simply because the total daily dose is high—the decision to split insulin glargine should be based on inadequate 24-hour coverage or specific glycemic patterns (such as morning hypoglycemia followed by evening hyperglycemia), not on reaching a particular dose number 7.