What is the proper way to write an order for a patient with diabetes requiring insulin therapy for Lantus (insulin glargine) 10 units subcutaneously once daily in the morning?

Lantus 10 Units Daily Order

Order: Lantus (insulin glargine) 10 units subcutaneously once daily in the morning at the same time each day.

Complete Order Components

Medication: Lantus (insulin glargine) 100 units/mL 1

Dose: 10 units 2, 3

Route: Subcutaneous 1

Frequency: Once daily 1

Timing: Every morning at the same time (patient should select a consistent time) 1

Injection sites: Rotate between abdominal area, thigh, or deltoid with each injection to reduce risk of lipodystrophy and localized cutaneous amyloidosis 1

Critical Administration Instructions

• Do NOT dilute or mix Lantus with any other insulin or solution 1
• Do NOT administer intravenously or via insulin pump 1
• Visually inspect for particulate matter and discoloration before each use; only use if clear and colorless 1
• Administer at the same time every day, though morning administration is as effective as bedtime dosing 4

Monitoring Requirements

• Check fasting blood glucose daily during titration phase 2, 3
• Increase frequency of blood glucose monitoring during initial weeks after starting therapy 1
• Target fasting plasma glucose: 80-130 mg/dL 2, 3

Titration Algorithm

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

Additional Prescriptions Needed

• Glucagon for emergency hypoglycemia treatment 2, 3
• Blood glucose meter and testing supplies 2, 3
• Sharps disposal container 2

Patient Education Requirements

• Proper injection technique and site rotation 3
• Recognition and treatment of hypoglycemia (treat with 15 grams fast-acting carbohydrate if blood glucose ≤70 mg/dL) 3
• Self-monitoring of blood glucose 3
• Insulin storage and handling 3
• Never share pens, needles, or syringes with others 1

Foundation Therapy

• Continue metformin unless contraindicated when initiating basal insulin 2, 3
• Consider continuing one additional non-insulin agent 2, 3

Critical Threshold Warning

When Lantus dose exceeds 0.5 units/kg/day (approximately 35-50 units for most adults) and glucose remains elevated, this signals need for prandial insulin coverage rather than further basal insulin escalation 2, 3. Signs of "overbasalization" include bedtime-to-morning glucose differential ≥50 mg/dL, hypoglycemia episodes, and high glucose variability 2, 3.