From the Guidelines
For an insulin-naive patient starting Lantus, the initial dose should be 10 units or 0.1 to 0.2 units/kg of body weight per day, with adjustments made by 10% to 15%, or 2 to 4 units, once or twice weekly until the fasting blood glucose target is met. This approach is based on the most recent guidelines, including those from the American Diabetes Association 1 and the 2023 standards of care in diabetes 1. The dose should be administered at the same time each day, typically at bedtime, though morning dosing is also acceptable as long as it's consistent.
When initiating Lantus, it's essential to consider the patient's weight and start with a dose that minimizes the risk of hypoglycemia. For example, a 70 kg person would start with approximately 7-14 units. After starting Lantus, blood glucose should be monitored regularly, ideally before meals and at bedtime, with dose adjustments made every 3-5 days based on these readings.
Some key points to consider when starting Lantus include:
- Starting with a low dose and gradually increasing it to minimize hypoglycemia risk
- Administering the dose at the same time each day for consistency
- Monitoring blood glucose levels regularly to adjust the dose as needed
- Considering the patient's weight and individual needs when determining the initial dose
- Being aware of the potential for hypoglycemia and taking steps to prevent it, such as adjusting the dose or timing of administration.
The most recent guidelines from 2023 suggest an initial dose of 4 units per day or 10% of basal, with adjustments made by lowering the basal dose by 4 units per day or 10% of basal dose 1. However, the approach of starting with 10 units or 0.1 to 0.2 units/kg of body weight per day remains a widely accepted and safe method for initiating Lantus therapy in insulin-naive patients.
From the Research
Insulin Naive Patients and Lantus Dosage
- The initial dosage of Lantus for insulin-naive patients is not explicitly stated in the provided studies, but we can look at the dosages used in the studies to get an idea.
- In the study 2, the patients were categorized into four groups depending on their HbA1c and insulin glargine dose at 24 weeks. The greatest reduction in HbA1c was observed in the group with HbA1c <7.0% and dose ≥8.5 U/day.
- The starting dose of insulin glargine in this study was significantly greater in the group with HbA1c <7.0% and dose ≥8.5 U/day (0.142 U/kg/day) compared to the group with HbA1c ≥7.0% and dose <8.5 U/day (0.086 U/kg/day).
- Another study 3 compared the initiation of insulin glargine in suboptimally controlled patients with type 2 diabetes in primary and secondary care settings in the UK. The study found that insulin glargine can be initiated and titrated as effectively in primary care as in secondary care.
Dosage Titration
- The study 2 suggests that appropriate starting dosage and subsequent dose adjustment are essential to achieve target HbA1c (<7%) and that the fasting plasma glucose (FPG) level should be decreased to be 110 mg/dL or below for this achievement.
- The study 4 found that a patient-managed insulin intensification strategy with insulin glargine and insulin glulisine provides similar glycemic control as a physician-managed strategy.
- The study 3 found that insulin glargine can be safely and effectively initiated in a diverse range of suboptimally controlled subjects with type 2 diabetes in both primary and secondary care settings in the UK.
Glycemic Control
- The study 5 found that Lantus group showed lower 24h mean blood glucose (24h MBG), 24h mean amplitude of glycemic excursion (24h MAGE), and lower 24h standard deviation of blood glucose (24h SDBG) than the Basalin group.
- The study 6 found that the initiation of treatment with insulin glargine using the basal-bolus regime in patients with previous insulin therapy resulted in a reduction in the incidence of hypoglycemic events, including severe hypoglycemia and severe nocturnal hypoglycemia, and improved metabolic control in patients with diabetes.