From the Guidelines
Lantus (insulin glargine) for type 2 diabetes typically starts at 10 units once daily, usually at bedtime, and is adjusted based on fasting blood glucose levels. The dose is often increased by 2-4 units every 3-7 days until target blood glucose levels are reached, with most patients requiring between 20-80 units daily 1. Lantus should be injected subcutaneously at the same time each day, rotating injection sites between the abdomen, thigh, or upper arm to prevent lipohypertrophy. Blood glucose monitoring is essential when starting or adjusting Lantus, with target fasting glucose typically between 80-130 mg/dL. Hypoglycemia is the main risk, so patients should know its symptoms (shakiness, sweating, confusion) and keep fast-acting carbohydrates available. Some key points to consider when initiating insulin therapy include:
- Starting with a basal insulin regimen and adjusting as needed based on blood glucose levels
- Using a long-acting basal analog such as U-100 glargine or detemir instead of NPH insulin
- Considering the cost-effectiveness of different antihyperglycemic agents in a patient-centered approach to care
- Educating patients on self-monitoring of blood glucose, diet, and the avoidance of and appropriate treatment of hypoglycemia. Lantus works by providing a steady basal insulin level over 24 hours, addressing the liver's excess glucose production that occurs in type 2 diabetes. It's often prescribed when oral medications alone aren't sufficient to control blood glucose levels.
From the FDA Drug Label
- 3 Initiation of Insulin Glargine Therapy Recommended Starting Dosage in Patients with Type 2 Diabetes The recommended starting dosage of Insulin Glargine in patients with type 2 diabetes who are not currently treated with insulin is 0.2 units/kg or up to 10 units once daily.
The recommended starting dose of Lantus for type 2 diabetes is 0.2 units/kg or up to 10 units once daily 2.
From the Research
Lantus Dose for Type 2 Diabetes
- The optimal dose of Lantus (insulin glargine) for type 2 diabetes patients can be determined using a formula that takes into account the patient's weight and target HbA1c level 3.
- A starting dose of 0.15 U/kg/day is recommended, with adjustments made based on the patient's response to treatment 3.
- The dose can be titrated based on fasting blood glucose levels, with a target of <5.5 mmol/L (<100 mg/dL) 4.
- A simple titration regimen can be used, where the daily insulin dose is increased by 0-2,4, or 6-8 IU if the mean fasting plasma glucose over the previous 3 days is >or=5.6-<6.7, >or=6.7-<7.8, >or=7.8-<10.0 or >or=10 mmol/L (>or=100-<120, >or=120-<140, >or=140-<180, or >or=180 mg/dL), respectively, in the absence of plasma glucose <4.0 mmol/L (<72 mg/dL) 4.
- Patient-managed dose titration can be effective, with greater reductions in HbA1c compared to clinic-managed titration 4.
- The choice of titration algorithm may depend on clinical circumstances and the patient's willingness and ability to become more involved in their therapy management 4.
Comparison with Other Treatments
- Lantus has been compared to other treatments, such as biphasic insulin aspart and semaglutide, in terms of efficacy and safety 5, 6.
- Semaglutide has been shown to result in greater reductions in HbA1c and weight, with fewer hypoglycemic episodes, compared to Lantus 6.
- A systematic review and network meta-analysis found that self-titration at least twice a week with healthcare provider support leads to superior HbA1c reduction, without increasing the risk of severe hypoglycemia, compared to other strategies 7.