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Type 1 Diabetes Mellitus
- Basal insulin for those not using an Insulin Pump (or for emergency use when Insulin Pump fails)
- Type 2 Diabetes Mellitus with Insulin Resistance refractory to non-Insulin therapy
- See Insulin
- Insulin Glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar)
- Insulin Glargine U-100 is the standard Insulin Glargine concentration (100 units/ml)
- Do not confuse with Insulin Glargine U-300 (3 fold higher concentration)
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Pharmacokinetics
- Most closely matches 24 hour coverage
- Onset: 1-2 hours
- Duration: 21 to 24 hours
- Peak: No peak (flat action curve mimics continuous Insulin Infusion)
- Several products are considered biosimilar and interchangeable with Lantus
- Allows pharmacists to auto-substitute less expensive formulations for Lantus
- Semglee (Glargine-yfgn U-100) is considered an interchangeable biosimilar as of 2021 in U.S.
- Rezvoglar (Glargine-aglr) is considered an interchangeable biosimilar
- However, Basaglar is not considered a biosimilar (cannot be auto-substituted)
- (2021) Presc Lett 28(9): 51
- (2025) Presc Lett 32(1):2-3
- Insulin Glargine (Lantus)
- See Insulin Dosing
- See Insulin Dosing in Type I Diabetes
- See Insulin Dosing in Type II Diabetes
- Insulin Glargine is injected subcutaneously (SQ)
- Typical daily dosing
- Basal insulins are injected subcutaneously (SQ)
- Total daily Insulin
- Type 1 Diabetes: 0.3 to 0.5 units/kg (up to 0.5 to 1.0 units/kg in children)
- Type 2 Diabetes: 1 to 1.5 units/kg
- Basal insulin dose
- Give 50% in Type 2 DM (30% in Type 1 DM) of total daily dose as Basal insulin once daily SQ
- Give remaining 50% of total Insulin daily units as Bolus Insulin divided over 3 meals
- In type 2 diabetes, Basal insulin is often started without Bolus Insulin
- Starting dose in Type 2 Diabetes Mellitus (no prior Insulin)
- Hemoglobin A1C <8%: 0.1 units/kg
- Hemoglobin A1C >8-10%: 0.2 units/kg
- Hemoglobin A1C >10%: 0.3 units/kg
- Common starting dose (use units/kg as above instead)
- Type I Diabetes: 10 Units at bedtime
- Type II Diabetes: 10-14 Units at bedtime
- Conversion from other Long-Acting Insulin
- NPH/ultralente at bedtime: start Lantus at same dose
- Consider starting Lantus at 80% of prior NPH dose
- NPH twice daily: Start Lantus at 80% of total daily NPH dose
- NPH/ultralente at bedtime: start Lantus at same dose
- Adjustment based on Fasting plasma Glucose (FPG)
- Typical adjustment is 1 to 2 units (or 5 to 10%) once to twice weekly
- Protocol 1
- FPG <70 mg/dl for 3 days: Decrease Lantus 1-2 units
- FPG 140-250 for 3 days: Increase Lantus 2-4 units
- FPG >250 for 3 days: Increase Lantus 4-8 units
- Protocol 2
- FPG <80 for 3 days: Decrease Lantus by 2 units
- FPG 100-120 for 3 days: Increase Lantus by 2 units
- FPG 120-140 for 3 days: Increase Lantus by 4 units
- FPG 140-180 for 3 days: Increase Lantus by 6 units
- FPG >180 for 3 days: Increase Lantus by 8 units
- Timing of dose for Lantus
- Studies gave Lantus at bedtime to avoid confusion
- Lantus is most effective if given in the morning
- May require divided dosing twice daily to maintain basal rate (21 to 24 hour duration)
- See Insulin
- Less nocturnal Hypoglycemia than other Insulins
- Lower post-prandial Glucose
- Insulin Glargine (Lantus, DailyMed)