Colleague Recommended Methods for Starting Patients on LANTUS^®
(insulin glargine [Recombinant DNA origin] injection)

 

Once daily insulin glargine provides basal control of glycemia in type 1 and 2 diabetes without plasma insulin peaks. 

Insulin glargine is a recombinant human insulin analogue derived from a nonpathogenic strain of escherichia coli. Two modifications of human insulin result in a stable molecule, which is soluble in slightly acidic conditions (pH 4.0) and precipitates in the neutral pH of subcutaneous tissue. Thus, absorption of insulin glargine is delayed. Like a continuous subcutaneous insulin infusion, the analogue provides a fairly constant basal insulin supply for about 24 hours without plasma insulin peaks.

The question has been how do we change the patient on NPH, NPH/Reg mix, or NPH/Log mix to Lantus?  

Based on information gathered from endocrinologists and internal medicine specialists with significant experience in Lantus dosing, the following methodologies have emerged.  

1. For those patients who are replacing NPH on QD or BID therapy, they begin with an initial dose of glargine of 8-10 units at bedtime.  Then when the fasting blood sugars are checked after 3 days they increase or decrease the dosage dependent upon getting the patient to an average fasting blood glucose of 100mg/Dl.  The oral medication may need to be reduced, so PPBG blood sugars need to be monitored.

Sample Scale

If the FPG is 100-120mg/Dl.  They increase the evening dose of glargine by 2 units

If the FPG is 120-140mg/Dl.  They increase the evening dose of glargine by 4 units.

If the FPG is 140-180mg/Dl.  They increase the evening dose of glargine by 6 units.

If the FPG is >180mg/Dl.  They increase the evening dose of glargine by 8 units. 

They would leave the dose the same for 3 days and then evaluate.  

2. If the patient is on a mixed regimen then the Regular or Fast acting component would be injected at the same time as the previously dosed with the NPH. 

3. The practitioner multiplies the total NPH dose by .80 and gives that in one dose at bedtime. This dose is left consistent for 3 days and then adjusted by no more than 4 units every 3 days.

4. If the patient is on a mixed regimen then the Regular or Fast acting component would be injected at the same time as the previously dosed with the NPH.

These dosing ideas do not represent guidelines established by Aventis, the maker of LANTUS^® (insulin glargine [Recombinant DNA origin] injection). If you have any questions concerning the   manufacturer’s recommended dosage, please contact your local Aventis Rep or call Aventis Pharmaceuticals Inc.   1-800-981-2491

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