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Insulin Glargine Dosage

Applies to the following strength(s): 300 units/mL ; 100 units/mL

The information at Drugs.com is not a substitute for medical advice. ALWAYS consult your doctor or pharmacist.

Usual Adult Dose for:

Usual Geriatric Dose for:

Usual Pediatric Dose for:

Additional dosage information:

Usual Adult Dose for Diabetes Type 1

Dose should be individualized based on clinical response; this basal insulin should be used in regimens with short-acting insulin
Initial dose: One-third to one-half the total daily insulin requirement subcutaneously once a day
Maintenance dose: Dose should be adjusted according to metabolic needs, blood glucose measurements, and glycemic goals

U-300:
-Metabolic needs during the first 24 hours may not be fully covered with the first U-300 dose; monitor closely
-Dose titration should occur no more frequently than every 3 to 4 days due to the longer time for U-300 to achieve steady-state
Maximum dose: 80 units per 1 injection

Conversion of U-100 to U-300: Initial dose should be the same, however for patients controlled on U-100, expect a higher daily dose of U-300 to maintain the same level of glycemic control.

Conversion of NPH insulin to insulin glargine:
-From ONCE-DAILY NPH insulin: Initial insulin glargine dose should be the same dose of NPH that is being discontinued
-From TWICE-DAILY NPH insulin: Initial insulin glargine dose should be 80% of the total NPH dose that is being discontinued

Comments:
-The initial total daily insulin requirement in insulin naive patients is generally 0.2 to 0.4 units of insulin per kilogram of body weight.
-When changing treatment regimens, the dose and frequency of short-acting insulin may need to be adjusted.
-To minimize hypoglycemia, closely monitor blood glucose, especially with changing regimens.
-During clinical trials, patients treated with U-300 used 17.5% more basal insulin than patients treated with U-100.

Use: To improve glycemic control in patients with type 1 diabetes mellitus.

Usual Adult Dose for Diabetes Type 2

Dose should be individualized based on clinical response

Insulin-naive:
Initial dose: 10 units or 0.2 units/kg subcutaneously once a day
Maintenance dose: Dose should be adjusted according to metabolic needs, blood glucose measurements, and glycemic goals

U-300:
-Metabolic needs during the first 24 hours may not be fully covered with the first U-300 dose; monitor closely
-Dose titration should occur no more frequently than every 3 to 4 days due to the longer time for U-300 to achieve steady-state
Maximum dose: 80 units per 1 injection

Conversion of U-100 to U-300: Initial dose should be the same, however for patients controlled on U-100, expect a higher daily dose of U-300 to maintain the same level of glycemic control.

Conversion of NPH insulin to insulin glargine:
-From ONCE-DAILY NPH insulin: Initial insulin glargine dose should be the same dose of NPH that is being discontinued
-From TWICE-DAILY NPH insulin: Initial insulin glargine dose should be 80% of the total NPH dose that is being discontinued

Comments:
-When changing treatment regimens, the dose and frequency of short-acting insulins and doses of any oral anti-diabetic drugs may need to be adjusted.
-To minimize hypoglycemia, closely monitor blood glucose, especially with changing regimens.
-During clinical trials, patients treated with U-300 used 11% to 15% more basal insulin than patients treated with U-100.

Use: To improve glycemic control in patients with type 2 diabetes mellitus.

Usual Geriatric Dose for Diabetes Type 2

Initial dosing, dose increments, and maintenance dosage should be conservative to avoid hypoglycemic reactions.

Usual Geriatric Dose for Diabetes Type 1

Initial dosing, dose increments, and maintenance dosage should be conservative to avoid hypoglycemic reactions.

Usual Pediatric Dose for Diabetes Type 1

U-100: Age: 6 years or older:
-Dose should be individualized based on clinical response; this basal insulin should be used in regimens with short-acting insulin

Initial dose: One-third total daily insulin requirement subcutaneously once a day
Maintenance dose: Dose should be adjusted according to metabolic needs, blood glucose measurements, and glycemic goals

Conversion of NPH insulin to insulin glargine:
-From ONCE-DAILY NPH insulin: Initial insulin glargine dose should be the same dose of NPH that is being discontinued
-From TWICE-DAILY NPH insulin: Initial insulin glargine dose should be 80% of the total NPH dose that is being discontinued

Comments:
-The initial total daily insulin requirement in insulin naive patients is generally 0.2 to 0.4 units of insulin per kilogram of body weight.
-When changing treatment regimens, the dose and frequency of short-acting insulin may need to be adjusted.
-To minimize hypoglycemia, closely monitor blood glucose, especially with changing regimens.

Use: To improve glycemic control in pediatric patients 6 years or older with type 1 diabetes mellitus.

Renal Dose Adjustments

Use with caution; frequent glucose monitoring and insulin dose reduction may be required

Liver Dose Adjustments

Use with caution; frequent glucose monitoring and insulin dose reduction may be required

Dose Adjustments

-Daily insulin requirements may be higher during illness, stress, pregnancy, in obese patients, trauma, during concurrent use with medications having hyperglycemic effects, or after surgery
-Daily insulin requirements may be lower with exercise, weight loss, calorie restricted diets, or during concurrent use of medications having hypoglycemic effects.

Supplemental doses may be prescribed during illness
Patients with type 2 diabetes receiving oral medications may be switched to insulin therapy temporarily.

Dosage adjustments may be required when the brand, type, or species of insulin is changed; oral antidiabetic treatment may need to be adjusted as well.

Precautions

U-100: Safety and efficacy have not been established in patients with type 1 diabetes younger than 6 years and has not been studied in pediatric patients with type 2 diabetes.

U-300: Safety and efficacy have not been established in patients younger than 18 years.

Consult WARNINGS section for additional precautions.

Dialysis

Data not available

Other Comments

Administration advice:
-Give subcutaneously once a day at any time of day, but at the same time every day
-Rotate injection sites within the same region (abdomen, thigh, or deltoid) to reduce the risk of lipodystrophy

-Never share an insulin pen between patients, even if the needle is changed; do not reuse or share needles or syringes between patients.
-There are 2 concentrations of insulin glargine; the dose counter on the U-300 pen shows the number of units to be injected.
-Do not dilute or mix with any other insulin or solution
-Do not administer via an insulin pump; do not administer IV or IM

Storage requirements:
-Unopened: Store in refrigerator 2C to 8C (36F to 46F), do not freeze, discard if frozen
-Opened (in-use): May keep unrefrigerated for up to 28 days after opening; keep away from direct heat and light; temperature should not exceed 30C (86F); discard 28 days after opening.

General:
-This drug is not recommended for the treatment of diabetic ketoacidosis; IV short-acting insulin is the preferred treatment for this condition.
-Insulin requirements may be altered during stress, major illness, or with changes in exercise, meal patterns, or coadministered drugs.
-Hypoglycemia is the most common adverse reaction of insulin therapy; the timing generally reflects the time-action profile of the administered insulin.

Monitoring:
-Blood glucose monitoring is essential for all patients receiving insulin therapy, more frequent monitoring is recommended when insulin regimens are being adjusted.
-Monitor potassium levels in patients at risk for hypokalemia.
-Monitor for signs and symptoms of heart failure in patients receiving concomitant thiazolidinediones.
-Urine ketone testing is recommended for patients with type I diabetes if they develop symptoms of colds, influenza, nausea, vomiting, or other illnesses, polyuria, or if blood glucose levels are unexpectedly high or inconsistent.
-Glycosylated hemoglobin measurements are recommended every 3 months.

Patient advice:
-Patients should be advised to never share an insulin pen with another person, even if the needle is changed; patients should understand that sharing needles or syringes with another person carries a risk for transmission of blood-borne pathogens.
-Patients should be instructed on glucose monitoring, proper injection technique, and the management of hypoglycemia and hyperglycemia.
-Patients should be instructed on how to handle situations which may affect their insulin requirements.
-Remind patients to check insulin labels before injection to avoid medication errors.
-Patients should check blood sugar prior to driving a car or operating machinery.
-Advise patient to speak to physician or health care professional if pregnant or if they intend to become pregnant.

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