Insulin Glargine Dosing Guidelines

Initial Dosing Recommendations

For insulin-naive patients with type 2 diabetes, the American Diabetes Association recommends starting insulin glargine at 10 units once daily or 0.1-0.2 units/kg body weight, administered subcutaneously at the same time each day 1
Total daily insulin typically ranges from 0.4-1.0 units/kg/day, with 0.5 units/kg/day being standard for metabolically stable patients 1, 2
The American College of Endocrinology suggests distributing insulin as 40-60% basal insulin (glargine) and 40-60% prandial insulin 1, 2

The American Association of Clinical Endocrinologists recommends increasing insulin glargine by 2-4 units every 3 days until fasting blood glucose reaches 80-130 mg/dL 1
If fasting glucose is 140-179 mg/dL, increase by 2 units every 3 days 1
If fasting glucose is ≥180 mg/dL, increase by 4 units every 3 days 1
If hypoglycemia occurs without clear cause, reduce dose by 10-20% immediately 1

For high-risk patients, such as the elderly (>65 years), renal failure, or poor oral intake, the American Geriatrics Society recommends starting with lower doses of 0.1-0.25 units/kg/day 1
For hospitalized patients on high-dose home insulin (≥0.6 units/kg/day), reduce total daily dose by 20% upon admission 1
During puberty, insulin requirements may increase up to 1.5 units/kg/day 2, 3
In patients with renal impairment, such as CKD Stage 5, reduce total daily insulin by 50% for type 2 diabetes and 35-40% for type 1 diabetes 1

The American Diabetes Association recommends treating any glucose <70 mg/dL immediately with 15 grams of fast-acting carbohydrate, recheck in 15 minutes, and repeat if needed 1
All insulin-requiring patients should carry at least 15g carbohydrate 4
If hypoglycemia occurs, determine the cause and reduce dose by 10-20% 1

Toujeo (U-300 glargine) provides longer duration of action with lower hypoglycemia rates than U-100 glargine 3
Requires approximately 10-18% higher daily doses compared to U-100 glargine 1