Insulin Conversion Guidelines
Standard Conversion Protocol
- The American Diabetes Association recommends converting the total daily dose of Levemir to Lantus on a 1:1 unit basis and administering once daily for most patients, but reduce the converted dose by 10-20% for patients at high risk of hypoglycemia or those previously on twice-daily Levemir 1
- For patients on once-daily Levemir, calculate the total daily Levemir dose and convert unit-for-unit to once-daily Lantus 1
- For patients on twice-daily Levemir, sum both daily doses of Levemir, then reduce by 10-20% when converting to once-daily Lantus due to differences in dosing requirements between the two insulins 1
High-Risk Patient Modifications
- Reduce the converted dose by 10-20% for elderly patients (>65 years), patients with renal impairment, history of severe hypoglycemia, and poor oral intake or acute illness 2
Post-Conversion Monitoring Requirements
- Daily fasting blood glucose monitoring is essential during the first 1-2 weeks after conversion to assess adequacy of the new dose, with dose adjustments every 3 days based on fasting glucose values, targeting 80-130 mg/dL 1
- If fasting glucose is 140-179 mg/dL, increase the dose by 2 units every 3 days 2
- If fasting glucose is ≥180 mg/dL, increase the dose by 4 units every 3 days 2
- If hypoglycemia occurs, reduce the dose immediately by 10-20% and reassess the conversion 1
Critical Timing Considerations
- Administer Lantus at the same time each day, typically with the evening meal or at bedtime 2