Maximum Daily Dose of Lantus (Insulin Glargine)

Typical Dosing Ranges by Diabetes Type

The American College of Physicians recommends initial dosing of Lantus starting at 10 units or 0.1-0.2 units/kg once daily for type 2 diabetes patients 2, 1
For type 1 diabetes patients, total daily insulin requirements typically range from 0.4 to 1.0 units/kg/day, with approximately 50% given as basal insulin (Lantus) 1
The American Diabetes Association suggests that for a metabolically stable type 1 diabetes patient, 0.5 units/kg/day is typical for total insulin, meaning basal insulin would be approximately 0.25 units/kg/day 1

The American College of Physicians indicates that U-500 regular insulin is indicated for patients requiring more than 200 units of insulin per day 2
Obese, insulin-resistant patients may require very high volumes of insulin and may benefit from twice-daily Lantus administration or concentrated insulin formulations 2

The American Association of Clinical Endocrinologists recommends that once basal insulin dose exceeds 0.5 units/kg/day, addition of prandial insulin may be more appropriate than further basal insulin increases 1
If basal insulin has been titrated to acceptable fasting glucose (or dose >0.5 units/kg/day) and HbA1c remains above target, combination injectable therapy should be considered 2

The American Diabetes Association suggests increasing the dose by 10-15% or 2-4 units once or twice weekly until fasting blood glucose target is met 2, 1
For fasting glucose ≥180 mg/dL, increase by 4 units every 3 days 1
Target fasting glucose: 80-130 mg/dL (4.4-7.2 mmol/L) 1

The Endocrine Society recommends that daily self-monitoring of fasting blood glucose is essential during titration 1
Reassess every 3 days during active titration and every 3-6 months once stable 1
Continuing to escalate basal insulin beyond 0.5-1.0 units/kg/day without addressing postprandial hyperglycemia leads to suboptimal control and increased hypoglycemia risk 1
If hypoglycemia occurs, determine the cause and reduce the dose by 10-20% 1
If >2 fasting values/week are <80 mg/dL, decrease dose by 2 units 3