Insulin Therapy with Novolog and Lantus

Basic Characteristics and Pharmacokinetics

The American College of Physicians recommends that Novolog should be administered immediately before meals to control postprandial glucose excursions, while Lantus is typically given once daily to provide background insulin coverage 1, 2
Lantus has approximately 24-hour duration of action, making it suitable for once-daily dosing 3

The American Diabetes Association suggests that basal insulin, such as Lantus, is used to provide background insulin coverage throughout the day and night, mainly to control blood glucose by suppressing hepatic glucose production between meals and during sleep 2
The American College of Physicians recommends that basal insulin, such as Lantus, is typically initiated at 10 units or 0.1 to 0.2 units/kg of body weight 1
The American College of Physicians also recommends that basal insulin, such as Lantus, is often used in combination with metformin and perhaps one additional non-insulin agent 1

The American College of Physicians recommends that when basal insulin, such as Lantus, has been titrated to appropriate fasting blood glucose levels but HbA1c remains above target, adding mealtime insulin, such as Novolog, should be considered to reduce postprandial glucose excursions 1

The American Diabetes Association suggests that for type 1 diabetes, both a basal insulin, such as Lantus, and mealtime insulin, such as Novolog, are typically required in a basal-bolus regimen 2
The American College of Physicians recommends that for type 2 diabetes, basal insulin, such as Lantus, is often started alone, potentially with oral medications, and mealtime insulin, such as Novolog, is added when basal insulin alone fails to achieve glycemic targets 1, 2, 4
The American Diabetes Association suggests that when initiating insulin therapy in type 2 diabetes, basal insulin is typically the first choice 2

The American College of Physicians recommends that in patients requiring intensification beyond basal insulin, adding Novolog before the largest meal or before all meals may be necessary 4
The American Diabetes Association suggests that optimal diabetes management often requires both types of insulin to achieve comprehensive glycemic control - Lantus for baseline insulin needs and Novolog for mealtime coverage 2, 4