II. Indications

  1. Type 1 Diabetes Mellitus
    1. Basal insulin for those not using an Insulin Pump (or for emergency use when Insulin Pump fails)
  2. Type 2 Diabetes Mellitus with Insulin Resistance refractory to non-Insulin therapy

III. Mechanism

  1. See Insulin

IV. Medications: Insulin Glargine U-100 (Lantus, Basaglar, Semglee, Rezvoglar)

  1. Insulin Glargine U-100 is the standard Insulin Glargine concentration (100 units/ml)
    1. Do not confuse with Insulin Glargine U-300 (3 fold higher concentration)
  2. Pharmacokinetics
    1. Most closely matches 24 hour coverage
    2. Onset: 1-2 hours
    3. Duration: 21 to 24 hours
    4. Peak: No peak (flat action curve mimics continuous Insulin Infusion)
  3. Several products are considered biosimilar and interchangeable with Lantus
    1. Allows pharmacists to auto-substitute less expensive formulations for Lantus
    2. Semglee (Glargine-yfgn U-100) is considered an interchangeable biosimilar as of 2021 in U.S.
    3. Rezvoglar (Glargine-aglr) is considered an interchangeable biosimilar
    4. However, Basaglar is not considered a biosimilar (cannot be auto-substituted)
    5. (2021) Presc Lett 28(9): 51
    6. (2025) Presc Lett 32(1):2-3

V. Dosing: Insulin Glargine (Lantus)

  1. See Insulin Dosing
  2. See Insulin Dosing in Type I Diabetes
  3. See Insulin Dosing in Type II Diabetes
  4. Insulin Glargine is injected subcutaneously (SQ)
  5. Typical daily dosing
    1. Basal insulins are injected subcutaneously (SQ)
    2. Total daily Insulin
      1. Type 1 Diabetes: 0.3 to 0.5 units/kg (up to 0.5 to 1.0 units/kg in children)
      2. Type 2 Diabetes: 1 to 1.5 units/kg
    3. Basal insulin dose
      1. Give 50% in Type 2 DM (30% in Type 1 DM) of total daily dose as Basal insulin once daily SQ
      2. Give remaining 50% of total Insulin daily units as Bolus Insulin divided over 3 meals
        1. In type 2 diabetes, Basal insulin is often started without Bolus Insulin
  6. Starting dose in Type 2 Diabetes Mellitus (no prior Insulin)
    1. Hemoglobin A1C <8%: 0.1 units/kg
    2. Hemoglobin A1C >8-10%: 0.2 units/kg
    3. Hemoglobin A1C >10%: 0.3 units/kg
  7. Common starting dose (use units/kg as above instead)
    1. Type I Diabetes: 10 Units at bedtime
    2. Type II Diabetes: 10-14 Units at bedtime
  8. Conversion from other Long-Acting Insulin
    1. NPH/ultralente at bedtime: start Lantus at same dose
      1. Consider starting Lantus at 80% of prior NPH dose
    2. NPH twice daily: Start Lantus at 80% of total daily NPH dose
  9. Adjustment based on Fasting plasma Glucose (FPG)
    1. Typical adjustment is 1 to 2 units (or 5 to 10%) once to twice weekly
    2. Protocol 1
      1. FPG <70 mg/dl for 3 days: Decrease Lantus 1-2 units
      2. FPG 140-250 for 3 days: Increase Lantus 2-4 units
      3. FPG >250 for 3 days: Increase Lantus 4-8 units
    3. Protocol 2
      1. FPG <80 for 3 days: Decrease Lantus by 2 units
      2. FPG 100-120 for 3 days: Increase Lantus by 2 units
      3. FPG 120-140 for 3 days: Increase Lantus by 4 units
      4. FPG 140-180 for 3 days: Increase Lantus by 6 units
      5. FPG >180 for 3 days: Increase Lantus by 8 units
  10. Timing of dose for Lantus
    1. Studies gave Lantus at bedtime to avoid confusion
    2. Lantus is most effective if given in the morning
    3. May require divided dosing twice daily to maintain basal rate (21 to 24 hour duration)

VI. Adverse Effects

  1. See Insulin
  2. Less nocturnal Hypoglycemia than other Insulins
  3. Lower post-prandial Glucose

VII. Safety

  1. Insulin is considered safe in pregnancy and Lactation

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Related Studies

Cost: Medications

insulin glargine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
INSULIN GLARGINE 100 UNIT/ML VIAL Generic $10.88 per ml
INSULIN GLARGINE SOLOSTAR U100 Generic $10.87 per ml
INSULIN GLARGINE-YFGN U100 PEN Generic $9.50 per ml
INSULIN GLARGINE-YFGN U100 VL Generic $9.49 per ml
lantus (on 4/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LANTUS 100 UNIT/ML VIAL $27.23 per ml
LANTUS SOLOSTAR 100 UNIT/ML $27.23 per ml
basaglar (on 2/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
BASAGLAR 100 UNIT/ML KWIKPEN $20.93 per ml
BASAGLAR TEMPO PEN 100 UNIT/ML $20.93 per ml
semglee (on 3/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
SEMGLEE (YFGN) 100 UNIT/ML PEN $25.86 per ml
SEMGLEE (YFGN) 100 UNIT/ML VL $25.83 per ml

Ontology: Lantus (C0876064)

Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116)
MSH C106526
English Lantus, lantus

Ontology: Insulin Glargine (C0907402)

Definition (NCI) A recombinant human insulin analog with long-acting, blood glucose-lowering activity. Insulin glargine, like regular types of human insulin, regulates glucose metabolism by binding to insulin receptors on muscle and fat cells, thereby facilitating the cellular uptake of glucose. This lowers blood glucose levels. At the same time, insulin glargine inhibits the liver's conversion of stored glycogen into glucose, which also contributes to lower blood glucose levels. Insulin glargine also inhibits lipolysis in adipose tissue, inhibits proteolysis, and enhances protein synthesis. (NCI05)
Definition (NCI_NCI-GLOSS) A drug used to control the amount of sugar in the blood of patients with diabetes. It is a form of the hormone insulin that is made in the laboratory. Insulin glargine controls blood sugar longer than insulin does. It is a type of therapeutic insulin.
Concepts Pharmacologic Substance (T121) , Amino Acid, Peptide, or Protein (T116) , Hormone (T125)
MSH C106526
SnomedCT 126212009, 126207008, 411529005
English A21-Gly-B31-Arg-B32-Arg-insulin, Insulin Glargine,Hum.Rec.Anlog, insulin, Gly(A21)-Arg(B31,B32)-, insulin, glycyl(A21)-arginyl(B31,B32)-, insulin glargine, Insulin Glargine, Insulin glargine preparation, Insulin Glargine Recombinant, INSULIN GLARGINE, glargine [Chemical/Ingredient], glargine insulin, insulin glargine human, glargine, Insulin glargine (product), insulin glargine recombinant, Insulin glargine product (product), Insulin glargine product, Insulin glargine preparation (substance), Insulin glargine, Insulin glargine (substance), INSULIN,GLARGINE,HUMAN/rDNA
Spanish insulina glargina (producto), preparado de glargina insulínica (producto), preparado de glargina insulínica, glargina insulínica (producto), glargina insulínica, glargina insulínica (sustancia), preparado de glargina insulínica (sustancia), insulina glargina (sustancia), insulina glargina