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Guidelines for Using Insulin Glargine (Lantus®) for

Hospitalized Patients with Diabetes Mellitus (DM)

 

1.  Indications for Insulin Glargine in Type 1 Diabetes:

  • Patient taking multiple daily doses of other insulin with glycosylated hemoglobin results over 7%
  • Patient taking NPH or Lente insulin and having problems with hypoglycemia from the insulin peak effects
  • Patient who desire some flexibility with meal times and daily schedules in general

 

2.  Indications for Insulin Glargine in Type 2 Diabetes:

  • Patients on maximum recommended doses of combined oral diabetes agents with glycosylated hemoglobin over 7%
  • Patients on monotherapy who are not candidates for combined oral diabetes agents with glycosylated hemoglobin over 7%

 

3.  Initiation of Insulin Glargine in Type 1 Diabetes:

  • Request insulin administration education for the patient/family as soon as home insulin therapy is an identified need; a Diabetes Education Consult can be requested via MIS Monday through Friday
  • Page the Endocrine Fellow-on-call (PIC 1676) for questions related to glargine initiation
  • Step 1:  calculate the total daily insulin dose required by the patient and give half of that amount as glargine*; use an average fasting blood glucose goal of  less than 150 mg/dl as a guide for adjusting the glargine dose
  • Step 2:  if patient is eating full meals, meal insulin is indicated:
    • divide half of the total daily dose by 3 and give that amount as fast-acting insulin (Regular or Humalog) before each meal
    • the amount of fast-acting insulin can be adjusted according to premeal blood glucose
    • hold the fast-acting insulin if the patient is NPO

 

4.  Initiation of Insulin Glargine in Type 2 Diabetes:

  • Request insulin administration education for the patient/family as soon as home insulin therapy is an identified need; a diabetes education consult can be requested via MIS Monday through Friday
  • Page the Endocrine Fellow-on-call (PIC 1676) for questions related to glargine initiation
  • Step 1:  calculate the total daily insulin dose required by the patient and give half of that amount as glargine*; use an average fasting blood glucose goal of  less than 150 mg/dl as a guide for adjusting the glargine dose
  • Step 2:   if patient is eating full meals, additional glucose-lowering agents may be indicated:
    • patient may require oral diabetes agent(s) during the day to manage blood glucose
    • patient may require fast-acting insulin (Regular or Humalog) during the day before meals to manage blood glucose
    • the amount of fast-acting insulin can be adjusted according to premeal blood glucose
    • hold the oral agent(s) or fast-acting insulin if the patient is NPO

 

 

*  Glargine can be given any time of day but is most often prescribed at bedtime

** Regular insulin should be given 30 minutes before meals; Humalog should be given       immediately prior to or immediately after a meal

 

 

 

 

 

Developed November 2004

Diabetes Inpatient Team