Lantus Regret, Stopping, and Restarting: What Real Patients and Clinicians Say

What the Lantus label says about changing a regimen

The label states that changes to an insulin regimen, including insulin strength, manufacturer, type, injection site or method of administration, may affect glycemic control and predispose to hypoglycemia or hyperglycemia [1]. It says these changes should be made under close medical supervision with increased frequency of blood glucose monitoring [1]. The label also says that in type 1 diabetes Lantus must be used with a short-acting mealtime insulin, and that it is not recommended for treating diabetic ketoacidosis [1].

Low blood sugar: the numbers

Severe symptomatic hypoglycemia, meaning an event requiring another person's help, occurred in 10.6% of adults with type 1 diabetes on Lantus versus 15.0% on NPH over 28 weeks, and in 1.7% versus 1.1% of adults with type 2 diabetes over 52 weeks alongside oral agents [1]. In a 52-week trial of 570 adults with type 2 diabetes taking oral agents, at least one night-time low was reported by 12% of those on insulin glargine versus 24% on NPH insulin (P=0.002) [2].

Weight gain

Weight gain is listed among the adverse reactions commonly associated with insulin glargine products, attributed in the label to the anabolic effects of insulin and the decrease in glucose lost in urine [1]. In ORIGIN, which enrolled 12,537 people with cardiovascular risk factors plus impaired fasting glucose, impaired glucose tolerance or type 2 diabetes, weight rose 1.6 kg on insulin glargine versus a 0.5 kg fall on standard care over a median of 6.2 years [3].

Doses used when insulin glargine is started

For type 2 diabetes not currently treated with insulin, the label lists a starting dose of 0.2 units/kg or up to 10 units once daily [1]. For type 1 diabetes it lists approximately one-third of the total daily insulin requirement as basal insulin, with short-acting premeal insulin covering the rest [1]. The label says to monitor glucose closely when switching to Lantus and during the initial weeks afterward [1]. It says Lantus is injected subcutaneously once daily at the same time each day, is not diluted or mixed with other insulin, and is not given intravenously or by insulin pump [1].

Brand and strength switches

Semglee (approved July 2021) and Rezvoglar (December 2021) are FDA-approved biosimilars of Lantus, and FDA lists Semglee as the first interchangeable biosimilar insulin [5]. A change of manufacturer is still listed as a regimen change in the Lantus label [1]. Toujeo is insulin glargine at 300 units/mL, three times the concentration of Lantus at 100 units/mL [6][7]. For a switch from once-daily Toujeo, the Lantus label starts Lantus at 80% of the Toujeo dose [1].