Benefits of twice-daily injection with insulin glargine: a case report and review of the literature.

Insulin Glargine is recommended as a once-daily basal insulin. We report a patient in whom nocturnal administration of Glargine was associated with significant morning hypoglycemia despite titration of insulin dose. Changing the Glargine regimen to morning administration did not result in improvement. However, changing to a twice-daily regimen of Glargine resulted in the resolution of the hypoglycemia. Few studies have addressed the role of multiple daily injections of Glargine and this remains a valuable option in the management of diabetic patients. Prior studies using multiple daily injections with NPH insulin and Ultralente have demonstrated success. We propose that patients with hypoglycemia despite titration of once daily Glargine should be considered for a twice-daily regimen. Despite a slight increase in cost and inconvenience for the patient, the increases frequency of administration may result in a greater success in achieving glycemic targets.