From the Guidelines
Insulin glargine is a long-acting basal insulin analog. It provides steady, prolonged insulin release with no pronounced peak, typically lasting 24 hours or more after injection. Glargine is designed to mimic the body's natural basal insulin secretion pattern, providing background insulin throughout the day and night to control blood glucose between meals and during sleep. Unlike regular human insulin, glargine has modifications to its amino acid sequence that cause it to precipitate in subcutaneous tissue after injection, creating a depot that slowly releases insulin into circulation. This pharmacokinetic profile allows for once-daily dosing, typically administered at the same time each day. Glargine cannot be mixed with other insulins in the same syringe and is not intended for intravenous administration. It's used in both type 1 and type 2 diabetes management, often in combination with rapid-acting insulin or other diabetes medications to provide complete glycemic control. According to the most recent study 1, long-acting insulin analogs have longer duration of action with flatter, more constant plasma concentrations and activity profiles than NPH insulin. The study also found that treatment with analog insulins is associated with less hypoglycemia and weight gain as well as lower A1C compared with human insulins. Some key points to consider when using glargine include:
- It is a long-acting basal insulin analog
- It provides steady, prolonged insulin release with no pronounced peak
- It is designed to mimic the body's natural basal insulin secretion pattern
- It is typically administered once daily at the same time each day
- It cannot be mixed with other insulins in the same syringe and is not intended for intravenous administration. Overall, insulin glargine is a valuable treatment option for patients with type 1 and type 2 diabetes, providing effective glycemic control with a relatively simple dosing regimen.
From the FDA Drug Label
Insulin glargine is a long-acting human insulin analog produced by recombinant DNA technology utilizing a non-pathogenic laboratory strain of Escherichia coli (K12). Insulin glargine differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine and two arginines are added to the C-terminus of the B-chain
Insulin Type: Insulin glargine is a long-acting human insulin analog.
- It is produced by recombinant DNA technology.
- The main difference between insulin glargine and human insulin is the replacement of asparagine with glycine at position A21 and the addition of two arginines to the C-terminus of the B-chain 2.
From the Research
Insulin Glargine Characteristics
- Insulin glargine is a recombinant human insulin analogue produced by DNA technology using a nonpathogenic strain of Escherichia coli 3.
- It is a long-acting insulin analog with a duration of action of 24 hours, providing a fairly constant, basal insulin supply without peaks in plasma insulin levels 3, 4.
- Insulin glargine is soluble at pH 4.0 and forms amorphous microprecipitates in subcutaneous tissue, allowing for gradual release of the insulin 5.
Therapeutic Use
- Insulin glargine is indicated as a once-daily subcutaneous injection to provide basal glycaemic control in adults and children aged >6 years with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus 3.
- It has been shown to improve fasting plasma glucose and fasting blood glucose levels, and reduce the frequency of nocturnal hypoglycaemia compared to Neutral Protamine Hagedorn (NPH) insulin 3, 5, 6.
- Insulin glargine has also been shown to be well tolerated, with a low incidence of adverse events, including injection site pain 3.
Comparison to Other Insulins
- Insulin glargine has been compared to NPH insulin in several clinical trials, with results showing improved glycaemic control and reduced frequency of hypoglycaemia with insulin glargine 3, 5, 6.
- It has also been shown to have a more consistent and prolonged time-action profile compared to NPH insulin, making it a useful addition to the armamentarium of insulin therapy 3, 7.