From the Guidelines
In Canada, the most appropriate long-acting insulin pen options for diabetes management, based on recent evidence, include Lantus and Toujeo (both insulin glargine), Levemir (insulin detemir), Tresiba (insulin degludec), and Basaglar (a biosimilar insulin glargine) 1. These pens provide 24-hour basal insulin coverage with varying onset and duration profiles.
- Lantus and Basaglar generally last 24 hours with a relatively flat profile,
- while Toujeo offers more consistent coverage with less risk of hypoglycemia.
- Levemir may require twice-daily dosing for some patients and has a slightly shorter duration.
- Tresiba provides ultra-long coverage exceeding 24 hours, allowing flexible dosing times. These insulin pens are designed for subcutaneous injection and come pre-filled for convenience. Patients should store unopened pens in the refrigerator and can keep in-use pens at room temperature for specified periods (typically 28-42 days depending on the product) 1. The choice between these options depends on individual factors including glycemic patterns, risk of hypoglycemia, dosing preferences, and cost considerations, with insurance coverage varying across provinces 1. It is essential to consider the patient's specific needs and preferences when selecting a long-acting insulin pen, prioritizing factors such as efficacy, safety, and convenience to optimize diabetes management and improve quality of life.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Long-Acting Insulin Pens Available in Canada
- Insulin glargine (Lantus) is a long-acting, human insulin analogue that provides a relatively constant basal level of circulating insulin with no pronounced peak 2.
- Insulin detemir (Levemir) is another long-acting insulin product with a lower within-subject variability of fasting plasma glucose levels than NPH insulin and insulin glargine 3.
Key Characteristics of Long-Acting Insulin Pens
- Insulin glargine is well tolerated and elicits less hypoglycaemia, especially nocturnal episodes, than NPH insulin, with similar levels of glycaemic control 2, 4.
- Insulin detemir has a long duration of action due to its high binding affinity to albumin, which may decrease hypoglycemic events and contribute to a decreased incidence of weight gain 3.
Usage and Administration
- Insulin glargine can be administered once daily, usually at nighttime, but can also be given in the morning or at any other time convenient for the patient 5.
- Insulin detemir can be given once or twice daily as part of basal-bolus insulin therapy, and is at least as effective as NPH insulin in maintaining overall glycemic control in adult patients with type 1 or type 2 diabetes mellitus 3.