What alternative long-acting insulin can be given to a patient instead of Basaglar (insulin glargine)?

Alternative Long-Acting Insulins to Replace Basaglar

Patients can be switched from Basaglar (insulin glargine) to other long-acting insulin analogs including insulin degludec (Tresiba), insulin detemir (Levemir), or another insulin glargine formulation (Lantus, Toujeo) with comparable efficacy and safety profiles. 1, 2

Available Long-Acting Insulin Alternatives

Second-Generation Long-Acting Insulin Analogs

• Insulin degludec (Tresiba) - Once-daily dosing with duration of action up to 42+ hours and minimal peak action 1, 2
• Insulin detemir (Levemir) - Once or twice-daily dosing with duration of 20-24 hours 1, 3
• Insulin glargine U-300 (Toujeo) - More concentrated formulation of glargine with longer duration and more stable profile than U-100 1, 2
• Other insulin glargine U-100 formulations (Lantus) - Similar pharmacokinetic profile to Basaglar 1

First-Generation Options

• NPH insulin (Neutral Protamine Hagedorn) - Intermediate-acting insulin with pronounced peak at 6-8 hours and shorter duration (12-18 hours) 1, 2

Comparison of Long-Acting Insulin Options

Insulin Type	Onset	Peak	Duration	Key Advantages	Key Disadvantages
Insulin degludec	1-2 hours	Minimal	24-42+ hours	Longest duration, lowest hypoglycemia risk	May be more expensive
Insulin detemir	1-2 hours	Minimal	20-24 hours	Less weight gain than other options	May require twice-daily dosing for some patients
Insulin glargine U-300	1-2 hours	Minimal	24-36 hours	More stable profile than U-100	May be more expensive
NPH insulin	1 hour	6-8 hours	12-18 hours	Lower cost	Higher hypoglycemia risk, pronounced peak

Conversion Considerations

When switching from Basaglar to another long-acting insulin:

• For most insulin analogs: Can typically convert unit-for-unit initially 2
• When switching to insulin detemir: May require a 10-20% higher dose compared to glargine based on comparative trials 1, 3, 4
• When switching to NPH: Consider dividing into twice-daily dosing due to shorter duration of action 1
• For patients at high risk of hypoglycemia: Consider initial dose reduction of 10-20% when switching between insulin types 1, 2

Clinical Decision Algorithm

1. Assess patient's current glycemic control and risk factors:

   • If nocturnal hypoglycemia is a concern: Choose degludec or glargine U-300 1, 2
   • If weight gain is a concern: Consider detemir 1, 4
   • If cost is a major concern: Consider NPH insulin 1

2. Consider dosing convenience:

   • For patients requiring once-daily dosing: Degludec or glargine U-300 provide most consistent 24-hour coverage 1, 2
   • For patients with variable schedules: Degludec offers the most flexibility due to longest duration 1, 2

3. Monitor after switching:

   • Check fasting blood glucose levels frequently in the first 1-2 weeks after switching
   • Adjust dosing as needed based on glucose patterns

Important Considerations and Pitfalls

• Avoid mixing long-acting analogs: Unlike NPH, insulin glargine and detemir should not be mixed with other insulins in the same syringe 2
• Insurance coverage: Verify insurance coverage before prescribing alternatives, as formulary restrictions may limit options 1
• Patient education: Ensure patients understand any differences in administration, timing, or appearance of the new insulin 2
• Hypoglycemia risk: While long-acting analogs generally have lower hypoglycemia risk than NPH, all insulins can cause hypoglycemia 1, 2

Long-acting insulin analogs provide more consistent basal insulin coverage with less pronounced peaks compared to NPH insulin, resulting in lower risk of hypoglycemia, particularly nocturnal hypoglycemia 1, 5, 6. The choice between alternatives to Basaglar should be based on individual patient factors including hypoglycemia risk, dosing preference, and cost considerations.