From the Guidelines
Glargine (Insulin Glargine) is a long-acting insulin analog that provides a steady, basal level of insulin for approximately 24 hours with minimal peaks in action, making it an effective treatment for managing diabetes mellitus. The most recent and highest quality study, 1, published in 2024, supports the use of Glargine as a basal insulin, which can be added to metformin and other noninsulin injectables for individuals with type 2 diabetes. Some key points to consider when using Glargine include:
- Starting doses can be estimated based on body weight (0.1–0.2 units/kg/day) and the degree of hyperglycemia, with individualized titration over days to weeks as needed 1
- The principal action of basal insulin is to restrain hepatic glucose production and limit hyperglycemia overnight and between meals 1
- Long-acting basal analogs (U-100 glargine or detemir) have been demonstrated to reduce the risk of level 2 hypoglycemia and nocturnal hypoglycemia compared with NPH insulin 1
- Longer-acting basal analogs (U-300 glargine or degludec) convey a lower nocturnal hypoglycemia risk compared with U-100 glargine 1 It is essential to be aware of the potential for overbasalization with insulin therapy, and clinical signals that may prompt evaluation of overbasalization include basal dose greater than 0.5 units/kg, high bedtime-to-morning or preprandial-to-postprandial glucose differential 1. Overall, Glargine is a valuable treatment option for managing diabetes mellitus, providing a steady and consistent level of insulin to help maintain baseline blood glucose control.
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 Glargine is a long-acting man-made insulin used to control high blood sugar in adults and children with diabetes mellitus.
Insulin Glargine is a long-acting man-made insulin used to control high blood sugar in adults and children with diabetes mellitus. It is produced by recombinant DNA technology and differs from human insulin by replacements and additions of certain amino acids 2.
From the Research
Definition and Properties of Insulin Glargine
- Insulin glargine is a recombinant human insulin analogue produced by DNA technology using a nonpathogenic strain of Escherichia coli 3, 4, 5.
- It has two modifications of human insulin, resulting in a stable molecule that is soluble in slightly acidic conditions (pH 4.0) and precipitates in the neutral pH of subcutaneous tissue 3, 4, 5.
- This property allows for delayed absorption and provides a fairly constant, basal insulin supply without peaks in plasma insulin levels for approximately 24 hours 3, 4, 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, 4, 5.
- It is used to improve fasting plasma glucose and fasting blood glucose levels, and to reduce the incidence of hypoglycaemia, especially nocturnal hypoglycaemia, compared to Neutral Protamine Hagedorn (NPH) insulin 3, 4, 5, 6.
- Insulin glargine has been shown to be effective in improving glycaemic control and reducing the risk of hypoglycaemia in patients with type 1 and type 2 diabetes mellitus 3, 4, 5, 6, 7.
Safety and Tolerability
- The most common adverse event associated with insulin glargine treatment is injection site pain, which is generally mild and does not require treatment discontinuation 3, 4.
- Insulin glargine is well tolerated and does not appear to be immunogenic 3, 4, 5.
- It has been shown to be cost-effective and to improve patient quality of life compared to NPH insulin 6, 7.