Lantus (Insulin Glargine) Peak Profile
Insulin glargine (Lantus) has no pronounced peak action time, providing a relatively constant concentration profile over 24 hours, which distinguishes it from intermediate-acting insulins and makes it an ideal basal insulin. 1, 2
Pharmacokinetic and Pharmacodynamic Profile
- Insulin glargine has an onset of action of approximately 1 hour after subcutaneous injection 1
- Unlike intermediate-acting insulins such as NPH which peak at 6-8 hours, insulin glargine has no pronounced peak in its action profile 1
- The duration of action is approximately 24 hours, allowing for once-daily dosing 1, 2
- Insulin glargine slowly releases insulin over 24 hours, causing more physiologic basal insulin levels 1
- The FDA label confirms that insulin glargine provides "a relatively constant concentration/time profile over 24 hours with no pronounced peak in comparison to NPH insulin" 2
Clinical Implications of Lantus' Peakless Profile
- The absence of a peak action time reduces the risk of hypoglycemia compared to intermediate-acting insulins 1
- Studies show that symptomatic hypoglycemia, especially nocturnal episodes, is less common in patients using glargine compared to NPH insulin (39.9% versus 49.2% over one month) 1, 3
- The peakless profile allows for more stable blood glucose levels between meals and overnight 1
- The consistent absorption profile makes insulin glargine particularly valuable for maintaining basal insulin needs without the fluctuations seen with other long-acting insulins 3, 4
Administration Considerations
- Insulin glargine is typically administered once daily, often at bedtime, though it can be given at any time of day with similar efficacy 1, 4
- In some patients, particularly those with type 1 diabetes who are more insulin sensitive, glargine may not last the full 24 hours, and dividing the dose into two daily injections may be necessary 1
- For patients with high insulin requirements due to insulin resistance, two separate doses may be more effective due to the high volumes required 4
- Insulin glargine should not be mixed in the same syringe with other insulins as it may coprecipitate with them 4
Comparison with Other Insulins
- The table below shows how insulin glargine compares to other insulin types:
| Insulin Type | Onset | Peak (hours) | Duration (hours) |
|---|---|---|---|
| Rapid-acting (aspart, lispro) | 5 minutes | 1-2 | 3-4 |
| Regular insulin | 15 minutes | 3-4 | 6-8 |
| Intermediate-acting (NPH) | 1 hour | 6-8 | 12 |
| Glargine | 1 hour | None | 24 |
- The peakless profile of insulin glargine makes it more suitable as a basal insulin compared to NPH, which has a pronounced peak that can increase hypoglycemia risk 1, 3, 5
- Unlike rapid-acting insulins that are designed to control postprandial glucose excursions, glargine is specifically designed to provide consistent background insulin levels 4, 6
Clinical Advantages
- The absence of a peak makes insulin glargine particularly valuable for patients prone to hypoglycemia 1, 3
- The consistent 24-hour coverage allows for more physiologic insulin replacement 1, 5
- Patients with type 1 and type 2 diabetes report higher treatment satisfaction with insulin glargine compared to NPH insulin 3
- The peakless profile allows for more aggressive titration to target without the same risk of hypoglycemia seen with peaked insulins 3, 6
Understanding the peakless nature of insulin glargine is essential for proper dosing and patient education to optimize glycemic control while minimizing hypoglycemia risk.