What type of insulin is Basaglar (glargine)?

Basaglar is a Long-Acting Insulin Glargine

Basaglar is a long-acting human insulin analog (insulin glargine) used as basal insulin for glycemic control in patients with diabetes mellitus. 1

Pharmacological Classification and Properties

• Insulin glargine (Basaglar) is a recombinant human insulin analog produced by DNA technology using a non-pathogenic strain of Escherichia coli with modifications that result in a stable molecule 1
• It differs from human insulin by replacing the amino acid asparagine at position A21 with glycine and adding two arginines to the C-terminus of the B-chain 1
• Insulin glargine has no pronounced peak action time, providing a relatively constant concentration profile over 24 hours, making it an ideal basal insulin 2
• It has an onset of action of approximately 1 hour after subcutaneous injection with a duration of action of approximately 24 hours 2, 3

Clinical Applications

• Insulin glargine is indicated to improve glycemic control in adult and pediatric patients with diabetes mellitus 1
• It serves as basal insulin therapy, primarily restraining hepatic glucose production and limiting hyperglycemia overnight and between meals 4
• In type 1 diabetes, it should be used in combination with short-acting insulin analogs to cover prandial insulin needs 4
• In type 2 diabetes, it can be added to oral medications when they fail to provide adequate glycemic control 3

Administration Characteristics

• Insulin glargine is typically administered once daily at any time of day, but should be given at the same time each day for consistency 1
• 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 4
• It should be administered subcutaneously into the abdominal area, thigh, or deltoid 1
• Unlike intermediate-acting insulins, it does not require resuspension before use as it is a clear solution 1

Clinical Advantages

• Compared to NPH insulin, insulin glargine has demonstrated a lower risk of symptomatic and nocturnal hypoglycemia 4, 3
• The peakless profile allows for more stable blood glucose levels between meals and overnight 2, 5
• Once-daily dosing may improve treatment adherence compared to insulins requiring multiple daily injections 6

Important Considerations

• Insulin glargine should not be diluted or mixed with any other insulin or solution 1
• It is not recommended for the treatment of diabetic ketoacidosis 1
• Injection sites should be rotated to reduce the risk of lipodystrophy and localized cutaneous amyloidosis 1
• Close monitoring of blood glucose is necessary when switching to insulin glargine and during initial weeks thereafter 1

Comparison with Other Insulin Types

• Unlike rapid-acting insulins (aspart, lispro) which have onset within minutes and peak at 1-2 hours, insulin glargine has no pronounced peak 2
• Compared to intermediate-acting insulin (NPH) which has a peak at 6-8 hours and duration of 12 hours, insulin glargine provides more consistent insulin levels over 24 hours 2, 7
• Insulin glargine belongs to the same class as other long-acting insulin analogs such as detemir and degludec, all designed to provide basal insulin coverage 4