Basaglar (Insulin Glargine) is a Long-Acting Basal Insulin Analog, Not NPH Insulin
Basaglar (insulin glargine) is a long-acting basal insulin analog, not an NPH (Neutral Protamine Hagedorn) insulin. 1, 2, 3
Pharmacological Classification and Properties
- Insulin glargine (Basaglar) is a recombinant DNA-derived insulin analog that has been modified from human insulin to provide a relatively constant, peakless insulin profile over 24 hours 1, 4
- Unlike NPH insulin (which is an intermediate-acting insulin), insulin glargine has no pronounced peak action time, providing a more physiologic basal insulin level 1, 3
- After subcutaneous injection, insulin glargine forms a depot in the subcutaneous tissue from which it is slowly released, resulting in a relatively constant concentration/time profile over 24 hours 2
Pharmacokinetic Comparison with NPH Insulin
- Insulin glargine has an onset of action of approximately 1 hour after injection, with a duration of action of approximately 24 hours, allowing for once-daily dosing 1
- In contrast, NPH insulin is an intermediate-acting insulin with an onset of 1 hour, a peak at 6-8 hours, and a duration of about 12 hours 1
- The following table highlights the key differences between insulin types 1:
| 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 |
Clinical Advantages of Insulin Glargine vs. NPH
- Insulin glargine has demonstrated a lower risk of symptomatic and nocturnal hypoglycemia compared to NPH insulin in clinical trials 5, 6
- The peakless profile of insulin glargine allows for more stable blood glucose levels between meals and overnight compared to the peaked profile of NPH insulin 1, 3
- In clinical studies, insulin glargine has shown a 26% reduction in nocturnal hypoglycemia and a 46% reduction in severe hypoglycemia compared to NPH insulin 6
- The absence of a pronounced peak with insulin glargine reduces the risk of hypoglycemia compared to intermediate-acting insulins like NPH 1, 7
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
- NPH insulin, due to its shorter duration and peaked profile, is often administered twice daily to provide 24-hour coverage 2, 7
- When switching from NPH to insulin glargine, doses can often be converted unit-for-unit, but an initial dose reduction of 10-20% may be needed for patients at high risk of hypoglycemia 4
Clinical Applications
- Both insulin glargine and NPH work primarily by restraining hepatic glucose production and limiting hyperglycemia overnight and between meals 5, 4
- In type 1 diabetes, insulin glargine should be used in combination with short-acting insulin analogs to cover prandial insulin needs 1
- In type 2 diabetes, insulin glargine can be used in combination with oral antidiabetic medications or as part of a basal-bolus regimen 1, 8
Understanding the distinction between insulin glargine (a long-acting basal insulin analog) and NPH (an intermediate-acting insulin) is crucial for appropriate insulin selection and dosing in diabetes management.