Lantus (Insulin Glargine) Has No Peak Action Time
Insulin glargine (Lantus) has no pronounced peak action time, providing a relatively constant concentration profile over 24 hours. 1, 2
Pharmacokinetic Profile of Insulin Glargine
- Insulin glargine has an onset of action of approximately 1 hour after subcutaneous injection 1, 2
- Unlike intermediate-acting insulins which peak at 6-8 hours, insulin glargine maintains a relatively constant concentration/time profile over 24 hours with no pronounced peak 2
- The duration of action is approximately 24 hours, allowing for once-daily dosing 1, 2
- After subcutaneous injection, insulin glargine forms microprecipitates in the tissue from which small amounts are gradually released, resulting in the peakless profile 3
Clinical Advantages of the Peakless Profile
- The absence of a peak action time reduces the risk of hypoglycemia compared to intermediate-acting insulins 4, 1
- Insulin glargine is absorbed more consistently than intermediate-acting insulins, contributing to its stable glucose-lowering effect 4
- The peakless profile allows for more stable blood glucose levels between meals and overnight 1
- A study comparing glargine with NPH insulin in patients with type 1 diabetes showed that symptomatic hypoglycemia was less common in patients who used glargine (39.9% versus 49.2% over one month) 4
Comparison with Other Insulin Types
The following table highlights the pharmacokinetic differences between insulin glargine and 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 |
Clinical Implications
- 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
- The median time between subcutaneous injection and the end of pharmacological effect was 24 hours for insulin glargine, compared to 14.5 hours for NPH insulin 2
- The peakless profile makes insulin glargine ideal for providing basal insulin coverage, as it mimics more closely the natural physiological profile of basal endogenous insulin secretion 5
- Due to its stable profile, insulin glargine can be administered at any time of day, though consistency in timing is recommended 6, 3
Practical Considerations
- In patients with type 1 diabetes, insulin glargine should be used in combination with rapid-acting insulin to cover prandial insulin needs 1
- The peakless nature of insulin glargine means it does not adequately treat postprandial hyperglycemia, necessitating supplementation with short-acting insulin at mealtimes 6
- The pharmacokinetic properties of insulin glargine allow for easier titration of basal insulin dose, facilitating adequate blood glucose control while decreasing the risk of hypoglycemia 3