What are the guidelines for using embecta (insulin glargine) in a patient with diabetes?

Embecta for Diabetes Management

Critical Clarification: Product Identification

Embecta is NOT insulin glargine (Lantus) - it is a medical device company that manufactures diabetes care products including syringes, pen needles, and injection devices. 1 The FDA drug label information provided indicates Embecta products are topical/external use devices with warnings against use on wounds or damaged skin and restrictions for children under 12 years. 1

Embecta Device Usage Guidelines

Contraindications and Warnings

• Do not use Embecta products on wounds or damaged skin 1
• Do not use in children under 12 years old without consulting a physician 1
• Do not use if allergic to any ingredients in the product 1

When to Discontinue Use

• Discontinue use and consult a physician if the condition worsens, symptoms persist for more than 7 days, or symptoms clear up and recur within a few days 1

If You Meant Insulin Glargine (Lantus) Instead

Initial Dosing for Insulin Therapy

For insulin-naive patients with type 2 diabetes, start with 10 units once daily or 0.1-0.2 units/kg/day, administered at the same time each day. 2 For a 50 kg patient, this translates to 10 units once daily. 2

• For patients with severe hyperglycemia (A1C ≥9%, blood glucose ≥300-350 mg/dL, or symptomatic/catabolic features), consider higher starting doses of 0.3-0.4 units/kg/day or a basal-bolus regimen immediately 2
• For type 1 diabetes, total daily insulin requirements typically range from 0.4-1.0 units/kg/day, with approximately 50% as basal insulin 2, 3

Dose Titration Algorithm

Increase the basal insulin dose by 2-4 units every 3 days until fasting blood glucose reaches 80-130 mg/dL. 2

• If fasting glucose ≥180 mg/dL: increase by 4 units every 3 days 2
• If fasting glucose 140-179 mg/dL: increase by 2 units every 3 days 2
• If fasting glucose <80 mg/dL on more than 2 occasions per week: decrease by 2 units 2

Critical Threshold: Recognizing Overbasalization

When basal insulin exceeds 0.5 units/kg/day and A1C remains elevated despite controlled fasting glucose, add prandial insulin rather than continuing to escalate basal insulin. 2

Clinical signals of overbasalization include: 2

• Basal insulin dose >0.5 units/kg/day
• High bedtime-to-morning glucose differential (≥50 mg/dL)
• Hypoglycemia episodes
• High glucose variability

Adding Prandial Insulin Coverage

Start with 4 units of rapid-acting insulin before the largest meal or 10% of the current basal dose when basal insulin is optimized but A1C remains above target. 2

• Titrate prandial insulin by 1-2 units or 10-15% every 3 days based on postprandial glucose readings 2
• Rapid-acting insulin analogs (lispro, aspart) provide better postprandial control than regular insulin 2

Administration and Storage Guidelines

Insulin glargine should NOT be mixed with other insulins due to its low pH diluent. 4, 3

• Administer at the same time each day for consistent 24-hour coverage 3
• Store unopened vials refrigerated; avoid extreme temperatures (<36°F or >86°F) 4
• Insulin in use may be kept at room temperature to reduce injection site irritation 4
• Replace vials after 1 month of use due to potential potency loss 4
• Inspect before each use - insulin glargine should be clear; discard if cloudy, clumped, or discolored 4

Foundation Therapy Requirement

Continue metformin when initiating or intensifying insulin therapy unless contraindicated, as it remains the foundation of type 2 diabetes treatment. 2

Common Pitfalls to Avoid

• Delaying insulin initiation in patients not achieving glycemic goals with oral medications 2
• Continuing to escalate basal insulin beyond 0.5-1.0 units/kg/day without addressing postprandial hyperglycemia leads to suboptimal control and increased hypoglycemia risk 2
• Failing to teach proper injection technique, hypoglycemia recognition/treatment, and self-monitoring of blood glucose 2
• Not adjusting insulin doses based on home glucose monitoring patterns 2

Special Considerations

• Insulin glargine may require twice-daily dosing if once-daily administration fails to provide 24-hour coverage 4, 3
• During puberty, insulin requirements may increase to 1.5 units/kg/day due to hormonal influences 3
• Elderly hospitalized patients with reduced oral intake should start with reduced doses of 0.1-0.15 units/kg/day 3
• U-300 glargine (Toujeo) requires approximately 10-18% higher daily doses compared to U-100 formulations 3