From the Guidelines
Insulin glargine is a long-acting insulin analog that should be used to manage diabetes mellitus, providing a steady, basal level of insulin for approximately 24 hours with minimal peaks in action, as recommended by the most recent guidelines 1.
Key Points
- Insulin glargine is typically administered once daily at the same time each day to help control blood glucose levels between meals and overnight.
- The standard starting dose for adults with type 2 diabetes is often 10 units daily, while those with type 1 diabetes usually start with 0.2-0.4 units per kilogram of body weight, as suggested by previous studies 1.
- Dosage should be individualized based on blood glucose monitoring and adjusted gradually under medical supervision.
- Insulin glargine is injected subcutaneously in the abdomen, thigh, or upper arm, and injection sites should be rotated to prevent lipodystrophy.
- It should not be mixed with other insulins in the same syringe, and common brand names include Lantus, Toujeo, and Basaglar.
Benefits and Risks
- Insulin glargine works by forming microprecipitates in subcutaneous tissue that slowly release insulin into the bloodstream, providing consistent glucose control with lower risk of nocturnal hypoglycemia compared to older insulin formulations 1.
- Long-acting basal analogs (U-300 glargine or degludec) may convey a lower hypoglycemia risk compared with U-100 glargine when used in patients with type 1 diabetes, as reported in recent studies 1.
- However, the advantages of insulin analogs in patients with type 1 diabetes may be modest, and the expense and/or intensity of treatment required for their use can be prohibitive for some patients 1.
From the FDA Drug Label
Twice-daily NPH insulin to once-daily Insulin Glargine, the recommended starting Insulin Glargine dosage is 80% of the total NPH dosage that is being discontinued
- Insulin Glargine is a long-acting insulin.
- The recommended starting dosage of Insulin Glargine is 80% of the total NPH dosage that is being discontinued when switching from twice-daily NPH insulin to once-daily Insulin Glargine 2.
- Key considerations for using Insulin Glargine include:
- Hypoglycemia: the most common adverse reaction associated with insulins, including Insulin Glargine.
- Hyperglycemia: may occur with changes in insulin regimen.
- Hypersensitivity reactions: severe, life-threatening, generalized allergy, including anaphylaxis, can occur with insulins, including Insulin Glargine.
- Administration: Insulin Glargine is injected under the skin (subcutaneously) of your upper legs (thighs), upper arms, or stomach area (abdomen) 2.
From the Research
Insulin Glargine Long Acting
- Insulin glargine is a long-acting insulin analogue that provides a fairly constant, basal insulin supply without peaks in plasma insulin levels for approximately 24 hours 3, 4.
- It is used as a basal insulin and exhibits a flat pharmacokinetic profile, with a duration of action of at least 24 hours 3.
- Insulin glargine is indicated as a once daily subcutaneous injection to provide basal glycaemic control in adults and children aged >6 years with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus 4.
Clinical Efficacy
- Clinical trials have shown that insulin glargine improves glycemic control in patients with type 1 and type 2 diabetes mellitus, with a lower incidence of hypoglycaemia, especially nocturnal hypoglycaemia, compared with NPH insulin 3, 4, 5.
- Insulin glargine has been shown to be clinically superior to NPH insulin in terms of providing at least as effective glycemic control, but with significantly fewer episodes of nocturnal hypoglycemia in patients with type 2 diabetes requiring insulin therapy 5, 6.
Administration and Dosage
- Insulin glargine should not be mixed with any other insulin product and should be administered with a syringe that has not been used for other insulin products or other medications 3.
- Patients previously receiving twice-daily isophane insulin (NPH) should receive an insulin glargine dosage 20% less than the total daily dose of NPH insulin 3.
- Insulin glargine is administered once daily at bedtime 3.