Lantus SoloStar is a Long-Acting Basal Insulin Analog
Lantus SoloStar (insulin glargine) is a long-acting basal insulin analog designed to provide 24-hour background insulin coverage with a relatively constant, peakless concentration profile. 1, 2, 3
Pharmacological Classification
- Insulin glargine belongs to the class of long-acting insulin analogs, alongside insulin detemir and insulin degludec, all engineered to provide sustained basal insulin coverage 2
- It is a recombinant human insulin analog produced through DNA technology using a nonpathogenic strain of Escherichia coli 4
- The molecular modifications at position A21 and the C-terminus of the B-chain create a compound that is soluble at pH 4.0 but forms microprecipitates in subcutaneous tissue (pH >7.4), allowing gradual insulin release 5, 4
Pharmacokinetic Profile
- Onset of action: Approximately 1 hour after subcutaneous injection 1, 2
- Peak action: No pronounced peak—provides a relatively constant concentration over 24 hours 1, 2, 6
- Duration of action: Approximately 24 hours, permitting once-daily dosing 1, 2, 4
- The peakless profile distinguishes insulin glargine from intermediate-acting insulins like NPH, which exhibit a pronounced peak at 6–8 hours 2
Clinical Role and Indications
- Insulin glargine functions as basal insulin therapy, primarily suppressing hepatic glucose production between meals and overnight 2
- It is indicated for once-daily subcutaneous injection to control high blood sugar in adults and children with type 1 and type 2 diabetes mellitus 3
- In type 1 diabetes, insulin glargine must be combined with rapid-acting insulin analogs (lispro, aspart, glulisine) to cover prandial insulin needs 2, 6
- In type 2 diabetes, insulin glargine can be used alone or in combination with oral antidiabetic agents 1, 6
- Insulin glargine is not indicated for treating diabetic ketoacidosis 3
Key Clinical Advantages
- Reduced hypoglycemia risk: Insulin glargine demonstrates significantly lower rates of symptomatic hypoglycemia (11% reduction) and nocturnal hypoglycemia (26% reduction) compared to NPH insulin 7
- Severe hypoglycemia reduction: Risk of severe hypoglycemia is reduced by 46%, and severe nocturnal hypoglycemia by 59%, compared to NPH insulin 7
- More stable glucose control: The absence of a peak action time allows for more physiologic basal insulin levels and stable blood glucose between meals and overnight 2, 5
- Improved reproducibility: Plasma insulin levels show better day-to-day consistency compared to NPH insulin 5
Administration Considerations
- Insulin glargine can be administered at any time of day, but must be given at the same time every day for optimal efficacy 1, 3
- It is typically given once daily, often at bedtime, though morning administration is acceptable 2
- The medication is injected subcutaneously in the upper legs (thighs), upper arms, or abdomen 3
- Do not mix or dilute insulin glargine with any other insulin or solution due to its acidic pH 1
- Do not use in insulin pumps or inject intravenously 3
Comparison with Other Insulin Types
| Insulin Type | Onset | Peak | Duration |
|---|---|---|---|
| Rapid-acting (lispro, aspart) | 5 minutes | 1–2 hours | 3–4 hours |
| Regular insulin | 15 minutes | 3–4 hours | 6–8 hours |
| NPH (intermediate-acting) | 1 hour | 6–8 hours | 12 hours |
| Insulin glargine (Lantus) | 1 hour | None (peakless) | 24 hours |