insulin glargine

insulin /in·su·lin/ (in´sdbobr-lin)

1. a protein hormone formed from proinsulin in the beta cells of the pancreatic islets of Langerhans. The major fuel-regulating hormone, it is secreted into the blood in response to a rise in concentration of blood glucose or amino acids. Insulin promotes the storage of glucose and the uptake of amino acids, increases protein and lipid synthesis, and inhibits lipolysis and gluconeogenesis.

Insulin. The precursor proinsulin is cleaved internally at two sides (arrows) to yield insulin and C peptide.

2. a preparation of insulin, either of porcine or bovine origin or a recombinant form with sequence the same as or similar to that in humans, used in the treatment of diabetes mellitus; classified as rapid-acting, intermediate-acting, or long-acting on the basis of speed of onset and duration of activity.

3. regular insulin; a rapid-acting, unmodified form of insulin prepared from crystalline bovine or porcine insulin.

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insulin aspart  a rapid-acting analogue of human insulin created by recombinant DNA technology.

buffered insulin human  insulin human buffered with phosphate; used particularly in continuous infusion pumps.

extended insulin zinc suspension  a long-acting insulin consisting of porcine or human insulin in the form of large zinc-insulin crystals.

insulin glargine  an analogue of human insulin produced by recombinant DNA technology, having a slow, steady release over 24 hours.

insulin human  a protein corresponding to insulin elaborated in the human pancreas, derived from pork insulin by enzymatic action or produced synthetically by recombinant DNA techniques; sometimes used specifically to denote a rapid-acting regular insulin preparation of this protein.

isophane insulin suspension  an intermediate-acting insulin consisting of porcine or human insulin reacted with zinc chloride and protamine sulfate.

Lente insulin  insulin zinc suspension.

insulin lispro  a rapid-acting analogue of human insulin synthesized by means of recombinant DNA technology.

NPH insulin  isophane i. suspension.

prompt insulin zinc suspension  a rapid-acting insulin consisting of porcine insulin with zinc chloride added to produce a suspension of amorphous insulin.

regular insulin  insulin (3).

Semilente insulin  prompt insulin zinc suspension.

Ultralente insulin  extended insulin zinc suspension.

insulin zinc suspension  an intermediate-acting insulin consisting of porcine or human insulin with a zinc salt added such that the solid phase of the suspension contains a 7:3 ratio of crystalline to amorphous insulin.

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insulin glargine,

an analog of human insulin produced by recombinant DNA technology, differing from human insulin in that the asparagine at position A21 is replaced by glycine and two arginines are added to the C-terminus of the B-chain. It is administered subcutaneously for once-daily insulin replacement therapy.

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insulin glargine (rDNA origin) Warning - High-alert drug!

Lantus

Pharmacologic class: Pancreatic hormone

Therapeutic class: Hypoglycemic

Pregnancy risk category C

Action

Long-acting insulin form. Promotes glucose transport, which stimulates carbohydrate metabolism in skeletal and cardiac muscle and adipose tissue. Also promotes phosphorylation of glucose in liver, where it's converted to glycogen. Directly affects fat and protein metabolism, stimulates protein synthesis, inhibits release of free fatty acids, and indirectly decreases phosphate and potassium.

Availability

Injection: 100 units/ml in 10-ml vials and 3-ml cartridges

⊘Indications and dosages

➣ Type 1 (insulin-dependent) diabetes mellitus and type 2 (non-insulin-dependent) diabetes mellitus in patients who need long-acting insulin

Adults and children ages 6 and older: Subcutaneous injection daily at same time each day, with dosage based on blood glucose level

➣ Conversion from another insulin type in patients with type 1 diabetes mellitus who need long-acting insulin

Adults and children ages 6 and older: For patients switching from once-daily NPH or ultralente human insulin, start glargine at same dosage as current insulin dosage. For patients taking twice-daily NPH or ultralente human insulin, reduce initial glargine dosage by approximately 20% of current insulin dosage during week 1; then adjust based on blood glucose level.

➣ Type 2 diabetes mellitus in patients receiving oral hypoglycemics

Adults: Dosage highly individualized based on glucose levels and response

Contraindications

• Hypersensitivity to drug or its components
• Hypoglycemia

Precautions

Use cautiously in:
• pregnant or breastfeeding patients
• children.

Administration

☞ Be aware that insulin is a high-alert drug.
• Give by subcutaneous route only, at same time each day.
☞ Don't mix in solution with other drugs, including other insulins.
• Before drawing up insulin into syringe, roll vial between hands to ensure uniform dispersion; don't shake.
• Rotate injection sites to prevent lipodystrophy.

Route	Onset	Peak	Duration
Subcut.	1.1 hr	5 hr	24 hr

Adverse reactions

Metabolic: rebound hyperglycemia (Somogyi effect), hypoglycemia

Skin: urticaria, rash, pruritus, redness, stinging, or warmth at injection site

Other: edema, lipodystrophy, lipohypertrophy, allergic reactions including anaphylaxis

Interactions

Drug-drug. Acetazolamide, albuterol, antiretrovirals, asparaginase, calcitonin, corticosteroids, cyclophosphamide, danazol, dextrothyroxine, diazoxide, diltiazem, diuretics, dobutamine, epinephrine, estrogens, hormonal contraceptives, isoniazid, morphine, niacin, phenothiazines, phenytoin, somatropin, terbutaline, thyroid hormones: decreased hypoglycemic effect

Anabolic steroids, angiotensin-converting enzyme inhibitors, calcium, chloroquine, clofibrate, clonidine, disopyramide, fluoxetine, guanethidine, mebendazole, MAO inhibitors, octreotide, oral hypoglycemics, phenylbutazone, propoxyphene, pyridoxine, salicylates, sulfinpyrazone, sulfonamides, tetracyclines: increased hypoglycemic effect

Beta-adrenergic blockers (nonselective): masking of some hypoglycemia signs and symptoms, delayed recovery from hypoglycemia

Lithium carbonate: altered hypoglycemic effect

Pentamidine: increased hypoglycemic effect, possibly followed by hyperglycemia

Drug-diagnostic tests. Glucose, inorganic phosphate, magnesium, potassium: decreased levels

Liver and thyroid function studies: test interference

Urine vanillylmandelic acid: increased level

Drug-herbs. Basil, bee pollen, burdock, glucosamine, sage: altered glycemic control

Chromium, coenzyme Q10, dandelion, eucalyptus, fenugreek, marshmallow: increased hypoglycemic effect

Garlic, ginseng: decreased blood glucose level

Drug-behaviors. Alcohol use: increased hypoglycemic effect

Marijuana use: increased blood glucose level

Smoking: increased blood glucose level, decreased response to insulin

Patient monitoring

• Monitor blood glucose level frequently to assess drug efficacy and appropriateness of dosage.
• Watch blood glucose level closely if patient is converting from one insulin type to another or is under unusual stress (as from surgery or trauma).
☞ Check for signs and symptoms of hypoglycemia (such as CNS changes). Keep glucose source at hand.
☞ Monitor for signs and symptoms of hyperglycemia, such as polydipsia, polyphagia, polyuria, and diabetic ketoacidosis (blood and urine ketones, metabolic acidosis, extremely elevated glucose level, hypovolemia).
• Monitor for glycosuria.
• Closely monitor kidney and liver function test results in patients with renal or hepatic impairment.

Patient teaching

• Instruct patient how to administer insulin subcutaneously.
☞ Teach patient how to recognize and report signs and symptoms of hypoglycemia and hyperglycemia. Advise him to always carry glucose source.
• Advise patient to rotate subcutaneous injection sites and keep a record of sites used.
• Teach patient how to monitor and record blood glucose level and, if indicated, urine glucose and ketone levels.
• Inform patient that changes in diet, activity, and stress level can affect blood glucose level and insulin requirements.
• Advise patient to wear medical identification stating that he is diabetic and takes insulin.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs, tests, herbs, and behaviors mentioned above.