insulin glargine

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insulin glargine (rDNA origin)


Pharmacologic class: Pancreatic hormone

Therapeutic class: Hypoglycemic

Pregnancy risk category C


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.


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


• Hypersensitivity to drug or its components
• Hypoglycemia


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


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.

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


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.

insulin glargine

A long-acting insulin analog whose amino acid sequence differs from that of human insulin by the substitution of glycine for asparagine at one end of the A chain and the addition of two arginines to the B chain, used in the treatment of type 1 and type 2 diabetes.

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.

rDNA insulin

A single-dose insulin created by recombinant DNA technology.

Adverse effects
Hypoglycaemia, lipodystrophy, skin reactions (e.g., local irritation, pruritus, rash).

insulin glargine

A basal human insulin analogue modified so as to produce peakless release and a duration of effective action in DIABETES of as long as 24 hours. A brand name is Lantus.
References in periodicals archive ?
A third recombinant insulin that is longer acting is insulin glargine (Lantus[R]; Aventis Pharmaceuticals), which differs from regular human insulin by the substitution of glycine for asparagine at position A21 and by the addition of two arginine residues to the COOH terminus of the B chain.
Less Hypoglycemia Seen with Pump Therapy Compared to Insulin Glargine
The development of insulin glargine enhances that rich heritage and underscores our ongoing commitment to offer novel products that will help people with diabetes to achieve better control of the disease," said Frank L.
The Pipeline Developer report covers Insulin Glargine Insulin Glargine indications: Treatment of type 1 and type 2 diabetes mellitus for the control of hyperglycaemia Insulin Glargine innovator: Sanofi-Aventis (Lantus, Lantus Optiset, Lantus Solostar, Optisulin, Optisulin Optiset, Optisulin Solostar)
Mylan CEO Heather Bresch commented, "The PTAB's decision to institute IPR proceedings against the two Orange Book-listed patents for Lantus is another step forward in our ongoing efforts to bring an interchangeable insulin glargine to diabetes patients as soon as possible.
The aim of the trial was to evaluate the safety and efficacy of Xultophy in comparison to basal-bolus therapy in adults with type 2 diabetes that were previously treated with insulin glargine U100 and metformin.
The first fixed-ratio combination product approved in the United States combines insulin glargine U-100 and the GLP1RA lixisenatide (iGlarLixi).
Keywords: Degludec, detemir, glargine, insulin, NPH, U300 glargine.
Long-acting insulin products like insulin glargine play an important role in the treatment of types 1 and 2 diabetes melitus, and today's approval is expected to expand the availability of treatment options for health care professionals and patients," said Dr.
A prospective metaanalysis of phase Ma trials comparing insulin degludec with insulin glargine showed that type 1 diabetes patients who were on degludec had a statistically significant 17% lower rate of nocturnal hypoglycemia across the entire treatment period and a 25% lower rate over the maintenance period (16 weeks onward), compared with those on glargine (Diabetes Obes.
Patients were randomized to either glargine (Lantus; Aventis) or human premix insulin (mixture of 30% neutral soluble insulin and 70% isophane insulin) to be administered subcutaneously at bedtime (glargine) or twice a day (human premix insulin), using a pen injector or insulin syringe as preferred by patient for 24 weeks.
Olsson and coworkers also looked at the relationship between the antidiabetic medications metformin and glargine and cancer risk among all patients in the cancer registry, not just those with breast cancer.