insulin glargine

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insulin glargine (rDNA origin)

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.

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.

insulin glargine

(glär′jēn′)
n.
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.

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 ?
The recombinant human Insulin (rh-Insulin) and Insulin Glargine manufactured at this facility are addressing the needs of over 350,000 diabetic patients in Malaysia.
In this study, insulin glargine and insulin analogue acarbose were used in elderly patients with diabetes, and the effect of treatment was analyzed.
According to the company, Soliqua 100/33 is an injectable prescription medicine that contains 2 diabetes medicines, insulin glargine and lixisenatide, which may improve blood sugar (glucose) control in adults with type 2 diabetes when used with diet and exercise.
The basil insulin, upgraded generation of insulin glargine, was established to address unmet need of diabetics control as often blood sugar levels in patients with diabetes is increasingly reported to remain suboptimal.
Caprio, a pediatric endocrinologist at Yale University, New Haven, Conn., and her colleagues enrolled 91 youth who were randomized to one of two treatment arms: metformin alone titrated over 4 weeks from 500 mg/day to a 1,000 mg twice daily dose (modified if necessary for GI symptoms), or to glargine followed by metformin.
Insulin detemir, which was used by the patient, was replaced with glargine U300 U/mL, 30 units once daily because of the hypoglycemia at night and the high blood sugar levels in the evening.
(30) After a 12-week period to optimize the dose of insulin glargine (mean dose 61 units/d), patients with Alc >7.0% (N=627) were randomized to exenatide 5 to 10 meg twice daily or insulin lispro 3 times per day titrated to achieve a premeal glucose concentration of 100 to 108 mg/dL.
Edelstein and colleagues randomized 91 pubertal, overweight/obese 10 to 19-year-old youths with IGT (60 percent) or type 2 diabetes of less than six months duration (40 percent) to either three months of insulin glargine followed by nine months of metformin or to 12 months of metformin alone.
Comparison among Baseline, after Exenatide and Glargine Treatment.
DEVOTE is a randomised, multinational and double-blinded trial conducted to confirm the cardiovascular safety of Tresiba, as compared to insulin glargine U100 when added to standard of care, in people with type 2 diabetes.
Insulin glargine is the drug substance in drugs like Lantus[R] and Toujeo[R] that are produced by Sanofi in Frankfurt and exported to the US, amounting to more than 4 billion USD in 2015 (2).
launched Basaglar (insulin glargine injection 100 units/ml), a long-acting insulin for type 1 and type 2 diabetes, and Sanofi released Soliqua 100/33 (insulin glargine 100 units/ml and lixisenatide 33 mcg/ml injection), used in the treatment of type 2 diabetes.