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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
Use cautiously in:
• pregnant or breastfeeding patients
☞ 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.
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
• 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.
• 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.
rDNA insulinA single-dose insulin created by recombinant DNA technology.
Hypoglycaemia, lipodystrophy, skin reactions (e.g., local irritation, pruritus, rash).