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 Company has developed and commercialized a range of Biosimilars (Monoclonal Antibodies, Pegfilgrastim, rh- Insulin and Insulin Glargine), Novel Biologics and differentiated Small Molecules in India and key emerging markets.
On that basis, patients in the control group were subcutaneously injected with insulin glargine (Sanofi-Aventis Deutschland Gmb H, batch number: J2014052), 10 U each time, once a day, and the dose was adjusted according to the actual blood glucose level of patients.
Insulin glargine U300 takes the benefits of insulin to the next level, thus providing physicians a better tool to empower their diabetic patients, offering them insulin with lowest risk of hypoglycemia and being safest in reaching optimal glucose control.
For the first 4 days, it may be seen the diabetic ketoacidosis on the patients who have type 1 DM and, as in this case, longterm type 2 DM with decreased insulin reserve, who are newly administered insulin glargine U300 due to inadequate plasma basal insulin.
Ayers asks, "Why is the insulin glargine scheduled at bedtime?
One fixed-ratio product combines insulin glargine U-100 with lixisenatide (IGlarLixi) and the other combines insulin degludec U-100 with liraglutide (IDegLira).
The dosing instructions for insulin glargine vary depending on whether patients use the older SoloStar or the high-capacity Max SoloStar.
Spending on drugs used by patients with diabetes, 2015 Billions of dollars Insulin glargine 1 Rosuvastatin 2 Atorvastatin 4 Insulin aspart 7 Sitagliptin 8 Insulin isophane (NPH) 9 Pregabalin 10 Gabapentin 11 Insulin detemir 12 Metformin 14 Insulin lispro 16 Metformin-sitagliptin 20 The number in each bar represents the drug's place in the top 20 for spending for all drugs.
According to the company, in the trial, the primary endpoint was achieved by demonstrating non-inferiority of major adverse cardiovascular events (MACE) with Tresiba compared to insulin glargine U100.
In 2012, Sanofi started a project to validate an experimental in vitro test as an alternative to the rabbit bioidentity assay with two objectives: The first objective was to enable the export of drugs containing insulin glargine to the US without animal experiments and the second objective was to achieve the inclusion of the in vitro method as an alternative to the rabbit bioidentity assay in the USP for all insulins for the US market.
The medication is a follow-on insulin to Sanofi's top-selling Lantus, another U-100 insulin glargine. Basaglar has an amino acid sequence that is identical to Lantus but is not approved as a biosimilar.
Insulin degludec: four times lower pharmacodynamic variability than insulin glargine under steady-state conditions in type 1 diabetes.