glargine (Lantus, Basaglar, Toujeo, Semglee, opticlick pen)
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Introduction
A long-acting synthetic insulin, differing from human insulin by 3 amino acids.
Lantus is clear, NOT cloudy.
Dosage
- once daily (QHS)*, no maximum dose
- may be combined with lispro (Humalog) or oral hypoglycemic agents
- when switching from NPH to glargine, use same dose if NPH given QD, 20% less if NPH given BID
- 10 units QHS is usual starting dose[6]
- patient-managed dosing may be as good as physician- managed dosing[6]
* AM dosing more appropriate for some patients[3] BID dosing may be required for some patients[3]
Do NOT mix glargine with other insulins.
Discard 28 days after opening[4].
Do not store prefilled plastic syringe > 24 hours, use Detemir if prefilled syringes need to be stored
Opticlick pen useful for patients with dexterity or vision problems
Pharmacokinetics
- slow release from tissues resulting in relatively constant insulin levels over 24 hours.
Adverse effects
- less nocturnal hypoglycemia & weight gain than with NPH
- local irritation at site of injection (glargine more acidic than other insulins)
- hypersensitivity
- common adverse effects:
- serious adverse effects:
- reports of glargine associated with cancer risk
Notes
- daily glargine improves glycemic control in type 2 diabetics[7]
- Basaglar December of 2016 will be less expensive than Lantus[6]
- hypoglycemia & glycemic control no better with glargine than with neutral protamine Hagedorn insulin[11]
More general terms
References
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
- ↑ Journal Watch 21(1):1, 2001 Diabetes Care 23:1666, 2000
- ↑ 3.0 3.1 3.2 Prescriber's Letter 10(4):19-20 2003
- ↑ 4.0 4.1 Prescriber's Letter 10(8):47 2003
- ↑ Prescriber's Letter 12(6): 2005 Lantus OptiClik Pen Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=210602&pb=PRL (subscription needed) http://www.prescribersletter.com
- ↑ 6.0 6.1 6.2 6.3 6.4 6.5 Journal Watch 25(14):111, 2005 Davies M, Storms F, Shutler S, Bianchi-Biscay M, Gomis R. Improvement of glycemic control in subjects with poorly controlled type 2 diabetes: comparison of two treatment algorithms using insulin glargine. Diabetes Care. 2005 Jun;28(6):1282-8. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15920040
- ↑ 7.0 7.1 Kennedy L et al, Impact of active versus usual algorithmic titration of basal insulin and point-of-care versus laboratory measurement of HgbA1c on glycemic control in patients with type 2 diabetes: The Gycemic Optimization with Algorithms and Labs at point of care (GOAL A1C) trial Diabetes Care 2006; 29:1 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16373887
- ↑ Lantus insulin: a possible link with cancer which requires further investigation http://www.diabetologia-journal.org/cancer.html comment: includes list of full text articles (PDF)
Prescriber's Letter 16(8): 2009 COMMENTARY: Is Lantus Associated With An Increased Risk of Cancer? CHART: Comparison of Insulins Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=250802&pb=PRL (subscription needed) http://www.prescribersletter.com - ↑ Lowes R Insulin Glargine Copycat (Basaglar) Okayed by FDA. Medscape. Dec 17, 2015 http://www.medscape.com/viewarticle/856085
FDA News Release. December 16, 2015 FDA approves Basaglar, the first "follow-on" insulin glargine product to treat diabetes. http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm477734.htm - ↑ 10.0 10.1 Blonde L et al. Once-weekly dulaglutide versus bedtime insulin glargine, both in combination with prandial insulin lispro, in patients with type 2 diabetes (AWARD-4): A randomised, open-label, phase 3, non-inferiority study. Lancet 2015 May 23; 385:2057 PMID: https://www.ncbi.nlm.nih.gov/pubmed/26009229
- ↑ 11.0 11.1 Lipska KJ, Parker MM, Moffet HH, Huang ES, Karter AJ Association of initiation of basal insulin analogs vs neutral protamine Hagedorn insulin with hypoglycemia-related emergency department visits or hospital admissions and with glycemic control in patients with type 2 diabetes. JAMA 2018 Jul 3; 320:53. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29936529 https://jamanetwork.com/journals/jama/fullarticle/2685850
Crowley MJ, Maciejewski ML. Revisiting NPH insulin for type 2 diabetes: Is a step back the path forward? JAMA 2018 Jul 3; 320:38. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29936528 https://jamanetwork.com/journals/jama/fullarticle/2685849