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glargine (Lantus, Basaglar, Toujeo, Semglee, opticlick pen)

A long-acting synthetic insulin, differing from human insulin by 3 amino acids. Lantus is clear, NOT cloudy. Dosage: 1) once daily (QHS)*, no maximum dose 2) may be combined with lispro (Humalog) or oral hypoglycemic agents 3) when switching from NPH to glargine, use same dose if NPH given QD, 20% less if NPH given BID 4) 10 units QHS is usual starting dose [6] 5) 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: 1) less nocturnal hypoglycemia & weight gain than with NPH 2) local irritation at site of injection (glargine more acidic than other insulins) 3) hypersensitivity 4) common adverse effects: - hypoglycemia (80%) [10] - allergic reactions, edema, itching, lipodystrophy, weight gain [6] 5) serious adverse effects: - anaphylaxis, angioedema, bronchospasm, hypotension, shock [6] 6) 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]

Interactions

drug adverse effects of hypoglycemic agents

General

insulin analog (synthetic insulins, recombinant insulins) recombinant protein; chimer

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 11, American College of Physicians, Philadelphia 1998
  2. Journal Watch 21(1):1, 2001 Diabetes Care 23:1666, 2000
  3. Prescriber's Letter 10(4):19-20 2003
  4. Prescriber's Letter 10(8):47 2003
  5. Prescriber's Letter 12(6): 2005 Lantus OptiClik Pen Detail-Document#: 210602 (subscription needed) http://www.prescribersletter.com
  6. 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: 15920040
  7. 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: 16373887
  8. 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#: 250802 (subscription needed) http://www.prescribersletter.com
  9. 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. 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: 26009229
  11. 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: 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: 29936528 https://jamanetwork.com/journals/jama/fullarticle/2685849

Component-of

glargine/lixisenatide