Insulin Glargine

Drug Information: Insulin Glargine

Insulin Glargine is a long-acting, basal insulin analog used to manage blood sugar levels in individuals with diabetes mellitus, including both type 1 and type 2 diabetes. It provides a slow and steady release of insulin over an extended period (up to 24 hours or longer), mimicking the natural basal insulin secretion of a healthy pancreas. This helps control blood glucose levels between meals and during the night, reducing the need for frequent insulin injections. Unlike shorter-acting insulins used to cover mealtime carbohydrates, Insulin Glargine aims to provide a stable background level of insulin.

Category

Hormones – Insulin

Mechanism of Action

Insulin Glargine lowers blood glucose by stimulating peripheral glucose uptake, especially by skeletal muscle and fat, and by inhibiting hepatic glucose production. Insulin binds to insulin receptors on these cells, initiating a cascade of intracellular events. This binding promotes the translocation of GLUT4 glucose transporters to the cell surface, facilitating glucose entry into the cells. In the liver, insulin suppresses glucose production by inhibiting glycogenolysis (breakdown of glycogen to glucose) and gluconeogenesis (synthesis of glucose from non-carbohydrate sources). Insulin Glargine’s prolonged action is due to its unique formulation. After subcutaneous injection, it forms micro-precipitates that slowly release insulin monomers into the circulation, resulting in a relatively constant insulin concentration over an extended period. This minimizes peak concentrations and provides a more predictable and sustained glucose-lowering effect compared to shorter-acting insulins.

Clinical Uses

Insulin Glargine is primarily used as a basal insulin replacement in the management of both type 1 and type 2 diabetes mellitus. Its primary clinical use is to provide a consistent, long-lasting background insulin level to help maintain stable blood glucose levels throughout the day and night. This is particularly useful in patients who experience significant fluctuations in blood sugar, especially fasting hyperglycemia or nocturnal hypoglycemia. Insulin Glargine is often used in conjunction with rapid-acting or short-acting insulins taken before meals to cover carbohydrate intake. It is also used in insulin pump therapy as a basal insulin option. In type 2 diabetes, it may be used alone or in combination with oral antihyperglycemic agents. The goal of using Insulin Glargine is to improve glycemic control, reduce the risk of long-term complications associated with diabetes, such as cardiovascular disease, neuropathy, nephropathy, and retinopathy, and to improve the patient’s overall quality of life.

Dosage

Route of Administration: Subcutaneous injection only. Do not administer intravenously or intramuscularly.

Adult Dosage: Dosage is individualized and based on metabolic needs, blood glucose monitoring results, and glycemic control goals. Typically, the starting dose ranges from 0.2 to 0.4 units/kg per day. This is usually administered once daily at the same time each day. Dosage adjustments are made based on the patient’s glycemic response.

Pediatric Dosage: The dosage is individualized similarly to adults, starting with a low dose (e.g., 0.1 to 0.2 units/kg/day) and adjusting based on blood glucose monitoring. Careful monitoring is crucial.

Important Considerations:

• Rotate injection sites to prevent lipodystrophy (changes in fat tissue).
• Do not dilute or mix Insulin Glargine with other insulins.
• Administer at the same time each day.
• Closely monitor blood glucose levels, especially when starting Insulin Glargine or making dosage adjustments.

Indications

* Type 1 Diabetes Mellitus
* Type 2 Diabetes Mellitus (when other treatments are inadequate)
* Basal Insulin Replacement Therapy
* Management of Hyperglycemia

Contraindications

* Hypersensitivity to Insulin Glargine or any of its excipients.
* Hypoglycemia: Insulin Glargine is contraindicated during episodes of hypoglycemia.

FAQ

Q: What is Insulin Glargine used for?
A: Insulin Glargine is a long-acting insulin used to control blood sugar in people with diabetes. It provides a steady, background level of insulin for 24 hours or longer.

Q: How often should I inject Insulin Glargine?
A: Insulin Glargine is usually injected once a day, at the same time each day. Follow your doctor’s instructions carefully.

Q: Where should I inject Insulin Glargine?
A: Inject Insulin Glargine subcutaneously into the abdomen, thigh, or upper arm. Rotate injection sites to avoid lipodystrophy.

Q: What are the common side effects of Insulin Glargine?
A: Common side effects include hypoglycemia (low blood sugar), injection site reactions (redness, swelling, itching), and weight gain.

Q: What should I do if I experience hypoglycemia while taking Insulin Glargine?
A: Treat hypoglycemia immediately with a fast-acting source of sugar, such as glucose tablets, juice, or regular soda. Contact your doctor if you experience frequent or severe hypoglycemic episodes.

Q: Can I mix Insulin Glargine with other insulins?
A: No, Insulin Glargine should not be mixed with other insulins.

Q: How should I store Insulin Glargine?
A: Unopened Insulin Glargine vials or pens should be stored in the refrigerator (36°F to 46°F [2°C to 8°C]). Once opened, they can be stored at room temperature (below 86°F [30°C]) for a specified period (usually 28 days). Refer to the product label for specific instructions.

Q: What should I do if I miss a dose of Insulin Glargine?
A: If you miss a dose, inject it as soon as you remember, unless it is almost time for your next dose. In that case, skip the missed dose and continue with your regular schedule. Do not double the dose to make up for a missed one. Contact your doctor for specific guidance.