by What is Insulin Glargine?
Insulin glargine, also known by the brand names Lantus and Abasaglar, is a type of long-acting basal insulin used to treat diabetes. It is a synthetic man-made insulin that is designed to constantly provide a steady supply of insulin at a low-level throughout a 24-hour period. Unlike short-acting insulins which have a peak effect, glargine has no pronounced peak in activity.
How does Insulin Glargine Work?
Insulin glargine works by mimicking the body’s own basal insulin levels. In people without diabetes, the pancreas naturally secretes a steady supply of insulin over 24 hours to keep blood sugar levels stable between meals and overnight. Glargine attempts to replicate this basal insulin profile by forming a soluble compound with the injection site that gradually releases insulin. Once injected, glargine precipitates from its clear solution forming a gel depot that slowly dissolves. This allows it to have a longer duration of action ranging from 16-24 hours compared to regular human insulin which peaks at around 4-6 hours.
What are the Indications for Insulin Glargine?
Insulin Glargine is primarily used for type 1 diabetes to mimic the body’s nighttime basal insulin requirements. However, it may also be prescribed for some type 2 diabetics who require basal insulin supplementation either alone or along with oral medications and/or rapid-acting insulin. Specifically, insulin glargine is indicated for:
– Type 1 Diabetes: Glargine is a key part of insulin replacement therapy for type 1 diabetes which destroys the body’s natural insulin-producing cells. It helps manage blood sugar levels 24 hours a day.
– Type 2 Diabetes: For some patients with type 2 diabetes who cannot control blood sugar on oral medications alone, glargine may be added to provide continuous basal insulin coverage. It is often used in combination with rapid-acting insulin before meals.
– Gestational Diabetes: Pregnant women with gestational diabetes developing during pregnancy may need glargine to maintain healthy glucose levels that are safe for the developing fetus.
– Other Conditions: Glargine may occasionally be used off-label for other diseases where tight glycemic control is important like cystic fibrosis and steroid-induced diabetes.
How is Insulin Glargine Administered?
Insulin glargine comes in a solution for injection under the skin (subcutaneously) via an insulin syringe or insulin pen. It should always be administered at the same time each day, preferably at bedtime, to maintain steady blood sugar levels overnight and between meals. The injection site should be alternated between the abdomen, thighs, buttocks, or upper arms to prevent fatty tissue build-up under the skin. Glargine has a relatively flat dose-response curve meaning small variations in the dose will not cause large swings in blood sugar levels compared to short-acting insulins.
Advantages of Insulin Glargine
The main advantages of glargine over other basal insulins include:
– Longer duration of action up to 24 hours providing consistent basal insulin coverage.
– No pronounced peak in activity providing a smooth continuous release profile.
– Predictable absorption kinetics leading to consistent glucose-lowering effect.
– Lower risk of nocturnal hypoglycemia compared to NPH.
– Convenient once-daily dosing providing prolonged glycemic control.
– Flexible injection timing allowing dosing based on lifestyle and food habits.
Limitations and Side Effects
While insulin glargine offers improvements over older basal insulins, it still comes with some limitations and risks:
– Hypoglycemia: Like all insulin therapies, glargine carries a risk of hypoglycemia, especially if a dose is taken without eating or during intense physical activity.
– Injections: Patients must give themselves daily injections which some may find inconvenient or difficult to adhere to consistently.
– Weight Gain: By facilitating glucose entry into cells, exogenous insulin can potentially promote weight gain over time if calorie intake is not adjusted.
– Allergic Reactions: Rare cases of local or systemic allergic reactions have occurred with insulin glargine injections in susceptible individuals.
– Expense: Glargine is more expensive than older basal insulins like NPH due to patented modifications and production costs which may impact accessibility.
Ongoing research continues to develop newer basal insulins with improved pharmacokinetic profiles. One such example is insulin degludec which provides an ultra-long duration of action for over 42 hours with an even smoother release than glargine. Additional advances aim to produce inhaled or oral insulin formulations that don’t require daily injections. However, insulin glargine remains an effective basal insulin option and the standard of care for around-the-clock diabetes management for many patients globally. With proper use, monitoring and physician guidance, it provides reliable glycemic control and quality of life benefits.
