Insulin Glargine

Insulin Glargine is a sterile solution for subcutaneous injection. It is a recombinant human insulin analog that is a long-acting (up to 24-hour) parenteral blood glucose lowering agent. Its primary function is regulation of glucose metabolism. It lowers blood glucose by stimulating peripheral glucose uptake (primarily by skeletal muscle and fat) and by inhibiting hepatic glucose production. Insulin inhibits lipolysis and proteolysis and enhances protein synthesis.

• Type 1 diabetes mellitus in adults and children
• Type 2 diabetes mellitus in adults

Adult Dose (Subcutaneous):

• Type 1 Diabetes: Recommended starting dose: approximately one-third of total daily insulin requirements; short-acting premeal insulin used for remainder
• Type 2 Diabetes (insulin-naïve): 10 units (or 0.2 units/kg) once daily
• Conversion from other insulins: Once-daily NPH: same dose; Twice-daily NPH: 80% of total NPH dose
• Once daily at any time (preferably same time); relatively constant glucose-lowering profile over 24 hours

Child Dose (Type 1, ≥6 years): Approximately one-third of total daily insulin requirements; adolescents <1.2 units/kg/day during growth spurts

Side Effects:

• Hypoglycemia
• Allergic reactions
• Injection site reactions
• Lipodystrophy
• Pruritus
• Rash

Precautions:

• Renal or hepatic impairment may require dose reduction
• Blood glucose should be monitored in all patients treated with insulin
• Insulin regimens should be modified cautiously and only under medical supervision
• Insulin Glargine must not be diluted or mixed with any other insulin or solution
• Do not administer IV or via insulin pump (severe hypoglycemia can occur)

Contraindications:

• Hypersensitivity to insulin glargine or any excipients

Drug Interactions:

• Oral anti-diabetic products, ACE inhibitors, disopyramide, fibrates, fluoxetine, MAOIs, propoxyphene, pentoxifylline, salicylates, sulfonamide antibiotics reduce insulin requirements
• Thiazides, glucocorticoids, thyroid hormones, beta-sympathomimetics, growth hormone, danazol increase insulin requirements
• Beta-blockers, clonidine, lithium salts, alcohol may either potentiate or weaken insulin effect

Food Interactions: It is unsafe to consume alcohol with Insulin Glargine.

Use in Pregnancy: Category C; use only if potential benefit justifies potential risk to fetus; animal studies have shown harmful effects.

Use in Lactation: Unknown if excreted in human milk; caution due to many drugs (including human insulin) excreted in human milk; lactating women may require adjustments in insulin dose and diet.

Renal Impairment: Dose reduction may be required; regular blood glucose monitoring recommended.

Hepatic Impairment: Dose reduction may be required; regular blood glucose monitoring recommended.

Overdose: May result in hypoglycemia; mild episodes treated with oral carbohydrates; severe hypoglycemia treated with parenteral glucose or glucagon injections; adjustments in drug dosage, meal patterns, or exercise may be needed.