What is Insulin glargine?
Insulin glargine is a long-acting artificial diabetes medicine that is meant to mimic human insulin. It is prescribed for the treatment of type 1 diabetes (when the body does not produce insulin hence becomes unable to control blood glucose level) and type 2 diabetes ( when the body cannot use insulin adequately, thereby becomes unable to control the blood glucose level). This drug is recommended for all people with diabetes above the age of six, however, some types of Insulin glargine are prescribed for diabetic adults only.
Insulin glargine can be used in combination with another type of insulin or with other oral administered diabetes medicines used in the treatment of type 2.
How does it work?
Insulin glargine is designed to compensate for the naturally produced insulin, promotes the body tissues absorption of sugar from the blood and inhibits hepatic glucose production
To avoid complications that may occur to diabetic people who also suffer from high blood sugar including: strokes, kidney disorders, heart diseases, eye issues, certain precautions have to be put into consideration
- Adopting a healthy lifestyle
- Using medications
- Checking glucose level in the blood
Insulin glargine is proven to help with decreasing the chances of strokes, kidney failure, nerve damage, gum problems, and eye issues
Is there any precautions to be considered before taking Insulin glargine?
Your attendant physician must be consulted before using Insulin glargine in the following cases:
- Pregnancy/preparing for pregnancy or lactation
- having a scheduled surgery
- Allergy to insulin, any ingredients of insulin glargine or to other medicines
- Consuming alcohol as it may change glucose level in the blood
- Suffering from kidney or liver disorders
- Suffering from heart failure or any other heart disease
- Taking other oral diabetes medicines
- Being under the age of six
- Experiencing/ have previously experienced nerve damage caused be specific health circumstances including heart complications, kidney or liver failure, diabetes and decrease of potassium level in the blood
- Briefing your doctor on any other medications, vitamins, nutritional supplements or herbal products you are consuming particularly medicines containing alcohol, albuterol,as well as, medications for asthma and colds; medications for mental illness and nausea, angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin receptor blockers (ARBs), atypical antipsychotics, sulfa antibiotics, beta-blockers, certain cholesterol-lowering medications, HIV protease inhibitors, hormone replacement therapy, oral contraceptives, monoamine oxidase inhibitors, oral medications for diabetes, oral steroids, salicylate pain relievers, and thyroid medications.
Ask your doctor about:
- What should be done when you feel sick, change your dietary system, start to exercise… etc, as such transformations may influence blood glucose level thereby the amount of insulin needed
- If you need to measure blood glucose level before using machines or driving, and how many times should this be needed
Insulin glargine forms and usage :
Insulin glargine comes in two forms:
- Injectable solution (100 units/mL) 2. Prefilled pen (100 units/mL and 300 units/mL)
The dosage prescribed for type 1 diabetes patients:
Long-acting basal insulin (meant to enhance glycemic control):
The initial dose for insulin-naïve patients: patients should begin with one third only of the daily dose then follow it with short-acting premeal insulin (two-thirds of the daily dose). This initial dose which is usually between 0.2 to 0.4 units per kg, may not fulfill the metabolic needs in the first 24 hours of use and a decreased glucose level may not be reached before five days.
The dosage prescribed for type 2 diabetes patients:
Long-acting basal insulin (meant to enhance glycemic control):
The initial dose for insulin-naïve patients: patients should begin with 0.2 units per kg a day, the dose of the other diabetes medications has to be adjusted accordingly to avoid the occurrence of hypoglycemia
Insulin glargine interactions with other medications:
It is established that Insulin glargine interacts with 361 medicines (interaction with 15 of which may result in serious consequences, 306 of which are known to interact with Insulin glargine in a moderate manner, whereas interaction with the rest 40 drugs is considered minor)
Switching from other types of insulin drugs to Insulin glargine:
- Switching from the treatment with intermediate or long-acting insulin to the treatment with Insulin glargine: patients have to modify the dosing amount and timing of shorter-acting insulin -same goes for any oral diabetes medicine. Patients who use Lantus may need to increase their daily dose of Toujeo to preserve the level of glycemic control.
- Switching from once-daily NPH insulin to once-daily insulin glargine: The same dose of NPH (that is due to be abandoned) from insulin glargine has to be taken as an initial dose
- Switching from twice-daily NPH insulin to once-daily insulin glargine: Patients should consume only 80% of the usual daily NPH dose (that is due to be abandoned) as an initial dose in order to decrease the chance of hypoglycemia occurrence
- Switching from intermediate-to-long acting insulins to Toujeo: Initial dose of Toujeo should be the same dose as that of the once-daily long-acting medicine to reduce the risk of hypoglycemia. Patients who use Lantus may need to increase their daily dose of Toujeo to preserve the level of glycemic control.
- Switching from intermediate-to-long-acting insulins to Lantus: When patients shift from the treatment with intermediate- or long-acting insulin to the treatment with Lantus or Basaglar, the dose of basal insulin could change, also the dosing amount and timing of shorter-acting insulins and any oral diabetes medications should be modified accordingly.
- Switching from once-daily Toujeo to once-daily Lantus or Basaglar: Patients should consume only 80% of the usual daily Toujeo dose (that is due to be abandoned) as an initial dose, in order to decrease the chances of hypoglycemia occurrence
Storage and disposal recommendations:
First: All medicines should be safely kept out of the reach and sight of children, especially those which can be easily opened like creams, eye drops, inhalers…etc
Second: Preserve the drug in its original container out of children’s reach, preserve unused vials and pens in the fridge – they can be preserved in the fridge till the expiry date written on the drug label is due – but make sure not freeze insulin glargine and never use the drug in case it got frozen then defrosted
Third: Insulin glargine vials and pens can be preserved in room temperature away from direct sunlight in case they could not be kept in a fridge. In such an event, they have to be used within 28 days only. Opened vials can be preserved either in the fridge or at room temperature for 28 days from opening as well. Insulin vials or pens which were kept in extremely cold or extremely hot circumstances must be discarded
Fourth: Great caution has to be given to the disposal of unwanted drugs to avoid being consumed by others.
Important tips on drug usage:
- It should be used exactly as indicated
- It should be noted that Insulin glargine does not cure diabetes it rather controls it, so patients may not stop using it unless with the doctor’s consultation. Similarly, they may not change their dose or switch to another type of insulin without consultation. Insulin glargine must not be used when the blood glucose level is decreased
- Injectable Insulin glargine is injected under the skin once a day at a fixed time
- It should not be injected into a vein or a muscle.
- Never inject Insulin glargine unless the liquid is clear and colorless
- It should not be taken using an insulin pump and should not be mixed with other types of insulin.
- In case of using an injection pen, you may use the original injection pen only which comes with the medicine
- Do not transfer the medicine into a syringe
- Use a new needle every time
- Never share pens or needles
- Dispose of with used needles or pens in puncture-resistant containers
- Keep a constant healthy eating pattern
- Keep a fast-acting source of glucose as candies, raisins,…etc in case you experienced a low blood glucose ( hypoglycemia) incident, you may need glucagon emergency injection kit if the hypoglycemia was acute
- Pay attention to signs such as headache, blurred vision, thirst …etc, they may be an indication to hyperglycemia (high blood sugar)
What should be done in case of excessive or missed doses?
- Excessive doses of insulin may lead to deadly hypoglycemia, in case you exceeded the administered dose you have to contact the Poison Helpline immediately
- Consult your doctor if you have missed your daily dose (no more than one dose daily is allowed), it is recommended to keep a reserve refill of Insulin glargine to avoid missing any doses.
Issues for consideration:
- You must consult your doctor before you attempt to change the timing or amount of doses provided that your blood glucose level is observed
- Your dose is determined according to your own clinical response, however, it is very important for all people with diabetes who are under insulin treatment to watch their blood glucose level constantly
- Dosing of Titrate Toujeo: Treatment with Titrate Toujeo may not exceed one dose every 3 to 4 days
- Patients who suffer from vision loss should take great care when handling their insulin doses
What are the expected side effects of Insulin glargine?
Insulin glargine can affect blood glucose level, thus patients should be aware of the symptoms of both Hypoglycemia (low blood glucose) and hyperglycemia (high blood glucose) and should be able to deal with them if they occur
- Serious side effects due to the treatment with Insulin glargine, which require immediate help, as soon as you start to notice any of them include:
- Swelling of the face, eyes, tongue, lips, or throat
- Swelling of ankles or feet
- Rash, hives, or itching over the whole body
- Difficulty swallowing /breathing and wheezing
- Increased pulse rate and abnormal heartbeat
- Weakness and sweating
- Muscle cramps and decreased potassium level
- Gaining weight rapidly
- Increased thirst or urination
- Vision issues
- Common side effects of Insulin glargine, which necessitates your doctor interference if they persist, include:
- Sore Throat
- Redness, swelling or itching at the spot of injection
- Decreased blood pressure
- Skin thickening or hollowing