Action and Spectrum

Actions and Spectrum: 

Actions:

insulin glargine works by lowering blood sugar levels in the body. It mimics the action of natural insulin produced by the pancreas and helps the body to use glucose for energy. It does this by facilitating the uptake of glucose by cells, stimulating the conversion of glucose into glycogen and fat, and inhibiting the production of glucose by the liver. 

Spectrum:

insulin glargine has a relatively flat and consistent activity profile, with a peakless and prolonged action that lasts for up to 24 hours. This allows for once-daily dosing in most individuals. However, the onset and duration of action may vary depending on the individual’s metabolism and dosage. In general, it takes about 1-2 hours for the insulin to start working, and its effect lasts for about 24 hours. 

Drug Interaction

Adverse Reaction

Frequency not Defined 

Headache 

Dyspepsia 

Influenza-like symptoms 

Diarrhea 

Pharyngitis 

Back pain 

Lipodystrophy 

Pallor 

Lipohypertrophy 

Palpitation 

Local allergic reaction 

Tachycardia 

Peripheral edema  

Hypokalemia 

Black Box Warning

Contraindication / Caution

Contraindication/Caution: 

Contraindications: 

• Hypersensitivity: insulin glargine should not be used in individuals who have a known hypersensitivity to insulin glargine or any of the ingredients in the formulation. 
• Diabetic Ketoacidosis: insulin glargine should not be used to treat diabetic ketoacidosis, a serious condition that requires immediate medical attention. 

Caution: 

• Hypoglycemia: insulin glargine may cause hypoglycemia, or low blood sugar, which can be dangerous. Individuals who use insulin glargine should be aware of the signs and symptoms of hypoglycemia, such as sweating, shakiness, dizziness, confusion, and fast heartbeat. 
• Renal or hepatic impairment: insulin glargine should be used with caution in individuals with renal or hepatic impairment, as their ability to metabolize and excrete the drug may be impaired. 
• Pregnancy and breastfeeding: insulin glargine can be used during pregnancy and breastfeeding, but the dosage may need to be adjusted. Pregnant or breastfeeding individuals should consult with their healthcare provider before using insulin glargine. 
• Interactions: insulin glargine may interact with other medications, including certain oral hypoglycemic agents, glucocorticoids, and beta-blockers. Individuals who use these medications should consult with their healthcare provider before using insulin glargine. 

Pregnancy / Lactation

Pregnancy consideration:  

It is not secure to administer insulin glargine during pregnancy. 

Breastfeeding warnings:  

No data about the excretion of insulin glargine in human breast milk is available. Avoid using in lactating women. 

Pregnancy category: 

• Category A: Satisfactory and well-controlled studies show no risk to the fetus in the first or later trimester. 
• Category B: No evidence of risk to the fetus is found in animal reproduction studies, and there are not enough studies on pregnant women. 
• Category C: Adverse effects on the fetus found with evidence in animal reproduction studies and no adequate evidence for a human product; Pregnant women must take care of the potential risks. 
• Category D: There is adequate data with sufficient evidence of human fetal risk from various platforms. However, despite potential dangers may be used only in emergencies for potential benefits. 
• Category X: Drugs listed in this category outweigh the risks over benefits. The drug is not for pregnant women. 
• Category N: No data is available for the drug under this category. 

Pharmacology

Pharmacology: 

insulin glargine is a long-acting insulin analogue that is designed to provide a steady and prolonged effect on blood glucose levels in the body. It is used to treat diabetes mellitus in both Type 1 and Type 2 diabetes. 

Pharmacodynamics: 

insulin glargine binds to the insulin receptor on cell surfaces, which activates a signaling cascade that facilitates glucose uptake by cells, glucose conversion to glycogen, and glucose storage as fat. The insulin receptor is a tyrosine kinase receptor that activates a series of intracellular signaling pathways, including the PI3K/Akt pathway, the Ras/MAPK pathway, and the mTOR pathway.

These pathways regulate gene expression, protein synthesis, cell growth, and metabolism. The net effect of insulin glargine on these pathways is to reduce blood glucose levels and maintain normal glucose metabolism. 

insulin glargine has a relatively slow onset of action, with a peakless and prolonged activity profile that lasts up to 24 hours. The slow and steady release of insulin glargine into the bloodstream helps to maintain a stable level of insulin activity throughout the day and night. This reduces the risk of hypoglycemia and hyperglycemia, which can be detrimental to health. 

Pharmacokinetics: 

Absorption 

The absorption is delayed from subcutaneous site 

The onset of action takes place in 3-4 hours 

Distribution 

The duration of action is 24 hours (ranging from 10.8 to >24 hours) 

Metabolism 

The drug is metabolized in adipose tissue or muscle 

Metabolites (active) formed are M1 (21A-Gly-insulin) & M2 (21A-Gly-des-30BThr-insulin) 

Elimination and Excretion 

The drug is excreted in urine 

Adminstartion

Administration: 

insulin glargine is administered subcutaneously, which means it is injected into the layer of fat just below the skin. It is available as a solution for injection in prefilled pens, cartridges, or vials. The injection site should be rotated to avoid lipodystrophy, a condition in which fatty tissue becomes thickened or atrophied due to repeated injections. 

Here are the general steps for administering insulin glargine: 

• Check the expiration date and appearance of the insulin before using it. Insulin should be clear and colorless. Do not use it if it is cloudy or discolored. 
• Wash your hands with soap and water and dry them. 
• Prepare the injection site by cleaning it with an alcohol swab. Let the area dry before injecting. 
• Remove the cap from the insulin pen, cartridge, or vial. 
• Prime the pen, cartridge, or vial as per manufacturer instructions. 
• Dial the dose of insulin as per your healthcare provider’s instructions. 
• Pinch the skin at the injection site to create a fold. 
• Insert the needle into the fold of skin at a 90-degree angle. 
• Slowly inject the insulin and hold the needle in place for a few seconds. 
• Remove the needle from the skin and dispose of it in a sharps container. 
• Replace the cap on the insulin pen, cartridge, or vial. 
• Massage the injection site gently to help the insulin absorb. 
• Record the time and dose of insulin injected in your logbook or mobile app. 
• Wash your hands again. 

Patient Information Leaflet

Patient information leaflet 

Generic Name: insulin glargine 

Pronounced: in-su-lin glaar-jeen 

Why do we use insulin glargine? 

insulin glargine is used to treat diabetes mellitus, a chronic condition in which the body cannot produce or use insulin effectively. It is specifically used to control blood sugar levels in people with type 1 and type 2 diabetes. 

Insulin glargine is a long-acting insulin analog that provides a steady and consistent level of insulin activity in the body over 24 hours. Its slow and prolonged release of insulin helps to maintain normal blood glucose levels and prevent the complications of diabetes, such as kidney disease, nerve damage, blindness, and heart disease.