ABOUT
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Insulin glargine, marketed under the names Lantus among others, is a long-acting insulin, used in the management of type I and type II diabetes.[3] It is typically the recommended long acting insulin in the United Kingdom.[4] It is used once a day as an injection just under the skin.[3] Effects generally begin an hour after use.[3]
Common side effects include low blood sugar, problems at the site of injection, itchiness, and weight gain.[3] Other serious side effects include low blood potassium.[3] NPH insulin rather than insulin glargine is generally preferred in pregnancy.[4] After injection microcrystals slowly release insulin for about 24 hours.[3] This insulin causes body tissues to absorb glucose from the blood and decreases glucose production by the liver.[3]
Insulin glargine was approved for medical use in the United States in 2000.[3] In 2018, it was the 26th most commonly prescribed medication in the United States with more than 24 million prescriptions
Medical uses
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The long-acting insulin class, which includes insulin glargine, do not appear much better than neutral protamine Hagedorn (NPH) insulin, but do have a greater cost, making them, as of 2010, not cost effective for the treatment of type 2 diabetes.[7] It is unclear if there is a difference in hypoglycemia, given the significance of dose, and not enough data to determine any differences with respect to long term outcomes.[8] It is not typically the recommended long acting insulin in the United Kingdom.[4]
Mixing with other insulins
Unlike some other longer-acting insulins, glargine must not be diluted or mixed with other insulin or solution in the same syringe.[9] However, this restriction has been questioned.[10]
Adverse effects
Common side effects include low blood sugar, problems at the site of injection, itchiness, and weight gain.[3] Serious side effects include low blood potassium.[3]
As of 2012, tentative evidence shows no association between insulin glargine and cancer.[11] Previous studies had raised concerns.[12]
Pharmacology
Mechanism of action
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Insulin glargine differs from human insulin by replacing asparagine with glycine in position 21 of the A-chain and by carboxy-terminal extension of B-chain by 2 arginine residues. The arginine amino acids shift the isoelectric point from a pH of 5.4 to 6.7, making the molecule more soluble at an acidic pH and less soluble at physiological pH. The isoelectric shift also allows for the subcutaneous injection of a clear solution. The glycine substitution prevents deamidation of the acid-sensitive asparagine at acidic pH. In the neutral subcutaneous space, higher-order aggregates form, resulting in a slow, peakless dissolution and absorption of insulin from the site of injection.[13] It can achieve a peakless level for at least 24 hours.
Drug-Disease Interaction: Toujeo 300U/ml Solostar Injection 1.5 ml should not be given to patients with kidney disease, liver disease, low blood sugar/glucose level (hypoglycaemia), and low potassium level (hypokalaemia).
Safety Advice
CONSULT YOUR DOCTOR
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ALCOHOLYou are recommended not to consume alcohol along with Toujeo 300U/ml Solostar Injection 1.5 ml to avoid unpleasant side-effects. Alcohol may either decrease or increase the blood sugar level which can be fatal.
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PREGNANCYToujeo 300U/ml Solostar Injection 1.5 ml can be used during pregnancy. Your insulin dose may need to be changed during pregnancy and after delivery. Please consult your doctor before taking Toujeo 300U/ml Solostar Injection 1.5 ml.
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BREAST FEEDINGToujeo 300U/ml Solostar Injection 1.5 ml can be given safely to nursing mothers but only under the supervision of a physician. Physician may adjustments in your insulin doses and your diet.
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DRIVINGDrive with caution, Toujeo 300U/ml Solostar Injection 1.5 ml usually causes drowsiness and affects driving ability. Your ability to concentrate and react may be reduced if you have hypoglycaemia (low blood sugar).
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LIVERToujeo 300U/ml Solostar Injection 1.5 ml to be taken with caution, especially if you have a history of liver diseases/conditions. The dose may have to be adjusted by your doctor.
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KIDNEYToujeo 300U/ml Solostar Injection 1.5 ml to be taken with caution, especially if you have a history of kidney diseases/conditions. The dose may have to be adjusted by your doctor.
Habit Forming
Diet & Lifestyle Advise
- Exercise may lower your body’s need for insulin during and for some time after the physical activity.
- Exercise may also speed up the effect of an insulin dose, especially if the exercise involves the area of injection site (for example, the leg should not be used for injection just prior to running).
- Discuss with your doctor how you should adjust your insulin regimen to accommodate exercise.
- Avoid eating sugar food and prefer food cooked food low in calories.
- When travelling across more than 2 time zones, you should talk to your doctor concerning adjustments in your insulin schedule.
Special Advise
Change (rotate) your injection sites within the area you chose with each dose to reduce your risk of getting lipodystrophy (pitted or thickened skin) and localized cutaneous amyloidosis (skin with lumps) at the injection sites. Do not use the same spot for each injection or inject where the skin is pitted, thickened, lumpy, tender, bruised, scaly, hard, scarred or damaged.
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