Endocrinology Book

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Anologue Basal Insulin

Aka: Anologue Basal Insulin, Insulin Glargine, Glargine, Lantus, Levemir, Detemir
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  1. See Also
    1. Insulin
  2. Preparations
    1. Insulin Glargine (Lantus)
      1. Information below is based on Lantus
      2. Most closely matches 24 hour coverage
    2. Detemir (Levemir)
      1. Similar pharmacokinetics as Lantus
      2. Less burning on injection compared with Lantus
      3. Binds and released from circulating albumin
      4. Most consistent basal Insulin day to day
      5. Duration varies by dose (bid may be preferred)
  3. Precautions
    1. Basal Insulin does not cover meal times
    2. Use in combination with agents to cover meals
      1. Rapid acting Insulin (e.g. Lispro)
      2. Oral agents (Sulfonylureas, Metformin, Glitazone) or
        1. Switch to basal/bolus when Glargine >0.5 units/kg
  4. Pharmacokinetics
    1. Onset: 1 hour
    2. Duration: 21 to 24 hours
      1. May require divided dosing bid to maintain basal rate
    3. Peak: No peak
      1. Flat action profile throughout duration
      2. Mimics continuous Insulin Infusion
  5. Adverse effects
    1. Less nocturnal Hypoglycemia than other Insulins
    2. Lower post-prandial Glucose
  6. Dosing
    1. Starting dose (no prior Insulin)
      1. Hemoglobin A1C <8%: 0.1 units/kg
      2. Hemoglobin A1C >8-10%: 0.2 units/kg
      3. Hemoglobin A1C >10%: 0.3 units/kg
    2. Old regimen for starting dose (use units/kg as above instead)
      1. Type I Diabetes: 10 Units qhs
      2. Type II Diabetes: 10-14 Units qhs
    3. Conversion from other long-acting Insulin
      1. NPH/Ultralente qhs: start Lantus at same dose
        1. Consider starting Lantus at 80% of prior NPH dose
      2. NPH bid: Start Lantus at 80% of total daily NPH dose
    4. Adjustment based on fasting plasma Glucose (FPG)
      1. Protocol 1
        1. FPG <70 mg/dl for 3 days: Decrease Lantus 1-2 units
        2. FPG 140-250 for 3 days: Increase Lantus 2-4 units
        3. FPG >250 for 3 days: Increase Lantus 4-8 units
      2. Protocol 2
        1. FPG <80 for 3 days: Decrease Lantus by 2 units
        2. FPG 100-120 for 3 days: Increase Lantus by 2 units
        3. FPG 120-140 for 3 days: Increase Lantus by 4 units
        4. FPG 140-180 for 3 days: Increase Lantus by 6 units
        5. FPG >180 for 3 days: Increase Lantus by 8 units
    5. Timing of dose for Lantus
      1. Studies gave Lantus at bedtime to avoid confusion
      2. Lantus is most effective if given in the morning
  7. Delivery Devices: OptiClik Pen
    1. Pens are free from Aventis
      1. Phone: 800-207-8049
    2. Pens ease Insulin delivery
    3. Lantus in cartridges costs 2 cents/unit more than vial
    4. (2005) Prescriber's Letter 12:32
  8. References
    1. (2001) Med Lett Drugs Ther 43(1110):65-6
    2. Riddle (2003) Diabetes Care 26:3080-6
Medication Costs
Lantus SoloStar (on 2/9/2012 at DrugStore.com)
Lantus SoloStar 100unit/ml Solution 1 Box = Five 3ml Syringes #1 for $234.99 ($234.99/unit)
Lantus (on 2/9/2012 at DrugStore.com)
Lantus 100unit/ml Solution 10ml Vial #1 for $124.99 ($124.99/unit)
Levemir (on 2/9/2012 at DrugStore.com)
Levemir 100unit/ml Solution 10ml Vial #1 for $136.00 ($136.00/unit)
Levemir FlexPen (on 2/9/2012 at DrugStore.com)
Levemir FlexPen 100unit/ml Solution (five 3ml Syringes Per Box) #5 for $242.99 ($48.60/unit)
FPNotebook does not benefit financially from showing this medication data or their pharmacy links. This information is provided only to help medical providers and their patients see relative costs. Insurance plans negotiate lower medication prices with suppliers. Prices shown here are out of pocket, non-negotiated rates. See Needy Meds for financial assistance information.

insulin detemir (C0537270)

Concepts Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Hormone (T125)
MSH C105111
SnomedCT 414518007, 414515005
English 12C-Lys(B29)-DB30I, B29-tetradecanoyl-Lys-B30-des-Ala-insulin, Insulin Detemir, des-(B30)-insulin, Lys(B29)-tetradecanoyl-, insulin, tetradecanoyllysyl(B29)-desalanyl(B30)-, INSULIN DETEMIR, basal insulin detemir, insulin detemir (medication), Insulin detemir (substance), Insulin detemir product (product), Insulin detemir product, Insulin detemir, insulin detemir, insulin, tetradecanoyl-Lys(B29)-des-Ala(B30)-
Spanish insulina detemir (producto), producto con insulina detemir (producto), producto con insulina detemir, insulina detemir (sustancia), insulina detemir
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Basal insulin (C0650607)

Concepts Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
SnomedCT 416303005
English Basal insulin (product), Basal insulin
Spanish insulina basal (producto), insulina basal
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Lantus (C0876064)

Concepts Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
MSH C106526
English Lantus, lantu, lantus
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Insulin Glargine (C0907402)

Definition (NCI) A recombinant human insulin analog with long-acting, blood glucose-lowering activity. Insulin glargine, like regular types of human insulin, regulates glucose metabolism by binding to insulin receptors on muscle and fat cells, thereby facilitating the cellular uptake of glucose. This lowers blood glucose levels. At the same time, insulin glargine inhibits the liver's conversion of stored glycogen into glucose, which also contributes to lower blood glucose levels. Insulin glargine also inhibits lipolysis in adipose tissue, inhibits proteolysis, and enhances protein synthesis. (NCI05)
Definition (NCI) A drug used to control the amount of sugar in the blood of patients with diabetes. It is a form of the hormone insulin that is made in the laboratory. Insulin glargine controls blood sugar longer than insulin does. It is a type of therapeutic insulin.
Concepts Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Hormone (T125)
MSH C106526
SnomedCT 126212009, 126207008, 411529005
English A21-Gly-B31-Arg-B32-Arg-insulin, Insulin Glargine,Hum.Rec.Anlog, insulin, Gly(A21)-Arg(B31,B32)-, insulin, glycyl(A21)-arginyl(B31,B32)-, insulin glargine, Insulin Glargine, Insulin glargine preparation, Insulin Glargine Recombinant, INSULIN GLARGINE, glargine [Chemical/Ingredient], glargine insulin, insulin glargine human, insulin glargine recombinant, glargine, Insulin glargine product (product), Insulin glargine product, Insulin glargine (product), Insulin glargine preparation (substance), Insulin glargine, Insulin glargine (substance), INSULIN,GLARGINE,HUMAN/rDNA
Spanish insulina glargina (producto), preparado de glargina insulínica (producto), preparado de glargina insulínica, glargina insulínica (producto), glargina insulínica (sustancia), glargina insulínica, preparado de glargina insulínica (sustancia), insulina glargina (sustancia), insulina glargina
Sources
Derived from the NIH UMLS (Unified Medical Language System)


Levemir (C1314782)

Concepts Amino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Hormone (T125)
MSH C105111
English Levemir, levemir
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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