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Anologue Basal InsulinAka: 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
    2. Riddle (2003) Diabetes Care 26:3080

Lantus (C0876064)

ConceptsAmino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121)
MSHC106526
EnglishLantus
SourcesMSH, NCI, RXNORM
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)
ConceptsAmino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Hormone (T125)
MSHC106526
EnglishA21-Gly-B31-Arg-B32-Arg-insulin, glargine, Insulin Glargine, Insulin glargine preparation, Insulin glargine product, Insulin Glargine Recombinant
Spanishglargina insulinica, insulina glargina, preparado de glargina insulinica
Parent ConceptsRecombinant Insulin (C1533581), Insulin (C0021641), Unclassified Ingredients (C1372954), Insulin, Long-Acting (C0304870), basal insulin (C0650607), Duplicate concept (C1274013), Human insulin analog product (C1305435)
SourcesMSH, MTH, MTHSPL, NCI, NDFRT, RXNORM, SCTSPA, SNOMEDCT, USPMG, VANDF
Derived from the NIH UMLS (Unified Medical Language System)


Levemir (C1314782)

ConceptsAmino Acid, Peptide, or Protein (T116) , Pharmacologic Substance (T121) , Hormone (T125)
MSHC105111
EnglishLevemir
SourcesMSH, RXNORM
Derived from the NIH UMLS (Unified Medical Language System)



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