Anologue Basal Insulin

Aka: Anologue Basal Insulin, Insulin Glargine, Glargine, Lantus, Levemir, Detemir, Toujeo, Insulin Degludec, Tresiba, Basaglar, Semglee

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II. Precautions

  1. Insulin Dosing in the U.S. has become unconscionably expensive
    1. Consider NPH Insulin (still $25 per vial at Walmart as of 2016) for basal control instead
  2. Basal Insulin does not cover meal times
  3. 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

III. Medications: U-100

  1. Insulin Glargine U-100 (Lantus, Basaglar, Semglee)
    1. Information below is based on Lantus
    2. Most closely matches 24 hour coverage
    3. Semglee (Insulin Glargine-yfgn U-100) is considered interchangeable biosimilar to Lantus as of 2021 in U.S.
      1. Allows pharmacists to auto-substitute Semglee (one third Lantus cost) for Lantus
      2. (2021) Presc Lett 28(9): 51
  2. Insulin Degludec (Tresiba)
    1. Ultra Long acting Insulin (lasts 42 hours)
    2. Onset of activity in 90 minutes
    3. Available as U-100 or U-200
  3. Detemir U-100 (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 (twice daily may be preferred)
    6. Manufacturer discontinuing drug in U.S. in 2024 (for business reasons)
      1. Same total daily Detemir dose may be used when converting to other long acting agent
      2. May switch from Detemir total daily dose to any U-100 long acting Insulin (Lantus, Basaglar, Semglee)
      3. May also switch to the U-100 formulation of Insulin Degludec (Tresiba)
      4. Reduce total daily dose by 20% if patient at higher risk for Hypoglycemia
      5. (2024) Presc Lett 31(1): 4

IV. Medications: U-300

  1. Insulin Glargine U-300 (Toujeo, Toujeo Max Solostar)
    1. Toujeo Solostar pen
      1. Toujeo contains 80 u/injection (450 u/pen)
      2. Toujeo Max contains 160 u/injection (900 u/pen)
      3. Both contain the same 3x Glargine Insulin concentration of Lantus)
    2. Released in 2015 (curiously as Lantus becomes generic)
      1. Promoted as a longer acting Lantus (closer to 24 hour duration)
      2. However, more expensive ($500/month if 60 u/day); contrast with NPH at 10% of cost
    3. Do not adjust Toujeo dose more often than every 3-4 days
    4. Transitioning from other agents
      1. From Lantus, Basaglar daily
        1. Dose Toujeo at 110% of Lantus dose
      2. From Lantus twice daily
        1. Dose Toujeo at 100% of the Lantus dose
      3. From Detemir or NPH twice daily
        1. Dose Toujeo at 80% of total daily basal Insulin dose
    5. Transitioning to other agents
      1. To Lantus or Basaglar
        1. Dose Lantus or Basaglar at 80% of Toujeo dose to start, then titrate up
    6. References
      1. (2018) Presc Lett 25(8)
      2. Riddle (2014) Diabetes Care 37(10):2755-62 +PMID:25078900 [PubMed]

V. Pharmacokinetics: Insulin Glargine (Lantus)

  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

VI. Adverse effects

  1. Less nocturnal Hypoglycemia than other Insulins
  2. Lower post-prandial Glucose

VII. Dosing: Insulin Glargine (Lantus)

  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 at bedtime
    2. Type II Diabetes: 10-14 Units at bedtime
  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. Typical adjustment is 1 to 2 units (or 5 to 10%) once to twice weekly
    2. 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
    3. 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

VIII. Preparations: 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

IX. References

  1. (2001) Med Lett Drugs Ther 43(1110):65-6 [PubMed]
  2. Riddle (2003) Diabetes Care 26:3080-6 [PubMed]

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Related Studies

Cost: Medications

insulin glargine (on 12/21/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
INSULIN GLARGINE 100 UNIT/ML VIAL Generic $10.88 per ml
INSULIN GLARGINE SOLOSTAR U100 Generic $10.87 per ml
INSULIN GLARGINE-YFGN U100 PEN Generic $9.50 per ml
INSULIN GLARGINE-YFGN U100 VL Generic $9.49 per ml
lantus (on 4/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LANTUS 100 UNIT/ML VIAL $27.23 per ml
LANTUS SOLOSTAR 100 UNIT/ML $27.23 per ml
levemir (on 4/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
LEVEMIR 100 UNIT/ML VIAL $29.55 per ml
LEVEMIR FLEXPEN 100 UNIT/ML $29.56 per ml
LEVEMIR FLEXTOUCH 100 UNIT/ML $29.58 per ml
toujeo (on 4/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TOUJEO MAX SOLOSTR 300 UNIT/ML $82.96 per ml
TOUJEO SOLOSTAR 300 UNIT/ML $82.93 per ml
insulin degludec (on 1/18/2023 at Medicaid.Gov Survey of pharmacy drug pricing)
INSULIN DEGLUDEC FLEXTOUCH 100 UNIT/ML PEN Generic $11.34 per ml
INSULIN DEGLUDEC FLEXTOUCH 200 UNIT/ML PEN Generic $22.71 per ml
tresiba (on 4/20/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
TRESIBA 100 UNIT/ML VIAL $32.65 per ml
TRESIBA FLEXTOUCH 100 UNIT/ML $32.55 per ml
TRESIBA FLEXTOUCH 200 UNIT/ML $65.09 per ml
basaglar (on 2/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
BASAGLAR 100 UNIT/ML KWIKPEN $20.93 per ml
BASAGLAR TEMPO PEN 100 UNIT/ML $20.93 per ml
semglee (on 3/23/2022 at Medicaid.Gov Survey of pharmacy drug pricing)
SEMGLEE (YFGN) 100 UNIT/ML PEN $25.86 per ml
SEMGLEE (YFGN) 100 UNIT/ML VL $25.83 per ml
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. GoodRx is another tool for finding lower drug prices.

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