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insulin glargine

Pronunciation

Generic Name: insulin glargine (IN su lin GLAR gine)
Brand Name: Basaglar KwikPen, Lantus, Lantus Solostar Pen, Toujeo SoloStar, Lantus OptiClik Cartridge

What is insulin glargine?

Insulin is a hormone that works by lowering levels of glucose (sugar) in the blood. Insulin glargine is a long-acting insulin that starts to work several hours after injection and keeps working evenly for 24 hours.

Insulin glargine is used to improve blood sugar control in adults and children with diabetes mellitus. Some brands of this medicine are for use only in adults. Carefully follow all instructions for the brand of insulin glargine you are using.

Insulin glargine is used to treat type 2 diabetes in adults.

Insulin glargine is also used to treat type 1 diabetes in adults and children who are at least 6 years old.

Insulin glargine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about insulin glargine?

Never share an injection pen or syringe with another person, even if the needle has been changed.

What should I discuss with my healthcare provider before using insulin glargine?

You should not use this medicine if you are allergic to insulin, or if you are having an episode of hypoglycemia (low blood sugar).

Insulin glargine should not be given to a child younger than 6 years old. Insulin glargine should not be used to treat type 2 diabetes in a child of any age.

To make sure insulin glargine is safe for you, tell your doctor if you have:

  • liver or kidney disease;

  • low levels of potassium in your blood (hypokalemia); or

  • diabetic ketoacidosis (call your doctor for treatment).

Tell your doctor if you also take pioglitazone or rosiglitazone (sometimes contained in combinations with glimepiride or metformin). Taking certain oral diabetes medicines while you are using insulin may increase your risk of serious heart problems.

Follow your doctor's instructions about using insulin if you are pregnant or breast-feeding a baby. Blood sugar control is very important during pregnancy, and your dose needs may be different during each trimester of pregnancy. Your dose needs may also be different while you are breast-feeding.

How should I use insulin glargine?

Follow all directions on your prescription label. Do not use this medicine in larger or smaller amounts or for longer than recommended.

Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

The Toujeo brand of insulin glargine contains 3 times as much insulin per milliliter (mL) as the Lantus or Basaglar brands. There are 300 units of insulin in 1 mL of Toujeo, and 100 units in 1 mL of Lantus or Basaglar.

If there are any changes in the brand, strength, or type of insulin you use, your dosage needs may change.

Insulin is injected under the skin. You will be shown how to use injections at home. Do not give yourself this medicine if you do not understand how to use the injection and properly dispose of used needles and syringes.

Insulin glargine must not be given with an insulin pump, or mixed with other insulins. Do not inject insulin glargine into a vein or a muscle.

Insulin glargine is usually injected once per day at the same time each day. You will be shown how to use injections at home. Do not give yourself this medicine if you do not understand how to use the injection and properly dispose of used needles and syringes.

Your care provider will show you the best places on your body to inject insulin glargine. Use a different place each time you give an injection. Do not inject into the same place two times in a row.

If you use an injection pen, use only the injection pen that comes with insulin glargine. Attach a new needle before each use. Do not transfer the insulin from the pen into a syringe.

Never share an injection pen or syringe with another person, even if the needle has been changed. Sharing these devices can allow infections or disease to pass from one person to another.

Use a disposable needle and syringe only once. Follow any state or local laws about throwing away used needles and syringes. Use a puncture-proof "sharps" disposal container (ask your pharmacist where to get one and how to throw it away). Keep this container out of the reach of children and pets.

Low blood sugar (hypoglycemia) can happen to everyone who has diabetes. Symptoms include headache, hunger, sweating, irritability, dizziness, nausea, fast heart rate, and feeling anxious or shaky. To quickly treat low blood sugar, always keep a fast-acting source of sugar with you such as fruit juice, hard candy, crackers, raisins, or non-diet soda.

Your doctor can prescribe a glucagon emergency injection kit to use in case you have severe hypoglycemia and cannot eat or drink. Be sure your family and close friends know how to give you this injection in an emergency.

Also watch for signs of high blood sugar (hyperglycemia) such as increased thirst or urination, blurred vision, headache, and tiredness.

Blood sugar levels can be affected by stress, illness, surgery, exercise, alcohol use, or skipping meals. Ask your doctor before changing your insulin dose or schedule.

Insulin glargine is only part of a treatment program that may also include diet, exercise, weight control, blood sugar testing, and special medical care. Follow your doctor's instructions very closely.

Keep this medicine in its original container protected from heat and light. Do not draw insulin from a vial into a syringe until you are ready to give an injection. Do not freeze insulin or store it near the cooling element in a refrigerator. Throw away any insulin that has been frozen.

Storing unopened (not in use) Basaglar or Lantus:

  • Refrigerate and use until expiration date; or

  • Store at room temperature and use within 28 days.

Storing unopened (not in use) Toujeo:

  • Refrigerate and use until expiration date.

Storing opened (in use) Basaglar or Lantus:

  • Store the vial in a refrigerator or at room temperature and use within 28 days.

  • Store the injection pen at room temperature (do not refrigerate) and use within 28 days.

Storing opened (in use) Toujeo:

  • Store the injection pen at room temperature (do not refrigerate) and use within 42 days.

Do not store an injection pen with the needle attached.

Do not use the medicine if it looks cloudy, has changed colors, or has any particles in it. Call your pharmacist for new medicine.

Wear a diabetes medical alert tag in case of emergency. Any medical care provider who treats you should know that you have diabetes.

What happens if I miss a dose?

Call your doctor for instructions if you miss a dose of insulin glargine. You should not use more than one dose in a 24-hour period unless your doctor tells you to.

Keep insulin on hand at all times. Get your prescription refilled before you run out of medicine completely.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222. Insulin overdose can cause life-threatening hypoglycemia. Symptoms include drowsiness, confusion, blurred vision, numbness or tingling in your mouth, trouble speaking, muscle weakness, clumsy or jerky movements, seizure (convulsions), or loss of consciousness.

What should I avoid while using insulin glargine?

Avoid medication errors by always checking the medicine label before injecting your insulin.

Avoid drinking alcohol. It can cause low blood sugar and may interfere with your diabetes treatment.

Insulin glargine side effects

Get emergency medical help if you have signs of insulin allergy: redness or swelling where an injection was given, itchy skin rash over the entire body, trouble breathing, fast heartbeats, feeling like you might pass out, or swelling in your tongue or throat.

Call your doctor at once if you have:

  • fluid retention--weight gain, swelling in your hands or feet, feeling short of breath; or

  • low potassium--leg cramps, constipation, irregular heartbeats, fluttering in your chest, increased thirst or urination, numbness or tingling, muscle weakness or limp feeling.

Common side effects may include:

  • low blood sugar;

  • itching, mild skin rash; or

  • thickening or hollowing of the skin where you injected the medicine.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Insulin glargine dosing information

Usual Adult Dose for Diabetes Type 1:

Dose should be individualized based on clinical response; this basal insulin should be used in regimens with short-acting insulin
Initial dose: One-third to one-half the total daily insulin requirement subcutaneously once a day
Maintenance dose: Dose should be adjusted according to metabolic needs, blood glucose measurements, and glycemic goals
Maximum dose: 80 units per 1 injection; if a dose greater than 80 units is needed, it should be be given as 2 or more injections

U-300:
-Metabolic needs during the first 24 hours may not be fully covered with the first U-300 dose; monitor closely
-Dose titration should occur no more frequently than every 3 to 4 days due to the longer time for U-300 to achieve steady-state
Maximum dose: 80 units per 1 injection

Conversion of U-100 to U-300: Initial dose should be the same, however for patients controlled on U-100, expect a higher daily dose of U-300 to maintain the same level of glycemic control.

Conversion of NPH insulin to insulin glargine:
-From ONCE-DAILY NPH insulin: Initial insulin glargine dose should be the same dose of NPH that is being discontinued
-From TWICE-DAILY NPH insulin: Initial insulin glargine dose should be 80% of the total NPH dose that is being discontinued

Comments:
-The initial total daily insulin requirement in insulin naive patients is generally 0.2 to 0.4 units of insulin per kilogram of body weight.
-When changing treatment regimens, the dose and frequency of short-acting insulin may need to be adjusted.
-To minimize hypoglycemia, closely monitor blood glucose, especially with changing regimens.
-During clinical trials, patients treated with U-300 used 17.5% more basal insulin than patients treated with U-100.

Use: To improve glycemic control in patients with type 1 diabetes mellitus.

Usual Adult Dose for Diabetes Type 2:

Dose should be individualized based on clinical response

Insulin-naive:
Initial dose: 10 units or 0.2 units/kg subcutaneously once a day
Maintenance dose: Dose should be adjusted according to metabolic needs, blood glucose measurements, and glycemic goals

U-300:
-Metabolic needs during the first 24 hours may not be fully covered with the first U-300 dose; monitor closely
-Dose titration should occur no more frequently than every 3 to 4 days due to the longer time for U-300 to achieve steady-state
Maximum dose: 80 units per 1 injection

Conversion of U-100 to U-300: Initial dose should be the same, however for patients controlled on U-100, expect a higher daily dose of U-300 to maintain the same level of glycemic control.

Conversion of NPH insulin to insulin glargine:
-From ONCE-DAILY NPH insulin: Initial insulin glargine dose should be the same dose of NPH that is being discontinued
-From TWICE-DAILY NPH insulin: Initial insulin glargine dose should be 80% of the total NPH dose that is being discontinued

Comments:
-When changing treatment regimens, the dose and frequency of short-acting insulins and doses of any oral anti-diabetic drugs may need to be adjusted.
-To minimize hypoglycemia, closely monitor blood glucose, especially with changing regimens.
-During clinical trials, patients treated with U-300 used 11% to 15% more basal insulin than patients treated with U-100.

Use: To improve glycemic control in patients with type 2 diabetes mellitus.

Usual Geriatric Dose for Diabetes Type 2:

Initial dosing, dose increments, and maintenance dosage should be conservative to avoid hypoglycemic reactions.

Usual Geriatric Dose for Diabetes Type 1:

Initial dosing, dose increments, and maintenance dosage should be conservative to avoid hypoglycemic reactions.

Usual Pediatric Dose for Diabetes Type 1:

Age: 6 years or older: U-100 only:
-Dose should be individualized based on clinical response; this basal insulin should be used in regimens with short-acting insulin

Initial dose: One-third total daily insulin requirement subcutaneously once a day
Maintenance dose: Dose should be adjusted according to metabolic needs, blood glucose measurements, and glycemic goals

Conversion of NPH insulin to insulin glargine:
-From ONCE-DAILY NPH insulin: Initial insulin glargine dose should be the same dose of NPH that is being discontinued
-From TWICE-DAILY NPH insulin: Initial insulin glargine dose should be 80% of the total NPH dose that is being discontinued

Comments:
-The initial total daily insulin requirement in insulin naive patients is generally 0.2 to 0.4 units of insulin per kilogram of body weight.
-When changing treatment regimens, the dose and frequency of short-acting insulin may need to be adjusted.
-To minimize hypoglycemia, closely monitor blood glucose, especially with changing regimens.

Use: To improve glycemic control in pediatric patients 6 years or older with type 1 diabetes mellitus.

What other drugs will affect insulin glargine?

Many other medicines can affect your blood sugar, and some medicines can increase or decrease the effects of insulin. Some drugs can also cause you to have fewer symptoms of hypoglycemia, making it harder to tell when your blood sugar is low. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using. This includes prescription and over-the-counter medicines, vitamins, and herbal products.

Where can I get more information?

  • Your pharmacist can provide more information about insulin glargine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 11.02.

Date modified: November 30, 2016
Last reviewed: June 22, 2016

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