Indications
Insulin Glargine is indicated for once-daily subcutaneous administration for the treatment of adult and pediatric patients with type 1 diabetes mellitus or adult patients with type 2 diabetes mellitus who require basal (long-acting) insulin for the control of hyperglycemia.
Therapeutic Class
Long Acting Insulin
Pharmacology
Insulin Glargine (rDNA) is a sterile, clear, colourless solution of insulin human. It is a long-acting insulin and has a relatively long duration of action as compared with other insulin. Insulin glargine have substitution of glycine for asparagine at A21 and two arginines added to the carboxy terminal of B-chain. This allows insulin glargine to form a precipitate (hexamer) when injected subcutaneously into the patient. It can achieve a peakless level for at least 24 hours.
Dosage & Administration
The recommended starting dose of Insulin Glargine in patients with type 1 diabetes should be approximately one-third of the total daily insulin requirements. Short-acting, premeal insulin should be used to satisfy the remainder of the daily insulin requirements.
The recommended starting dose of Insulin Glargine in patients with type 2 diabetes who are not currently treated with insulin is 10 units (or 0.2 Units/kg) once daily, which should subsequently be adjusted to the patient’s needs.
The dose of Insulin Glargine should be adjusted according to blood glucose measurements. The dosage of Insulin Glargine should be individualized under the supervision of a healthcare provider in accordance with the needs of the patient.
Interaction
The following substances may reduce the Insulin as well as Insulin glargine requirements: oral anti-diabetic products, angiotensin converting enzyme (ACE) inhibitors, disopyramide, fibrates, fluoxetine, monoamine oxidase inhibitors, propoxyphene, pentoxifylline, salicylates and sulfonamide antibiotics.
The following substances may increase the Insulin as well as Insulin glargine requirements: Thiazides, glucocorticoids, thyroid hormones, beta-sympathomimetics, growth hormone and danazol. Beta-blockers, clonidine, lithium salts, and alcohol may either potentiate or weaken the blood-glucose-lowering effect of insulin.
Contraindications
Insulin glargine is contraindicated in patients with hypersensitivity to insulin glargine or any of its excipients.
Side Effects
Side effects of Insulin glargine are hypoglycemia, allergic reactions, injection site reaction, lipodystrophy, pruritus, and rash.
Pregnancy & Lactation
Pregnancy category C. Insulin glargine should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus.
Lactation: It is unknown whether insulin glargine is excreted in human milk. Because many drugs, including human insulin, are excreted in human milk, caution should be exercised when Insulin glargine is administered to a nursing woman. Lactating women may require adjustments in insulin dose & diet.
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