Glargine

# Glargine ## Overview - **Classification**: Long-acting insulin analog - **Mechanism**: Forms micro-precipitates at physiological pH from which insulin is slowly released, providing a relatively constant, peakless basal insulin level over 24 hours. ## Primary Indications 1. **Type 1 Diabetes Mellitus (T1DM)** - To provide basal insulin requirements. 2. **Type 2 Diabetes Mellitus (T2DM)** - To provide basal insulin when oral agents are insufficient. 3. **Gestational Diabetes** - When diet/lifestyle insufficient and other insulins not preferred. ## Adult Dosing ### Standard Dosing **Type 1 Diabetes Mellitus** - **Dose**: Typically **1/3 to 1/2 of total daily insulin** as basal. Initial **0.2-0.4 units/kg/day**. - **Frequency**: **Once daily** - **Route**: Subcutaneous (SC) **Type 2 Diabetes Mellitus** - **Dose**: Initial **10 units** or **0.1-0.2 units/kg/day**. - **Frequency**: **Once daily** - **Route**: Subcutaneous (SC) ### Dose Adjustments - **Renal Impairment**: Reduce initial dose; monitor glucose closely. Increased risk of **hypoglycemia**. - **Hepatic Impairment**: Reduce initial dose; monitor glucose closely. Increased risk of **hypoglycemia**. - **Elderly Patients**: Start with lower doses; titrate carefully due to increased hypoglycemia risk. ## Pediatric Dosing ### Neonates (0-28 days) - **Dose**: **Not recommended**. - **Special Notes**: Insufficient data. High risk of hypoglycemia. Use regular insulin infusions if needed. ### Infants (1-12 months) - **Dose**: **Not recommended**. - **Special Notes**: Insufficient data. High risk of hypoglycemia. ### Children (1-12 years) **Type 1 Diabetes Mellitus** - **Dose**: Initial **0.25 units/kg/day** as basal insulin. - **Frequency**: **Once daily** - **Maximum**: Individualized based on glycemic control. - **Special Notes**: Titrate based on fasting glucose. Ensure adequate prandial insulin. ### Adolescents (13-18 years) **Type 1 Diabetes Mellitus** - **Dose**: Similar to adult dosing. Initial basal **0.2-0.4 units/kg/day**. - **Frequency**: **Once daily** - **Maximum**: Individualized. Total insulin needs can be higher during puberty. ## Safety Information ### Contraindications - **Absolute**: Hypersensitivity to insulin glargine or excipients. - **Absolute**: During episodes of **hypoglycemia**. - **Relative**: Not for IV administration. Not for diabetic ketoacidosis (DKA) treatment. ### Common Adverse Effects - **Very Common (>10%)**: **Hypoglycemia**, injection site reactions (pain, redness, swelling). - **Common (1-10%)**: Lipodystrophy (lipoatrophy/lipohypertrophy), weight gain. - **Serious but Rare**: Anaphylaxis, severe hypoglycemia, peripheral edema, hypokalemia. ### Key Drug Interactions - **Oral Hypoglycemics/Other Insulins**: Increased risk of **hypoglycemia**. Monitor glucose closely. - **Beta-blockers**: Mask symptoms of **hypoglycemia**. May prolong recovery. - **Thiazolidinediones (TZDs)**: Increased risk of **fluid retention, heart failure**. Monitor for signs of HF. - **Corticosteroids, Diuretics, Sympathomimetics**: May **increase blood glucose**. May require increased insulin dose. - **Alcohol**: Can **potentiate hypoglycemic effect**. Advise moderation. ## Monitoring & Follow-up - **Before Treatment**: Baseline A1C, fasting plasma glucose. - **During Treatment**: Self-monitoring blood glucose (SMBG) daily (fasting). A1C every **3-6 months**. - **Clinical Signs**: Monitor for **hypoglycemia** symptoms (sweating, tremor, confusion). Observe injection sites. ## Clinical Pearls - 💡 **Timing**: Administer **once daily at the same time each day** for consistent basal coverage. - 💡 **Mixing**: Do **NOT** mix glargine with any other insulin or solution; it alters pH and efficacy. - 💡 **Storage**: Unopened: refrigerate. Opened: stable at room temp for **28-56 days** (product specific). - 💡 **Hypoglycemia**: Educate patients on symptoms and management (e.g., 15-20g simple carbs). - 💡 **Injection Site**: Rotate sites to prevent lipodystrophy. > **⚠️ Important**: This information is for educational purposes only. Always consult current prescribing information, local guidelines, and clinical judgment before prescribing.