What is Insulin Glargine and How Does it Work?
Insulin Glargine: A Long-Acting Insulin Analog
Insulin glargine, sold under the brand names Lantus and Basaglar, is a long-acting type of insulin used to treat diabetes. Specifically, it is an analog of human insulin - a synthetic version that is genetically engineered to have a slightly different structure than natural insulin.
The key difference with insulin glargine is that it has been modified to be soluble at a acidic pH but precipitates and forms microcrystals at a neutral pH in the body. This crystal formation slows absorption from the injection site, allowing it to have a very long duration of action of up to 24 hours. As a result, insulin glargine provides basal insulin coverage throughout the day and night.
Mechanism of Action
Once injected subcutaneously, Insulin Glargine travels from the injection site through the lymphatic system into circulation. Its unique crystal structure means it is slowly absorbed into the bloodstream over many hours. In the blood, insulin glargine binds to insulin receptors on cells. This initiates a process where glucose is transported from the bloodstream into fat and muscle cells where it can be used for energy or stored. By facilitating glucose uptake, insulin glargine helps control blood sugar levels.
Treating Type 1 and Type 2 Diabetes
Due to its long-acting properties, insulin glargine is primarily used as a "basal" or long-term insulin. It is prescribed to many patients with type 1 diabetes who require daily insulin injections. It can also be used by some people with type 2 diabetes, typically in combination with oral medications or other insulin formulations if blood sugars remain high.
Replacing once-daily injections of neutral protamine Hagedorn (NPH) insulin, insulin glargine provides more stable basal insulin coverage without pronounced peaks. This makes it easier for people to maintain steady blood glucose levels throughout each day and night. Moreover, clinical trials have found insulin glargine to be as safe and effective as NPH insulin in lowering A1C.
Administration and Dosage
Insulin glargine comes in a clear liquid formulation that is injected subcutaneously, just under the skin. It starts working within 1-2 hours and has a long duration of action lasting up to 24 hours for most people.
The dosage and frequency is individualized based on a person's medical history, type of diabetes, weight, lifestyle factors and target blood sugar goals. Insulin glargine is typically taken once daily at the same time each day, usually in the evening. It does not need to be taken with meals unlike rapid-acting insulin analogs. Doctors will adjust the dose up or down as needed based on blood glucose monitoring results.
Safety and Side Effects
Overall, insulin glargine has a good safety profile that is similar to other long-acting human insulins. The most common side effects include hypoglycemia (low blood sugar), weight gain, injection site reactions like redness, swelling or itching. However, these side effects are usually mild.
Rare potential safety issues that have been investigated include risk of certain cancers. According to the FDA, some epidemiological studies have reported a possible association between insulin glargine use and breast or prostate cancer, but a causal relationship has not been firmly established. More research is still needed.
Overall, insulin glargine remains an important treatment option for many people with type 1 and type 2 diabetes who require basal insulin therapy. When administered as directed and glucose is properly monitored, it provides effective blood sugar control with a low risk of side effects for most patients. Talk to your doctor if you have any questions or concerns about safely using insulin glargine.
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