INSULIN GLARGINE

INSULIN GLARGINE
(in'su-lyn glar'geen)
Lantus, Lantus SoloStar
Classifications: hormone; antidiabetic agent; insulin long-acting;
Therapeutic: antidiabetic
; insulin long-acting
Prototype: Insulin injection
Pregnancy Category: C

Availability

100 U/mL injection; 3 mL cartridge; Prefilled, disposable pen

Action

A recombinant human insulin analog with a long duration of action. Lowers blood glucose levels over an extended period of time by stimulating peripheral glucose uptake especially in muscle and fat tissue. In addition, insulin inhibits hepatic glucose production.

Therapeutic Effect

Lowers blood glucose levels over an extended period of time. It also prevents the conversion of glucagon to glucose in the liver.

Uses

Bedtime dosing of adults and children with type 1 diabetes, or adults with type 2 diabetes.

Contraindications

Prior hypersensitivity to insulin glargine; hypoglycemia; pregnancy (category C). Safety and efficacy in children with type 2 diabetes are unknown.

Cautious Use

Renal and hepatic impairment; lactation. Safety and efficacy in children <6 y of age in type 1 diabetes.

Route & Dosage

Type 1 Diabetes
Adult/Child: SC If not taking insulin, give 10 U at same time each day (usually at bedtime) once daily; if taking NPH or ultralente  insulin once daily, give same dose at same time each day (usually at bedtime); if taking NPH insulin twice daily, give 80% of total daily dose at same time each day (usually at bedtime)

Type 2 Diabetes
Adult: SC If already taking oral hypoglycemic drugs, start with 10 U at same time each day (usually at bedtime) once daily and adjust according to patient's needs

Administration

Subcutaneous
  • Do not give this product IV.
  • Give at same time each day (usually at bedtime) and do not mix with any other insulin product.
  • Store in refrigerator at 2°–8° C (36°–46° F), may store at room temperature, 15°–30° C (59°–86° F). Discard opened refrigerated vials after 28 d and unrefrigerated vials after 14 d. Do not expose to excessive heat or sunlight, and do not freeze.

Adverse Effects (≥1%)

Body as a Whole: Allergic reactions. Endocrine: Hypoglycemia, hypokalemia. Skin: Injection site reaction, lipodystrophy, pruritus, rash.

Interactions

Drug: oral antidiabetic agents, ace inhibitors, disopyramide, fluoxetine, mao inhibitors, propoxyphene, salicylates, sulfonamide antibiotics, octreotide may enhance hypoglycemia; corticosteroids, niacin, danazol, diuretics, sympathomimetic agents, phenothiazines, thyroid hormones, estrogens, progestogens, isoniazid, somatropin may decrease hypoglycemic effects; beta-blockers, clonidine, lithium, alcohol may either potentiate or weaken effects of insulin; pentamidine may cause hypoglycemia followed by hyperglycemia. Herbal: Garlic, ginseng may potentiate hypoglycemic effects.

Pharmacokinetics

Absorption: Slowly absorbed from SC injection site. Onset: 3–4 h. Duration: 10.4–24 h. Metabolism: In liver to active metabolites.

Nursing Implications

Assessment & Drug Effects

  • Monitor for S&S of hypoglycemia (see Appendix F), especially after changes in insulin dose or type.
  • Lab tests: Monitor fasting blood glucose and HbA1C periodically.
  • Withhold drug and notify physician if patient is hypokalemic.

Patient & Family Education

  • Do not inject into areas with redness, swelling, itching, or dimpling.
  • Absorption patterns for this drug are not dependent on the injection site.
  • Ingest some form of sugar (e.g., orange juice, dissolved table sugar, honey) if symptoms of hypoglycemia develop; and seek medical assistance.
  • Check blood sugar as prescribed; notify physician of fasting blood glucose <80 and >120 mg/dL.
  • Notify the physician of any of the following: fever, infection, trauma, diarrhea, nausea, or vomiting. Dosage adjustment may be needed.
  • Do not take any other medication unless approved by physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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