LANTUS (Insulin Glargine)

What is this medication?

LANTUS/BASAGLAR/TOUJEO (Insulin Glargine)
Long Acting Insulin

LANTUS/BASAGLAR/TOUJEO (Insulin Glargine) is indicated for diabetes mellitus types 1 and 2.

What is the difference between the brands?

Both LANTUS and BASAGLAR are generally injected around the stomach where they are slowly absorbed into the body. Lantus is available in both vial and pen dispensers, whereas BASAGLAR is only available in a pen dispenser. Both are commonly taken once per day.

While both TOUJEO and BASAGLAR contain long-acting insulin glargine, the former treats both Type 1 and Type 2 pediatric patients while the latter treats only Type 1 pediatric patients.

TOUJEO prefilled pens are available in two dosage units (160 and 80), whereas BASAGLAR is available in a single dose (80 units). People with Type 1 diabetes require an additional supplement of short-acting insulin along with BASAGLAR.

How does this medication work? 

LANTUS/BASAGLAR/TOUJEO (Insulin Glargine) works on liver, muscle and adipose (fat) tissue to regulate the metabolism of carbohydrates, protein, and fats.  In the liver and muscles, it increases glycogen synthesis which is the immediate storage form of glucose.  It increases fat production by increasing fatty acid release from the liver in the form of lipoproteins which adipose tissue converts to fatty acids then to triglycerides for storage whilst also stopping the metabolism of triglycerides (fat).  Insulin also increases the cellular uptake of amino acids and some electrolytes such as potassium into the cell.  In muscle tissue protein synthesis is increased.

Normally insulin is produced by the pancreas however insulin products for pharmaceutical use have been produced via recombinant DNA technology using certain bacteria (they splice the gene for insulin production into bacterial DNA so the cell produces insulin – a gene is a portion of DNA or RNA that produces one specific protein).  Insulin glargine is different from human insulin as it has some modifications to make it last longer.  It involves the addition of two arginine molecules and the substitution of an asparagine for a glycine (these are all names of amino acids which are the building blocks of proteins such as insulin).

How should I take this medication? 

Insulin glargine is long acting or basal insulin.  It is given by subcutaneously in one, or sometimes two, daily injections.  In type 2 diabetes someone usually starts around 10 units per day or 0.1-0.2mg/kg/day and the dosage is slowly increased until glucose control is achieved.  In type 1 diabetes 40-50% of total daily insulin is given as intermediate or long acting with the rest divided into fast acting mealtime insulin.  If converting from another insulin the number of units given may need to be lowered as a precaution.

How to Take: Follow instructions provided by physician/pharmacy label, use consistently at same times each day unless otherwise directed, refrigerate product not in use (36-46 Fahrenheit, 2-8 Celsius), the vial in use may be kept at room temperature (below 86 Fahrenheit, 30 Celsius) for up to 28 days (discard if not used by this point).  Injection generally into abdomen, thighs, buttocks, or arms with absorption rates varying from site to site.  Be consistent with the part of body you inject into but rotate injection site to avoid redistribution of fat and excessive irritation to the area.  For example, if you choose abdomen which is the most common, inject in circular order at least 2 inches from navel.

You Need to Avoid: Do not use if solution seems viscous (thick) or appears cloudy, only use if clear, colorless and with no visible particles.  Avoid injecting cold insulin as it may be painful.  

What should I watch for while using this medication? 

Before starting LANTUS/BASAGLAR/TOUJEO (Insulin Glargine), make sure your physician is aware of any allergies or medications you currently take, if you have had bariatric surgery, cardiovascular disease, have kidney disease, liver disease, diabetic ketoacidosis, are pregnant or breastfeeding.

What is the difference between a prefilled pen and a cartridge?

The prefilled pen is in a ready to use format including a fixed needle, whereas a cartridge needle is separate from the glass body.

What if I miss a dose?

If you forget to inject your dose, you should do so as soon as you remember. If it’s almost time for your next dose, skip your missed dose and inject your next dose at your usual time. If you missed your dose and aren’t sure what to do, talk with your doctor or pharmacist. But don’t use more than one dose per day, unless your doctor recommends it.

If you have missed a dose or if you have not injected enough insulin, your blood sugar level may become too high (hyperglycemia). Check your blood sugar frequently.

How should I store this medication?

Vials:
Store unused vials in the refrigerator between 36˚F to 46˚F (2˚C to 8˚C). Store in-use (opened) vials in a refrigerator or at room temperature below 86˚F (30˚C).

Pens:
Before opening, store Insulin Glargine in the refrigerator (36°F to 46°F). Keep pens in the original outer package until use.

Before injection, remove it from the refrigerator for an hour or two, cold insulin can be more painful to inject.

Note: Do not keep in direct heat and light. Do not freeze, if insulin has been frozen or overheated, throw it away. Throw away any opened insulin after 28 days, even if it still has product left. 

What are the possible side effects of using this medication?

Increased blood pressure, peripheral edema (fluid retention), diarrhea, hypoglycemia, urinary tract infection, antibody development, infection, cataracts, muscle pain, joint pain, depression.

Note this is not a complete list of side effects for LANTUS/BASAGLAR/TOUJEO (Insulin Glargine), only common ones.