Insulin glargine
LANTUS
What it isLong-acting insulin-receptor agonist providing basal coverage in type 1 and type 2 diabetes.
Why this oneIts relatively flat profile lowers nocturnal hypoglycemia versus NPH and separates basal titration from mealtime dosing.
What limits itHypoglycemia is the limiting toxicity. Titrate to fasting glucose; it cannot replace mealtime insulin.
FDA-approved for
- diabetes mellitus (2000)
FDA label
Read the full label on DailyMed ↗
| FDA dosing | Population | Start | Target | Max |
|---|---|---|---|---|
| Type 1 diabetes mellitus | Adults & peds ≥6 yr | ~1/3 of total daily insulin needs SC QD (remainder as premeal short-acting) | ||
| Type 2 diabetes mellitus | Adults, insulin-naive | 0.2 units/kg or up to 10 units SC QD |
Renal Undefined
Hepatic Undefined
Instructions
- Inject SC into abdomen, thigh, or deltoid once daily at the same time each day; rotate sites
- Do not dilute or mix with any other insulin or solution
- Do not give IV or via insulin pump
- In type 1 diabetes, use concomitantly with short-acting insulin
- When switching from glargine 300 units/mL, start at 80% of prior dose; intensify glucose monitoring during transition
Contraindications
- During episodes of hypoglycemia
Cautions
- Hypoglycemia — most common reaction; may be life-threatening
- Hyper-/hypoglycemia with any change in insulin regimen — change under supervision with increased glucose monitoring
- Hypoglycemia from medication errors — accidental insulin mix-ups; check label before each dose
- Hypersensitivity/anaphylaxis — discontinue
- Hypokalemia — monitor potassium in at-risk patients
- Fluid retention/heart failure with concomitant thiazolidinediones
- Never share a prefilled pen/needle between patients
Adverse reactions
- Hypoglycemia
- Allergic/injection-site reactions
- Lipodystrophy and localized cutaneous amyloidosis
- Pruritus, rash
- Peripheral edema
- Weight gain
Pregnancy Published data show no clear association with adverse developmental outcomes; poorly controlled diabetes itself raises maternal/fetal risk.
Lactation Limited data; endogenous insulin is present in human milk; weigh benefits of breastfeeding against clinical need.
NO BOXED WARNINGS
Principal riskHypoglycemia
Cost, est. cash$35–$650/month
Generic entryLong generic
Classes and tags
Clinical profile
Legacy pregnancy categoryMultiple / indication-, trimester- or formulation-dependent
Defining liabilityHypoglycemia can rapidly cause seizures, coma or death; dosing and meal mismatches are the principal hazard.
Mechanism of action: Insulin glargine ballicule
Open Insulin glargine in the interactive console ↗
Memory aids: mascots and interaction avatars
Insulin syringe landing on “Planet Glars”
