insulin glargine: prescribing and clinical use
Focused clinical detail for use alongside current product information, local policy and patient-specific assessment.
insulin glargine: clinical details
Prescribing considerations
- Prescribe and document the specific brand, strength and device; record product name and batch number for biological-product traceability.
- Confirm injection technique, site rotation, pen safety testing and ability to read the dose counter.
- Do not use Toujeo for intravenous treatment of diabetic ketoacidosis or in an insulin pump.
- Switches between Toujeo, insulin glargine 100 units/ml and other basal insulins require medical supervision and close metabolic monitoring.
- Review concomitant pioglitazone if oedema, weight gain or heart-failure symptoms develop.
Contraindications and cautions
- Hypersensitivity to insulin glargine or any product excipient.
Monitoring
- Blood glucose patterns and longer-term glycaemic control
- Frequency, timing and awareness of hypoglycaemia
- Injection sites for lipodystrophy or cutaneous amyloidosis
- Glucose after a product switch or change from an affected injection site
- Renal and hepatic function where altered insulin metabolism may affect requirements
- Ketones and metabolic status during intercurrent illness when clinically indicated
Clinical pharmacology
Insulin glargine is a recombinant human insulin analogue. Neutralisation after subcutaneous injection produces a precipitate that releases insulin gradually. It increases peripheral glucose uptake, suppresses hepatic glucose production and is metabolised principally to active metabolites including M1 and M2.
Formulation and product differences
- Toujeo is a concentrated insulin glargine 300 units/ml formulation supplied in dedicated pre-filled pens.
- Toujeo and insulin glargine 100 units/ml are not bioequivalent or directly interchangeable.
- The pen counter displays the units to inject; the user should not perform a strength conversion.
- Toujeo must not be withdrawn from the pen into a syringe, mixed or diluted.
- Before first use, store refrigerated without freezing. Once in use, follow product-specific room-temperature and light-protection instructions.
insulin glargine preparations and strengths
Injection
Route: Parenteral
Strengths: 100 units/mL, 300 units/mL
insulin glargine interactions
Medicines that alter glucose metabolism can change insulin requirements or make hypoglycaemia harder to recognise. Check with a clinician or pharmacist before starting or stopping medicines or supplements.
Other glucose-lowering medicines
The combined effect can increase the likelihood of hypoglycaemia.
ACE inhibitors
These may increase susceptibility to hypoglycaemia.
Beta-blockers
These can alter glucose control and may mask warning symptoms such as tremor or palpitations.
Sources
These sources were used to prepare and review this medicine page.
Prepared and reviewed by the iatroX editorial team.