Insulin Glargine: Eight Years Later

Insulin Glargine has become the most widely used insulin in the USA owing to its long duration of action without a pronounced peak. This introduction of a new form of insulin has made a dramatic effect on the ability of people to control their blood sugars. But is it being used properly? Should it be given once or twice a day?…

Insulin Glargine was the first long-acting insulin analog produced by recombinant DNA technology, approved for use by the US FDA in April 2000, and by the European Agency for the Evaluation of Medicinal Products in June 2000.

 

The principal advantage of insulin Glargine over neutral protamine Hagedorn (NPH) insulin is in a lower frequency of hypoglycemic reactions, thus affording improved safety. It is used in both Type 1 and Type 2 diabetes, usually as a single daily dose.

In Type 2 patients, it is often the first insulin introduced as a single daily dose. Although insulin Glargine is typically administered as a single nighttime dose, it can be given in the morning or at any other time convenient for the patient. In labile Type 1 diabetes, it is often most effective given as two daily injections.

In obese, insulin-resistant patients, it may be best to administer insulin Glargine in two separate doses, owing to the high volumes of injected insulin required. Insulin Glargine does not treat postprandial hyperglycemia. It is necessary to supplement with short-acting insulin at mealtimes to control glucose surges after meals. Insulin Glargine is effective in hospitalized and postsurgical patients on account of its lack of pronounced insulin peaks and long duration of action.

Although there is considerable use of Glargine in pregnant diabetic women, there is no definitive study to confirm its benefits. Insulin Glargine is thought to coprecipitate supplementary short-acting insulins when co-administered in the same syringe. Therefore, more injections are typically needed in the usual treatment regimen for insulin requiring diabetes.

In many cases, constant basal insulin levels may be achieved with multiple overlapping doses of NPH insulin given together with short-acting insulin at mealtimes. Such a therapy may be less costly, but the major advantage of insulin Glargine remains the greater safety of a lower frequency of hypoglycemic reactions.
Expert Opin Pharmacother. 2009 Mar;10(4):705-18.

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FACT:
U.S. Middle School Children are Physically Unfit, Study Shows: A study finds that a sedentary lifestyle and limited access to physical activity is compromising the fitness of U.S. children.  Using data from the Georgia Youth Fitness Assessment, researchers assessed the physical fitness levels of over 5,200 fifth- and seventh-grade students attending 93 schools in Georgia. According to the data, 52 percent of students failed to meet minimum standards for healthy aerobic fitness, while 23 percent fell short of standards for muscular strength, endurance and flexibility. In addition, the researchers found that 22 percent of students did not engage in the recommended 60 minutes of physical activity per day. Moreover, 30 percent of the studied students had a body mass index higher than the recommended level. Although all subgroups scored poorly on the fitness assessments, the data revealed that male students were more likely to be overweight and less likely to meet standards for aerobic fitness than female students. The report also notes that African-American and Hispanic students were less likely to meet physical activity requirements than students from other racial or ethnic groups. The researchers conclude that physical inactivity among school-age children has resulted in poor physical fitness and increased childhood obesity rates. They suggest that schools monitor all health-related fitness components to ensure overall student health.    Powell et al., American Journal of Preventive Medicine, April 2009 .

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