Insulin Glargine

How it works

It binds insulin receptors to promote cellular glucose uptake and suppress hepatic glucose output; an amino-acid modification shifts its isoelectric point so it precipitates at physiological pH, giving a slow, relatively peakless absorption and prolonged duration.

Prescribing in practice

• Hypoglycaemia is the principal hazard and may be more difficult to recognise when basal insulin is intensified or combined with other glucose-lowering agents.
• Administer subcutaneously, usually once daily at a consistent time, and rotate injection sites to reduce the risk of lipohypertrophy.
• Do not mix or dilute with other insulins, and be alert to differing strengths between glargine products to avoid dosing errors.

Monitoring

Monitor capillary blood glucose and HbA1c, adjusting the dose to the patient's glycaemic targets while watching for hypoglycaemia.

Counselling the patient

• Always carry a fast-acting source of sugar and learn to recognise the warning signs of a low blood glucose.
• Rotate injection sites within the same body region and never share insulin pens or needles.
• Continue background insulin during illness and seek advice, as requirements may change.

Evidence & guidelines

Long-acting insulin analogues are established basal therapy in UK diabetes care and feature in NICE diabetes guidance.