Insulin glargine is a recombinant analogue of human insulin, which, like other types of insulin, regulates glucose metabolism. Lowers blood glucose concentration because it stimulates its peripheral capture, especially in muscle and fat. It also inhibits hepatic glucose production, adipocyte lipolysis and proteolysis, and enhances protein synthesis.
Its hypoglycemic effect is longer. Structurally, it consists of two arginine molecules at the carboxyl terminus of the B chain and a substitution of asparagine for glycine at position A21.
These molecular changes produce an analog soluble in acid solution (pH 4). It forms microscopic precipitates at the neutral pH of the subcutaneous tissue where it is released slowly without pronounced peaks.
The onset of action of insulin glargine is slow, ranging from an hour to an hour and a half. It reaches its peak in four or six hours and persists for 20 to 24 hours.
For this reason, it is applied once a day, although in some patients with reduced sensitivity or greater resistance, it is applied twice a day.
Features
The interaction of insulin glargine with the insulin receptor is similar to that of human insulin. It presents more stable action with less variability, less weight gain, less risk of hypoglycemia, better glycemic control and improvement of glycosylated hemoglobin.
100 ul glargine has a continuous action profile without spikes. Furthermore, it offers less variability of absorption than human insulin, which gives it a higher affinity for physiological basal secretion. Hence, it provides the required insulin level throughout the day.
Diet
The amount of insulin glargine to be administered depends on several factors, such as previous treatment, degree of diabetes control, anthropometric characteristics of the patient, and insulin reserve.
Any patient with type 2 diabetes mellitus and with suboptimal control may benefit from treatment with insulin glargine. Patients with type 1 diabetes mellitus are also candidates for benefit from treatment with insulin glargine, either initially or during follow-up.
Insulinization
Insulinization may be done at the time of diagnosis or during follow-up. Early in the disease, if there is weight loss, acute ketonuria or major signs of diabetes, especially with HbA1c >9%.
The most frequent reason for insulinization is the persistence of poor control after one or more oral medications have been prescribed.
The combined use of insulin glargine and oral antidiabetic drugs in patients with type 2 diabetes is indicated when there is insufficient glycemic control. This combination has a positive effect on glycemic control and insulin requirements. Also, excess weight gain can be avoided if metformin is added to the insulin.
In collaboration with endocrinologists Rosa Quillez Toboso and José Juan Lozano García, and family physicians Francisco José Fernández-Rossillo Padilla and Albacete’s Carmen Campayo Ortega and Armando Jurado Fortol were used for the preparation of this article, Clever Vázquez Rodríguez, Ángel Avila Camejo, Yurel Flanagan Gonzalez and Francisca Garzón Ramos of the Muntanya Health Center.
