Generic Name

Basaglar

Mechanism

Basaglar works by mimicking endogenous basal insulin secretion.
• Structure: Two arginine residues are added to the C‑terminus of the B‑chain and a glycine at the N‑terminus of the A‑chain, which delays its precipitation in subcutaneous tissue.
• Action: The insulin molecule is slowly released over 24 h, providing a flat, peakless insulin profile that reduces post‑prandial spikes.
• Receptor binding: It binds the insulin receptor, activating the PI3K‑Akt pathway for glucose uptake and glycogen synthesis, and inhibiting hepatic gluconeogenesis.

Pharmacokinetics

• Absorption: Subcutaneous injection – peak formation at 4–12 h, minimal peak.
• Distribution: ~50 mL plasma volume; protein binding 24 h without significant accumulation, allowing once‑daily dosing.
• Special populations:
• *Renal/hepatic impairment*: minimal effect; dose adjustments guided by glucose monitoring.
• *Pregnancy*: Safe; used with caution in gestational diabetes.

Indications

• Type 1 Diabetes Mellitus: Basal insulin replacement.
• Type 2 Diabetes Mellitus: As basal component of a dual‑ or triple‑agent regimen (e.g., basal‑bolus or basal‑plus).
• Long‑acting insulin therapy in patients requiring steady glucose control across 24 h.

Contraindications

• Absolute contraindication: hypersensitivity to insulin glargine or excipients (e.g., protamine).
• Warnings:
• *Hypoglycemia*: common, especially nocturnal.
• *Weight gain*: monitor BMI and advise lifestyle.
• *Edema and allergic reactions*: rare anaphylaxis.
• *Ketosis*: discontinue until blood glucose <200 mg/dL and ketones negative.

Dosing

• Starting dose:
• *Type 1*: 10 units SC once daily.
• *Type 2*: 10–20 units SC once daily (or 0.3–0.5 units/kg for initial titration).
• Titration:
• Adjust 1–2 units every 3–4 days based on fasting BG or SMBG.
• Max daily dose typically <0.6 units/kg.
• Timing: Same time each day; flexible within ±1 h.
• Mixing: Safe with rapid‑acting insulins (e.g., insulin lispro).
• Route: Subcutaneous, pre‑filled pen or vial/needle.
• Storage: 2–8 °C; freeze‑drying tolerated if used within 30 days.

Adverse Effects

• Common
• Hypoglycemia (nocturnal or early‑morning).
• Weight gain.
• Injection‑site reactions (erythema, induration).
• Serious
• Severe hypoglycemia with neuroglycopenic symptoms.
• Anaphylaxis (rare).
• Prolonged lipohypertrophy (if repeated injections in same site).

Monitoring

• Blood glucose
• Fasting or pre‑meal SMBG 3–4 days per week.
• Post‑prandial BG at peak times if hyperglycemia persists.
• HbA1c
• Every 3 months; target 400 mg/dL.
• Weight & BMI
• Monthly during titration to gauge insulin needs.
• Injection sites
• Inspect for lipodystrophy; rotate sites weekly.

Clinical Pearls

• Pen‑to‑pen equivalence: 1‑to‑1 dose conversion when switching from Lantus to Basaglar; no dose adjustment needed unless SMBG indicates otherwise.
• Late‑night dosing: Administer at bedtime; if nocturnal hypoglycemia occurs, reduce dose by 2–4 units or switch the timing earlier (e.g., 10 p.m.).
• Combination with GLP‑1 agonists: Basiglar’s lack of cortisol‑mediated glucagon suppression complements GLP‑1’s satiety effect—improve glycemic control while limiting weight gain.
• Medication reconciliation: Verify that patients are not on other long‑acting insulins (e.g., detemir) to avoid iatrogenic hyperglycemia.
• Education tip: Instruct patients that the first injection can be in the thigh, abdomen, or upper arm; rotate sites to avoid lipohypertrophy.

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• Basaglar remains a cornerstone basal insulin offering steady, predictable glucose lowering with minimal hypoglycemia risk—an indispensable option for clinicians managing complex diabetic regimens.