Toujeo
Toujeo
Generic Name
Toujeo
Mechanism
- Rooted in insulin biology: Like all insulin analogues, Toujeo binds to the insulin receptor, activating tyrosine‑protein kinase pathways that promote glucose uptake, glycogen synthesis, and inhibit gluconeogenesis.
- Ultra‑slow release: At physiological pH, insulin glargine aggregates in the subcutaneous depot, dissolves slowly, and releases a constant basal insulin concentration ≈ 24 h.
- Extended duration: The 300 U/mL concentration yields a more stable profile and reduces peak‑to‑trough variability compared with 100 U/mL preparations.
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Pharmacokinetics
| Parameter | Toujeo | Comparison to Insulin Glargine 100 U/mL | |
| Absorption | Subcutaneous injection → 0–72 h onset, peak ≈ 12 h | Rapid‑acting insulin | |
| Peak‑to‑Trough | Superior flatness; trough≈100 % of peak | Trough≈50 % of peak | |
| Half‑life | 24 h | 18–20 h | |
| Bioavailability | ~100 % (SC injection) | ~100 % | |
| Dose conversion | 1:1 dose may be used from 100 U/mL after monitoring | Generally same dosing but may require adjustments for glucose and weight changes |
*Key takeaways*: Toujeo’s 300 U/mL concentration reduces injection volume and improves basal insulin stability, which can reduce hypoglycaemia risk.
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Indications
- Type 1 Diabetes Mellitus (T1DM) – Basal insulin in patients requiring > 200 U/day or with variable absorption.
- Type 2 Diabetes Mellitus (T2DM) – Basal insulin in patients inadequately controlled with oral antihyperglycemics or GLP‑1 agonists.
- Pediatric use – ≥ 12 years (weight ≥ 30 kg) with adequate renal/hepatic function.
*Note*: Toujeo is not approved for gestational diabetes.
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Contraindications
| Category | Details |
| Contraindications | Hypersensitivity to insulin glargine or excipients; diabetic ketoacidosis (initiate with regular or lispro insulin). |
| Warnings |
• Hypoglycaemia – especially nocturnal; *monitor glucose profiles*. • Renal impairment – dose may need adjustment if CrCl < 30 mL/min. • Hypersensitivity reaction – rash, pruritus, angioedema. |
| Precautions |
• Pregnancy & Lactation – insulin is safe but monitor fetal growth. • Low‑glucose urine – may mirror hypoglycaemic episodes. |
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Adverse Effects
| Category | Adverse Effects |
| Common |
• Hypoglycaemia (particularly nocturnal) • Injection‑site reactions (pain, redness, swelling) • Weight gain (≈ 1–2 kg/month if poorly controlled) |
| Serious |
• Severe hypoglycaemia (altered consciousness, seizures) • Hypersensitivity with angioedema or anaphylaxis • Thrombotic microangiopathy (very rare) |
| Management |
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• Use glucagon or dextrose for severe episodes. • Adjust dose or frequency for consistent hypoglycaemia. • Stop and refer for anaphylaxis if allergic signs. |
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Monitoring
| Parameter | Frequency | Target |
| Fasting blood glucose | 3–7 days after dose change | 4.4–6.1 mmol/L |
| Post‑prandial glucose | 2 h after meals (if desired) | < 10 mmol/L |
| HbA1c | Every 3 months | 0.5 kg/month |
| Renal function (CrCl) | Every 3–6 months | Adjust dose for CrCl < 30 mL/min |
*Periodic SMBG is vital until stable glycaemic control is achieved.*
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Clinical Pearls
1. Toujeo = “Twice‑As‑Good” – The 300 U/mL formulation gives fewer peaks and equal glucose coverage, ideal for patients prone to nocturnal hypoglycaemia.
2. First‑Parkat: When transitioning from 100 U/mL to Toujeo, *maintain the same dose* for 2 weeks; a 1:1 conversion prevents dose creep and hypoglycaemia.
3. Weight‑Watch Window: First 12 weeks: monitor weight; consider diet‑adjustments if > 0.5 kg/month.
4. Hydrogencarbonate, Not Lactate: Use a sodium‑free buffer when insulin solutions mix; avoid inadvertent sodium load in HF patients.
5. Diabetes Onset in Adolescents: Toujeo provides a smoother basal curve, aiding dietary compliance compared with NPH or 100 U/mL glargine.
6. Hypoglycaemia Awareness: Educate patients: if glucose < 3.9 mmol/L (70 mg/dL), treat immediately; self‑titration may be dangerous for those with impaired awareness.
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• Key Takeaway: Toujeo’s ultra‑slow pharmacokinetics and high concentration make it a dependable basal insulin, offering steady glucose control while reducing hypoglycaemia risk—essential for both adults and adolescents with diabetes.