Lantus
Lantus
Generic Name
Lantus
Mechanism
- Basal insulin analog: modified insulin A chain with two glycine residues at N‑terminus and arginine‑alanine at C‑terminus.
- Reduced de‑amidation → prolonged half‑life (~24 h).
- Forms micro‑precipitates on subcutaneous injection that slowly release active insulin.
- Low peak activity: provides a flat, steady‑state insulin level, minimizing hypoglycaemic spikes.
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Pharmacokinetics
| Property | Value | Notes |
| Absorption | 12–14 h to maximal concentration (Tmax) | Minimal peak (peak‑to‑trough < 0.5 IU/L) |
| Elimination | Hepatic metabolism; renal clearance of fragments | No dose adjustment in mild CKD |
| Half‑life | ~24 h | Near‑constant basal activity |
| Steady‑state | Achieved after ~7 days of daily dosing | Enables once‑daily dosing |
| Food interaction | None significant | Can be injected post‑meal or fasting |
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Indications
- Type 1 diabetes mellitus: basal insulin replacement, often combined with rapid‑acting analogues for mealtimes.
- Type 2 diabetes mellitus: basal insulin in insulin‑naïve or insulin‑experienced patients when oral agents are insufficient.
- Gestational diabetes: off‑label, if required, to improve glycaemia in pregnancy‑associated insulin resistance.
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Contraindications
- Hypersensitivity to insulin glargine, protamine, or excipients.
- Active lipid embolism: injection sites with lipodystrophy should be avoided.
- Severe renal or hepatic impairment: monitor glucose closely; adjust doses.
- Hypoglycaemia unawareness: patient education crucial before initiation.
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Dosing
- Starting dose: 0.2 U/kg once daily (usually 10–20 U).
- Adjustment: 0.05 U/kg increments every 3–4 days.
- Timing: Same time each day (evening or morning).
- Injection sites: abdomen, thighs, buttocks, upper arm; rotate sites.
- With or without meals: injection can be performed at the same time as the main meals or fasting.
- Switching: May transition from human basal insulin with overlap; titrate to avoid rebound hyperglycaemia.
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Adverse Effects
- Common
- Hypoglycaemia (most frequent).
- Injection‑site reactions (erythema, induration, ulceration).
- Weight gain (average 0.5–2 kg/month).
- Serious
- Severe hypoglycaemia (episodes with severe neuroglycæmia).
- Hypersensitivity reactions (angioedema, anaphylaxis).
- Macronodular skin changes (lipohypertrophy, lipoatrophy).
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Monitoring
- Blood glucose: fasting and pre‑meal; adjust dose after 1–2 weeks.
- HbA1c: every 3 months to evaluate long‑term control.
- Weight: monthly; counsel on diet/exercise.
- Injection‑site inspection: at each visit.
- Renal/hepatic labs: baseline and annually if clinically indicated.
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Clinical Pearls
- “One‑day, one‑dose”: Basal insulin analogue Lantus delivers a flat glucose‑lowering curve, so patients rarely need dose splitting.
- Avoid “peak‑to‑trough” hypoglycaemia by anchoring dosing to the same time daily; evening dosing often improves overnight control.
- Lipohypertrophy: Educate patients to rotate sites and avoid injecting over scarred or lipedema areas; consider ultrasound if lesions persist.
- Co‑administration: Lantus can be given with rapid‑acting insulin at meals without dose interference, but avoid mixing in the same syringe.
- Pregnancy: While not specifically FDA‑approved for gestational diabetes, Lantus is commonly used off‑label; ensure tight glucose monitoring to protect fetal outcomes.
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