Insulin glargine is a commonly used insulin analog for treating type 1 and type 2 diabetes. It has a longer duration of action, which allows for once-daily dosing, making it more convenient for patients. However, like any medication, insulin glargine has side effects, which need to be monitored closely by healthcare professionals.

Highlights

• Insulin is a hormone that works by lowering glucose (sugar) levels in the blood. Insulin glargine is a long-acting insulin that starts to work several hours after injection and keeps working evenly for 24 hours.
• Insulin improves blood sugar control in adults and children with diabetes mellitus. Some brands of this medicine are for use only in adults. Carefully follow all instructions for the brand of insulin glargine you are using.
• Insulin is also used to treat type 1 diabetes in adults and children at least six years old.
• Insulin glargine is used to treat type 2 diabetes in adults.
• Insulin works the same way as natural human insulin, but its action lasts longer. It helps diabetic patients regulate glucose or sugar in the body. Insulin glargine promotes the movement of sugar from the blood into body tissues and stops sugar production in the liver. Insulin glargine is an artificial insulin that mimics the actions of human insulin.
• Insulin, marketed under the name Lantus, is a long-acting insulin analog, given once daily to help control the blood sugar level of those with diabetes.

Mechanism Of Action

Insulin glargine binds to the insulin receptor (IR), a heterotetrameric protein consisting of 2 extracellular alpha units and two transmembrane beta units. The binding of insulin to the alpha subunit of IR stimulates the tyrosine kinase activity intrinsic to the beta subunit of the receptor. The bound receptor autophosphorylates and phosphorylates numerous intracellular substrates like insulin receptor substrates (IRS) proteins, Cbl, APS, Shc, and gab 1. Activation of those proteins results in the activation of downstream signal molecules as well as PI3 kinase and Akt. Akt regulates the activity of glucose transporter 4 (GLUT4) and protein kinase C (PKC), which play essential roles in metabolism. Insulin glargine is soluble at pH 4, the pH of the administered solution, and has low solubility at physiological pH 7.4. Upon subcutaneous injection, the solution is neutralized, leading to the formation of micro precipitates. Small amounts of insulin glargine are released from micro precipitates giving the drug a comparatively constant concentration over a time profile over 24 hours with no pronounced peak. This release mechanism permits the drug to mimic basal hormone levels within the body.

Side effects of Insulin Glargine

One of insulin glargine’s most common side effects is hypoglycemia or low blood sugar. Hypoglycemia occurs when blood sugar levels drop too low, leading to sweating, shakiness, confusion, and even loss of consciousness. It is essential to monitor blood sugar levels regularly and adjust the insulin dosage as needed to avoid hypoglycemia.

Another common side effect of insulin glargine is injection site pain. This can occur immediately after injection or develop over time with repeated injections. To reduce injection site pain, patients can rotate the injection site and use a fresh needle with each injection.

In some cases, insulin glargine can cause water retention in the joints and weight gain. This is due to insulin’s role in promoting glucose uptake and storage in cells, increasing fat and water retention. Patients should monitor their weight and report any significant changes to their healthcare provider.

Rarely some patients may develop an allergic reaction to insulin glargine. This can cause itching, irritation, redness, rash, or swelling at the injection site. In severe cases, patients may experience bronchospasm or low blood pressure. Any signs of an allergic reaction require immediate medical attention.

Local allergic reactions that may occur at the injection sites are:

• Itching
• Irritation
• Redness
• Rash
• Long-term use of insulin glargine can lead to the thickening of fat tissues at the injection site.

Severe allergic reactions are;

• Swelling under the skin
• Bronchospasm
• Very low blood pressure.

Bottom Line

Insulin glargine is an effective treatment option for diabetes but not without side effects. Patients should work closely with their healthcare provider to monitor their blood sugar levels, adjust their insulin dosage, and report any concerning symptoms. With proper management, insulin glargine can help patients achieve better blood sugar control and improve their overall health and quality of life.

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