Insulin glargine

Insulin glargine, sold under the name Lantus, is a long-acting basal insulin analogue, usually given once or twice daily to help control the blood sugar level of those with diabetes. Its theoretical advantage is that it has a 24 hour duration of action, with a "peakless" profile. Thus, it more closely resembles the basal insulin secretion of the normal pancreatic beta cells. In type 2 diabetes and in combination with a short acting sulfonylurea (drugs which stimulate the pancreas to make more insulin), it can offer moderate control of serum glucose levels. In the absence of endogenous insulin (Type 1 diabetes or depleted type 2), Lantus needs the support of a fast acting insulin taken with food to reduce the effect of prandially derived glucose. It is post-prandial glucose elevation which more significantly affects HbA_1c and thus determines the progression of the long-term complications of diabetes mellitus.   The peakless profile of Lantus also enables the dose to be relatively higher than standard NPH insulin. Because standard NPH is normally administered at night, its peak of action tends to coincide with the lower serum glucose levels associated with nocturnal metabolism. This can induce nocturnal hypoglycaemia. Lantus offers the benefit of a more consistent pharmacological dynamic without nocturnal hypoglycaemia. The result of this is a patient who feels more confident and more comfortable with a lower pre-bed and pre-breakfast capillary glucose level.

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Lantus is formulated at pH 4, where it is completely water soluble. After subcutaneous injection, the body, at pH 7, slowly neutralizes the solution, causing insulin microcrystals to gradually precipitate from the insulin glargine solution, which then release insulin in bioloigically active form. This gradual process ensures that small amounts of Lantus are released into the body continuously, giving an almost peakless profile.