Insulin glargine

Some of the views expressed in the following notes on newly approved products should be regarded as preliminary, as there may have been limited published data at the time of publication, and little experience in Australia of their safety or efficacy. However, the Editorial Executive Committee believes that comments made in good faith at an early stage may still be of value. Before new drugs are prescribed, the Committee believes it is important that more detailed information is obtained from the manufacturer's approved product information, a drug information centre or some other appropriate source.

Lantus (Aventis Pharma)
100 IU/mL in 3 mL cartridges, and 5 mL and 10 mL vials
Approved indication: diabetes mellitus
Australian Medicines Handbook section 10.1.1

Insulin glargine is a recombinant insulin. Its chemical structure differs from human insulin by three amino acids. The molecule is completely soluble at pH4, but after injection it becomes less soluble. Microprecipitates form, and these allow a slow continuous release of insulin. These properties make a daily injection of insulin glargine suitable for providing a patient's basal insulin requirements.

In clinical trials insulin glargine had similar effects to NPH human insulin, but in some studies fewer patients experienced symptomatic hypoglycaemia. These trials were relatively short, so the long-term effectiveness of insulin glargine is currently unknown.

Patients may find insulin glargine more painful to inject because of its acidity. It should not be mixed with other insulins.

An analysis by the National Institute for Clinical Excellence in the UK concluded that while insulin glargine is an option for type 1 diabetes, it is not recommended for routine use in people with type 2 diabetes who require insulin.¹