Insulin glargine

Basal Insulin·Endocrinology - Insulins & Injectables

Type 1 DM (as the basal component of a basal-bolus regimen), Type 2 DM

Authority requiredPBSINSULINLantus (100 U/mL), Toujeo (300 U/mL), OptisulinPre-filled pens or cartridge…+2

Max Dose

Titrated

Duration

24 h

Hypoglycemia

RISK

Peak

PEAKLESS

Rapid Summary

Overview

Ultra-long-acting, 'peakless' basal insulin. Provides a flat, continuous background level of insulin to suppress hepatic glucose production overnight and between meals.

Maximum Dose

No absolute max. Titrated strictly to fasting blood glucose targets.

Clinical Focus

Never mix glargine in the same syringe with any other insulin, as its acidic pH will cause it to precipitate and destroy the kinetics.

Bottom Line

Insulin glargine is the most widely used long-acting basal insulin providing 24-hour coverage, but causes weight gain and requires careful dose titration to avoid nocturnal hypoglycaemia.

Formulation & Access

Brand Names

Lantus (100 U/mL), Toujeo (300 U/mL), Optisulin

Parenteral

Pre-filled pens or cartridges for SC injection. Clear, colorless solution.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Type 1 DM (as the basal component of a basal-bolus regimen), Type 2 DM.

Clinical Place

The gold standard basal insulin. Provides much smoother, safer 24-hour coverage than old NPH (Protaphane) insulin.

Quick reference

Class & Role

Basal Insulin — Ultra-long-acting, 'peakless' basal insulin.

Route / Formulation

Pre-filled pens or cartridges for SC injection. Clear, colorless solution. (Lantus (100 U/mL), Toujeo (300 U/mL), Optisulin)

Usual Dose & Max

SC Administered once daily, exactly at the same time each day (often NOCTE or morning). Start 10 units, titrate by 2 units every 3 days based on fasting BSL. No absolute max. Titrated strictly to fasting blood glucose targets.

Key Indication Doses

Type 1 / Type 2 Diabetes: SC Administered once daily, exactly at the same time each day (often NOCTE or morning). Start 10 units, titrate by 2 units every 3 days based on fasting BSL. Renal / Hepatic: Insulin requirements drop significantly in severe renal/hepatic failure. Reduce dose to prevent hypos.

Best Uses

Insulin glargine is the most widely used long-acting basal insulin providing 24-hour coverage, but causes weight gain and requires careful dose titration to avoid nocturnal hypoglycaemia.

Avoid / Cautions

During an active episode of hypoglycemia. Pregnancy Category B3 (Safe, but detemir/NPH historically have more data).

Key Risks

Metabolic: Severe hypoglycemia (though lower risk than NPH due to lack of a peak). HIGH — Weight gain. Dermatological: Lipohypertrophy (fatty lumps) or lipoatrophy if injection sites are not rotated.

Key Interactions

Beta-blockers mask the adrenergic warning signs of hypoglycemia (tremor/tachycardia). Corticosteroids (Prednisolone) massively increase insulin resistance, requiring Glargine doses to be increased by 20-50%.

Monitoring

Check fasting morning BSL. This reading guides the titration of Glargine. Inspect abdomen for lipohypertrophy. Routine HbA1c.

Clinical Pearl

Glargine does NOT cover the glucose spike from a meal. It only covers the background glucose the liver makes. If the patient's fasting morning sugar is perfect, but their after-dinner sugar is 18, DO NOT increase the Glargine. You will cause a 3 AM hypo. Add a prandial insulin instead.

Access

Authority requiredLantus (100 U/mL), Toujeo (300 U/mL), Optisulin

Brand: Lantus (100 U/mL), Toujeo (300 U/mL), Optisulin
PBS status: Authority required

Insulin glargine

Basal Insulin·Endocrinology - Insulins & Injectables

Type 1 DM (as the basal component of a basal-bolus regimen), Type 2 DM

Authority requiredPBSINSULINLantus (100 U/mL), Toujeo (300 U/mL), OptisulinPre-filled pens or cartridge…+2

Max Dose

Titrated

Duration

24 h

Hypoglycemia

RISK

Peak

PEAKLESS

Rapid Summary

Overview

Ultra-long-acting, 'peakless' basal insulin. Provides a flat, continuous background level of insulin to suppress hepatic glucose production overnight and between meals.

Maximum Dose

No absolute max. Titrated strictly to fasting blood glucose targets.

Clinical Focus

Never mix glargine in the same syringe with any other insulin, as its acidic pH will cause it to precipitate and destroy the kinetics.

Bottom Line

Insulin glargine is the most widely used long-acting basal insulin providing 24-hour coverage, but causes weight gain and requires careful dose titration to avoid nocturnal hypoglycaemia.

Formulation & Access

Brand Names

Lantus (100 U/mL), Toujeo (300 U/mL), Optisulin

Parenteral

Pre-filled pens or cartridges for SC injection. Clear, colorless solution.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Type 1 DM (as the basal component of a basal-bolus regimen), Type 2 DM.

Clinical Place

The gold standard basal insulin. Provides much smoother, safer 24-hour coverage than old NPH (Protaphane) insulin.

Quick reference

Class & Role

Basal Insulin — Ultra-long-acting, 'peakless' basal insulin.

Route / Formulation

Pre-filled pens or cartridges for SC injection. Clear, colorless solution. (Lantus (100 U/mL), Toujeo (300 U/mL), Optisulin)

Usual Dose & Max

Key Indication Doses

Best Uses

Insulin glargine is the most widely used long-acting basal insulin providing 24-hour coverage, but causes weight gain and requires careful dose titration to avoid nocturnal hypoglycaemia.

Avoid / Cautions

During an active episode of hypoglycemia. Pregnancy Category B3 (Safe, but detemir/NPH historically have more data).

Key Risks

Key Interactions

Monitoring

Check fasting morning BSL. This reading guides the titration of Glargine. Inspect abdomen for lipohypertrophy. Routine HbA1c.

Clinical Pearl

Access

Authority requiredLantus (100 U/mL), Toujeo (300 U/mL), Optisulin

Brand: Lantus (100 U/mL), Toujeo (300 U/mL), Optisulin
PBS status: Authority required