Building Competency in Diabetes Education THE ESSENTIALS

BASAL-BOLUS INSULIN THERAPY | 12-38

U100 and degludec U200. The following section examines their properties and potential differences in efficacy and/or convenience.

Insulin glargine (lantus, basaglar, Toujeo) Glargine U100 and glargine U300 (Toujeo) form precipitates at the injection site that delay its distribution and absorption. It has a lower pH of 4.0 and forms a microprecipitate in the neutral pH of the subcutaneous space. This can result in some people noticing a sensation when injecting for the first couple of injections; others do not (40,77). • Once or twice daily glargine U100; basaglar o It has an onset of action at approximately 90 minutes and a duration of action of approximately 24 hours (78). Absorption differences from different sites are minimized, but not entirely eliminated (36). It can be given at breakfast, lunch, dinner or bedtime (79). Approximately 15-30% of people note that glargine lasts less than 20 hours and experience pre-injection hyperglycemia (80,81). It is not prevented by increases in either the basal insulin or prandial insulin of meal prior to hyperglycemia. In these cases, splitting the dose of glargine is recommended (80). o Some people may find twice-daily dosage provides better basal coverage (73,82,83), in a 50:50 format (73), with a second dose given at breakfast or lunch depending on BG results and the person’s preference, schedule and/or lifestyle.

• Glargine U300 (Toujeo) o Onset: 90 minutes (78). o Duration: >30 hours (78). o Steady state is reached in about four days. o Once daily injection:

 Any time of day, but should be given at same time, but up to three hours before or after usual time frame (84). o Meal-time insulin and correction factor may need to be adjusted.