Insulin glargine, recombinant

Generic name: Insulin Glargine, Recombinant
Drug class: Insulin

Usage of Insulin glargine, recombinant

Insulin glargine is a long-acting type of insulin that works slowly, over about 24 hours. Insulin is one of many hormones that help the body turn the food we eat into energy. This is done by using the glucose (sugar) in the blood as quick energy. Also, insulin helps us store energy that we can use later. When you have diabetes mellitus, your body cannot make enough insulin or does not use insulin properly. This causes you to have too much sugar in your blood. Like other types of insulin, insulin glargine is used to keep your blood sugar level close to normal. You may have to use insulin glargine in combination with another type of insulin or with a type of oral diabetes medicine to keep your blood sugar under control.

This medicine is available only with your doctor's prescription.

Insulin glargine, recombinant side effects

Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.

Check with your doctor immediately if any of the following side effects occur:

More common

  • Anxiety
  • behavior change similar to being drunk
  • blurred vision
  • chills
  • cold sweats
  • confusion
  • cool, pale skin
  • difficulty with thinking
  • dizziness or lightheadedness
  • drowsiness
  • excessive hunger
  • fast heartbeat
  • headache
  • nausea
  • nervousness
  • nightmares
  • restless sleep
  • seizures
  • shakiness
  • slurred speech
  • tingling in the hands, feet, lips, or tongue
  • unusual tiredness or weakness

    • Less common or rare

  • Depression or thickening of the skin at the injection site
  • fast pulse
  • itching, pain, redness, or swelling at the injection site
  • skin rash or itching over the entire body
  • sweating
  • trouble breathing

    • Incidence not known

  • Bloating or swelling of the face, hands, lower legs, or feet
  • cough
  • decreased urine
  • difficulty with swallowing
  • dry mouth
  • hives
  • increased thirst
  • irregular heartbeat
  • muscle pain or cramps
  • numbness or tingling in the hands, feet, or lips
  • puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
  • rapid weight gain
  • vomiting

    • Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:

    More common

  • Fever
  • sore throat
  • stuffy or runny nose

    • Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.

    Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.

    Before taking Insulin glargine, recombinant

    In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For this medicine, the following should be considered:

    Allergies

    Tell your doctor if you have ever had any unusual or allergic reaction to this medicine or any other medicines. Also tell your health care professional if you have any other types of allergies, such as to foods, dyes, preservatives, or animals. For non-prescription products, read the label or package ingredients carefully.

    Pediatric

    Appropriate studies performed to date have not demonstrated pediatric-specific problems that would limit the usefulness of Basaglar®, Lantus®, or Toujeo® to treat type 1 diabetes in children 6 years of age and older. However, safety and efficacy of Lantus® have not been established in children younger than 6 years of age with type 1 diabetes and in children with type 2 diabetes.

    Geriatric

    Appropriate studies performed to date have not demonstrated geriatric-specific problems that would limit the usefulness of insulin glargine in the elderly. However, elderly patients are more likely to have unwanted effects, which may require caution in patients receiving this medicine.

    Breast Feeding

    There are no adequate studies in women for determining infant risk when using this medication during breastfeeding. Weigh the potential benefits against the potential risks before taking this medication while breastfeeding.

    Interactions with Medicines

    Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.

    Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acarbose
  • Alogliptin
  • Bromocriptine
  • Canagliflozin
  • Chlorpropamide
  • Dapagliflozin
  • Empagliflozin
  • Ertugliflozin
  • Glimepiride
  • Glipizide
  • Glyburide
  • Lanreotide
  • Linagliptin
  • Liraglutide
  • Metformin
  • Metoclopramide
  • Metreleptin
  • Miglitol
  • Nateglinide
  • Octreotide
  • Pasireotide
  • Pioglitazone
  • Pramlintide
  • Repaglinide
  • Rosiglitazone
  • Sitagliptin
  • Thioctic Acid
  • Tolazamide
  • Tolbutamide
  • Vildagliptin

    • Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.

  • Acebutolol
  • Albiglutide
  • Atenolol
  • Betaxolol
  • Bisoprolol
  • Carteolol
  • Carvedilol
  • Celiprolol
  • Dulaglutide
  • Esmolol
  • Exenatide
  • Isocarboxazid
  • Labetalol
  • Levobunolol
  • Linezolid
  • Lixisenatide
  • Methylene Blue
  • Metipranolol
  • Metoprolol
  • Nadolol
  • Nebivolol
  • Oxprenolol
  • Ozanimod
  • Penbutolol
  • Phenelzine
  • Pindolol
  • Practolol
  • Procarbazine
  • Propranolol
  • Rasagiline
  • Safinamide
  • Selegiline
  • Sotalol
  • Timolol
  • Tranylcypromine

    • Interactions with Food/Tobacco/Alcohol

    Certain medicines should not be used at or around the time of eating food or eating certain types of food since interactions may occur. Using alcohol or tobacco with certain medicines may also cause interactions to occur. Discuss with your healthcare professional the use of your medicine with food, alcohol, or tobacco.

    Other Medical Problems

    The presence of other medical problems may affect the use of this medicine. Make sure you tell your doctor if you have any other medical problems, especially:

  • Congestive heart failure or
  • Hypokalemia (low potassium in the blood)—Use with caution. May make these conditions worse.
  • Emotional disturbances or
  • Illness or
  • Infection or
  • Stress—These conditions could change blood sugar levels, and may change the amount of insulin you need.
  • Hypoglycemia (low blood sugar)—Should not be used during episodes of hypoglycemia. If you have low blood sugar and take insulin, your blood sugar may reach dangerously low levels.
  • Kidney disease or
  • Liver disease—Use with caution. The effects may be increased because of slower removal of the medicine from the body.

    • Relate drugs

    How to use Insulin glargine, recombinant

    A nurse or other trained health professional may give you this medicine. You may also be taught how to give your medicine at home. This medicine is given as a shot under the skin of your stomach, thigh, buttocks, or upper arm.

    Always check the label before use, to make sure you have the correct type of insulin. Do not change the brand, type, or concentration unless your doctor tells you to. If you use a pump or other device, make sure the insulin is made for that device.

    Always double-check both the concentration (strength) of your insulin and your dose. Concentration and dose are not the same. The dose is how many units of insulin you will use. The concentration tells how many units of insulin are in each milliliter (mL), such as 100 units/mL (U-100), but this does not mean you will use 100 units at a time.

    Each package of insulin glargine contains a patient information sheet. Read this sheet carefully and make sure you understand:

  • How to prepare the medicine.
  • How to inject the medicine.
  • How to dispose of syringes, needles, and injection devices.

    • If you use this medicine at home, you will be shown the body areas where this shot can be given. Use a different body area each time you give yourself a shot. Keep track of where you give each shot to make sure you rotate body areas. Do not use the exact same spot for each injection. This will help prevent skin problems from the injections.

    Toujeo® injection is available in 2 prefilled pens: Max SoloStar® and SoloStar®.

    Since insulin glargine lowers the blood glucose over 24 hours, it should be injected once daily at bedtime.

    Check the liquid in the prefilled pen. It should be clear and colorless. Do not use it if it looks cloudy or thick, or has particles in it.

    Follow carefully the special meal plan your doctor gave you. This is the most important part of controlling your condition, and is necessary if the medicine is to work properly. Also, exercise regularly and test for sugar in your blood or urine as directed.

    Dosing

    The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

    The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For injection dosage form (solution):
  • Basaglar® or Lantus®:
  • For type 1 diabetes mellitus:
  • Adults and children 6 years of age and older—Dose is based on your blood sugar and must be determined by your doctor.
  • Children younger than 6 years of age—Use and dose must be determined by your doctor.
  • For type 2 diabetes mellitus:
  • Adults—Dose is based on your blood sugar and must be determined by your doctor.
  • Children—Use and dose must be determined by your doctor.
  • Toujeo®:
  • For type 1 diabetes mellitus:
  • Adults and children 6 years of age and older—Dose is based on your blood sugar and must be determined by your doctor.
  • Children younger than 6 years of age and older—Use and dose must be determined by your doctor.
  • For type 2 diabetes mellitus:
  • Adults and children 6 years of age and older—Dose is based on your blood sugar and must be determined by your doctor.
  • Children younger than 6 years of age and older—Use and dose must be determined by your doctor.

    • Storage

    Keep out of the reach of children.

    Do not keep outdated medicine or medicine no longer needed.

    Ask your healthcare professional how you should dispose of any medicine you do not use.

    Store unused vials, cartridges, Max SoloStar®, or SoloStar® prefilled pens in the refrigerator. Protect from light. Do not freeze.

    You may store the opened vials that you are currently using in the refrigerator or at room temperature in a cool place, away from sunlight and heat. Use within 28 days.

    The Max SoloStar® or SoloStar® prefilled pen that you are currently using should not be refrigerated. You should store the pen at room temperature, away from direct heat and light. Throw away any opened Lantus® SoloStar® pen after 28 days or Toujeo® Max SoloStar® or SoloStar® pen after 56 days.

    After a cartridge has been inserted into a pen, store the cartridge and pen at room temperature, not in the refrigerator.

    Throw away used needles in a hard, closed container that the needles cannot poke through. Keep this container away from children and pets.

    Warnings

    Never share insulin pens or cartridges with others under any circumstances. It is not safe for one pen to be used for more than one person. Sharing needles or pens can result in transmission of hepatitis viruses, HIV, or other bloodborne illnesses.

    Your doctor will want to check your progress at regular visits, especially during the first few weeks you use this medicine. Blood tests may be needed to check for unwanted effects.

    It is very important to follow carefully any instructions from your health care team about:

  • Alcohol—Drinking alcohol may cause severe low blood sugar. Discuss this with your health care team.
  • Other medicines—Do not take other medicines during the time you are using insulin glargine unless they have been discussed with your doctor. This especially includes nonprescription medicines such as aspirin, and medicines for appetite control, asthma, colds, cough, hay fever, or sinus problems.
  • Counseling—Other family members need to learn how to prevent side effects or help with side effects if they occur. Also, patients with diabetes may need special counseling about diabetes medicine dosing changes that might occur because of lifestyle changes, such as changes in exercise and diet. Furthermore, counseling on contraception and pregnancy is needed because of the problems that can occur in patients with diabetes during pregnancy.
  • Travel—Keep a recent prescription and your medical history with you. Be prepared for an emergency as you would normally. Make allowances for changing time zones and keep your meal times as close as possible to your usual meal times.

    • In case of emergency—There may be a time when you need emergency help for a problem caused by your diabetes. You need to be prepared for these emergencies. It is a good idea to:

  • Wear a medical identification (ID) bracelet or neck chain at all times. Also, carry an ID card in your wallet or purse that says that you have diabetes and a list of all of your medicines.
  • Keep an extra supply of insulin glargine and syringes with needles or injection devices on hand in case high blood sugar occurs.
  • Keep some kind of quick-acting sugar handy to treat low blood sugar.
  • Have a glucagon kit and a syringe and needle available in case severe low blood sugar occurs. Check and replace any expired kits regularly.

    • Too much insulin glargine can cause hypoglycemia (low blood sugar). Low blood sugar also can occur if you use insulin glargine with another antidiabetic medicine, changes in insulin regimen (eg, insulin strength, type of insulin, injection site), delay or miss a meal or snack, exercise more than usual, or drink alcohol. Symptoms of low blood sugar must be treated before they lead to unconsciousness (passing out). Different people may feel different symptoms of low blood sugar. It is important that you learn which symptoms of low blood sugar you usually have so that you can treat it quickly.

    Symptoms of low blood sugar include anxiety, behavior change similar to being drunk, blurred vision, cold sweats, confusion, difficulty in thinking, dizziness or lightheadedness, drowsiness, excessive hunger, fast heartbeat, headache, irritability or abnormal behavior, nervousness, nightmares, restless sleep, shakiness, slurred speech, and tingling in the hands, feet, lips, or tongue.

    If symptoms of low blood sugar occur, eat glucose tablets or gel, corn syrup, honey, or sugar cubes, or drink fruit juice, non diet soft drink, or sugar dissolved in water to relieve the symptoms. Also, check your blood for low blood sugar. Get to a doctor or a hospital right away if the symptoms do not improve. Someone should call for emergency help immediately if severe symptoms such as convulsions (seizures) or unconsciousness occur. Have a glucagon kit available, along with a syringe and needle, and know how to use it. Members of your household also should know how to use it.

    Hyperglycemia (high blood sugar) may occur if you do not take enough or skip a dose of your antidiabetic medicine, changes in insulin regimen, overeat or do not follow your meal plan, have a fever or infection, or do not exercise as much as usual.

    Symptoms of high blood sugar include blurred vision, drowsiness, dry mouth, flushed, dry skin, fruit-like breath odor, increased urination, ketones in the urine, loss of appetite, stomachache, nausea, or vomiting, tiredness, trouble breathing (rapid and deep), unconsciousness, and unusual thirst.

    If symptoms of high blood sugar occur, check your blood sugar level and then call your doctor for instructions.

    This medicine may make you dizzy or drowsy. Do not drive or do anything else that could be dangerous until you know how this medicine affects you.

    This medicine may cause serious allergic reactions, including anaphylaxis, which can be life-threatening and requires immediate medical attention. Call your doctor right away if you have a rash, itching, trouble breathing, trouble swallowing, or any swelling of your hands, face, or mouth while you are using this medicine.

    This medicine may cause low levels of potassium in your blood. Do not use medicines, supplements, or salt substitutes that contain potassium unless you have discussed this with your doctor.

    Using this medicine together with other diabetes medicine (eg, pioglitazone, rosiglitazone, Actos®, Actoplus Met®, Avandia®) may cause serious heart problems or edema (fluid retention). Check with your doctor immediately if you are rapidly gaining weight, having chest pain or discomfort, extreme tiredness or weakness, trouble breathing, uneven heartbeat, or excessive swelling of the hands, wrist, ankles, or feet.

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