Bone & endocrine

Insulin glargine

A long-acting insulin analogue that provides a flat basal insulin level over roughly 24 hours.

Strong evidenceApproved drugAdd to compare

What it is

Insulin glargine is a long-acting insulin analogue, and insulin itself is a 51-amino-acid peptide hormone. Two arginine substitutions shift its isoelectric point so that it precipitates in the neutral tissue under the skin and dissolves slowly, producing a flat profile over about a day. It is a prescription medicine used as basal insulin.

How it works

1
Binds the insulin receptor, triggering glucose uptake in muscle and fat.
2
Suppresses liver glucose output between meals and overnight.
3
Microprecipitates form at the injection site and dissolve slowly, giving a peakless profile.
4
Stimulates glycogen and fat storage and inhibits fat breakdown.
5
Shifts potassium into cells, which matters in overdose.

What it's studied for

Basal-bolus regimens in type 1 diabetes

Type 2 diabetes when oral agents are insufficient

Comparison with NPH insulin in treat-to-target trials

Cardiovascular and cancer outcomes (ORIGIN)

Diabetes in pregnancy

Reported and studied effects

HbA1c reduction similar to NPH insulin with fewer nocturnal hypoglycaemias
Roughly 24-hour duration with a flat action profile
Weight gain of about 1 to 3 kg
Neutral cardiovascular outcomes in ORIGIN over six years
Improved fasting glucose when titrated to target

Research protocol notes

Research context only

Research context only - prescription medicine. A common labelled starting basal dose is 0.1 to 0.2 units per kilogram once daily, titrated against fasting glucose every few days; trial protocols used fasting targets of roughly 5.0 to 6.5 mmol/L and ran from six months to over six years in ORIGIN. Insulin is a drug where the wrong number is dangerous, which is why a clinician sets it.

These figures are described so you can understand what researchers did. They are not a dose, a schedule, or a suggestion — and they are not a substitute for a doctor.

Possible side effects and contraindications

Safety profile

Possible side effects

Hypoglycaemia, including severe episodes
Weight gain
Lipohypertrophy at injection sites
Oedema
Hypokalaemia
Allergic and injection-site reactions

Contraindications and cautions

Current hypoglycaemia
Prior hypersensitivity to the insulin
Renal or hepatic impairment requires dose reduction
Acute illness requires altered dosing and monitoring

A side-effect list is never complete, and these are not the only situations that warrant caution. Anything unexpected, or anything you are unsure about, should be discussed with a doctor before use.

Evidence assessment

Strong evidenceReplicated, large human trials

Replicated, large human trials

Large randomised treat-to-target trials and the six-year ORIGIN outcome trial in over 12,000 participants, plus universal regulatory approval.

References

References link to published literature, regulator pages or literature indexes. Where a link points to a search, it collects the peer-reviewed work on that molecule rather than a single study.

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