Trade Name and Generic Name
The trade name for Insulin Glargine is Lantus and the generic name is Insulin Glargine.
Classification
Insulin Glargine is a long-acting recombinant human Insulin analog. It is formulated in a way such that its action is prolonged compared to the natural human insulin.
Mechanism of Action
Insulin Glargine works primarily by controlling the metabolism of glucose in the body. As an analog of insulin, the drug stimulates peripheral intake of glucose hence producing its effect of suppressing the glucose levels in the blood by increasing the absorption of glucose by the skeletal muscles and the fat cells ( Wang, Carabino & Vergara, 2003) . Additionally, Insulin Glargine prevents the liver from releasing more sugar into the blood. The drug also decreases the rate of proteolysis and lipolysis hence reducing further the production of insulin.
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Indications
Insulin Glargine is indicated for patients suffering from Diabetes type 1 and type 2. The minimum age for children who can receive this medication is six years. Although the drug is used for both type 1 and type 2 diabetes, it is preferred for use among patients with type 2 diabetes. It can only be used in patients with type 1 diabetes under exceptional circumstances.
Contraindications
There are various contra-indications for using Insulin Glargine. First, the use of Insulin Glargine is contraindicated in patients who are experiencing episodes of hypoglycemia. It would be risky for patients to take the drug when they are experiencing episodes of glycemia because it would worsen the condition. Very low blood sugar levels are likely to reduce the ability of a person to concentrate. In addition, hypoglycemia is likely to cause seizures and even death if the condition worsens. The other contraindication is for all patients who are hypersensitive to the Insulin Glargine. Since Insulin Glargine is an exogenous product, the body can recognize it as a foreign antigen and respond by producing antibodies against it. In instances where the patient is experiencing hypersensitivity reactions to the drug, its use should be stopped immediately and other forms of hypoglycemic agents brought into use.
Drug-Drug Interactions
Insulin Glargine interacts with several other drugs. Therefore, it is essential that these drugs are not taken together because they would interfere with its efficacy. Some of the drugs that are likely to increase the risk of occurrence of hypoglycemia include Angiotensin Converting Enzyme Inhibitors, angiotensin II, monoamine oxidase inhibitors and the salicylates ( Campbell, White, Levien & Baker, 2001) . Other drugs that are likely to increase the chances for the occurrence of hypoglycemia include the propoxyphene, analogs of somatostatin and the sulfonamide-based antibiotics.
In order to avoid putting the patient at the risk of becoming hypoglycemic, it is crucial to find alternative drugs that can be used for the same purpose but have less impact on the efficacy of the Insulin Glargine. However, sometimes a reduction of the dose administered can lead to a reduction in the likelihood of occurrence of hypoglycemia.
Other drugs are likely to reduce the ability of the Insulin Glargine to lower the blood glucose levels. These drugs include the atypical antipsychotics such as Olanzapine and clozapine. Other drugs that produce the same effects include corticosteroids, the danazol, diuretic agents and protease inhibitors. Phenothiazines and thyroid hormones also reduce the efficacy of the Insulin Glargine in lowering the blood glucose levels.
Some other drugs can make it difficult to notice the symptoms of hypoglycemia including the clonidine and beta blockers. Because of the interference, it becomes difficult to discern the onset of hypoglycemia hence the patient may end up experiencing extremely low levels of hypoglycemia which can cause seizures and even sudden death.
Important Warnings
Hypoglycemia
One of the risks of using Insulin Glargine is hypoglycemia. To this end, patients should be keen to notice any sign of low blood glucose levels and eat some food to boost their sugar levels. In fact, patients who are on insulin medication are required to eat to avoid experiencing episodes of low blood sugar levels. Several symptoms are associated with hypoglycemia. These include headaches, slurred speech, blurred vision, anxiety, tingling sensation, sweating, palpitations and dizziness. Thus, it is crucial for the patient to keep monitoring the onset of these symptoms to avoid hypoglycemia.
Hypokalemia
Insulin promotes the movement of potassium from the extracellular to the intracellular space. Consequently, the administration of Insulin Glargine causes a decrease in the levels of the extracellular Potassium. Low amounts of extracellular potassium cause many problems such as paralysis of the respiratory system. Moreover, it has negative consequences for the heart because it can easily cause arrhythmias.
Heart Failure When Used In Combination with the Ppargamma Agonists
The use of the Insulin Glargine in combination with the PPARgamma Agonists can cause fluid retention which can affect the heart. Therefore, it is crucial to constantly monitor the patient to ensure that the heart is managed well to avoid heart failure due to fluid overload.
P450 Precautions
Enzyme P450 plays a critical role in the metabolism of the Insulin Glargine. However, diabetic patients tend to have reduced amounts of the enzyme. Therefore, it is essential to investigate the levels of the P450 before beginning the administration of the Insulin Glargine. Low levels of enzyme P450 would reduce the rate of metabolism of the Insulin. Consequently, the amount of insulin in the body may keep increasing leading to worsening of hypoglycemic episodes.
Methods of Administration
The primary method of administration of the Insulin Glargine is through an intra-abdominal injection. The injection of the insulin can also be done in the thighs.
Dosage
The dosage of diabetes type 1 patients depends on the daily requirements since they do not produce any insulin. To this end, their daily needs may differ hence the amount of the dosage will depend on the amount that is required by the body. For type 2 diabetes patients, the starting dose is 0.2 units/kg daily. However, the amount can be changed depending on the response of the patient to the medication.
Social, Ethnic and Gender Considerations
Little research has been done to find out whether the social, ethnic and gender differences affect the efficacy of the Insulin Glargine. However, some ethnic groups have high levels of P450 implying that the rate of metabolism among these groups is higher compared to those ethnic groups that have low levels of P450. Therefore, the dose administered to these groups of people is increased to compensate for the faster rate of metabolism. Insulin Glargine is very expensive hence it is difficult for people with low income to afford. Moreover, since the drug is administered on a daily basis, it can be challenging for the patients with economic difficulties to afford the cost of the medication sustainably.
Side Effects
Some common side effects can be life-threatening if they are not handled well. The first common side effect is hypoglycemia. Since the drug is a long-acting analog of insulin, hypoglycemia is likely to occur especially if the patient does not take proper precautionary measures. Low blood glucose amounts expose the patient to the risk of developing seizures. Very low blood glucose levels can also result in the development of ketoacidosis due to the breakdown of ketone bodies. It is important to emphasize that the brain does not store any food for itself. Therefore, when the sugar levels are low, it tends to break down ketone bodies to have energy thus resulting in ketoacidosis.
The second life-threatening side effect associated with the intake of the Insulin Glargine is hypokalemia ( Joshi, Parikh & Das, 2007) . Low levels of potassium in the extracellular space can be catastrophic. Indeed, the heart heavily depends on the potassium to perform its role. Thus, any interference with the potassium levels will impact the normal functioning of the heart. Moreover, low potassium levels can have significant negative effects on the respiratory system by causing paralysis.
The third life-threatening side effect is an allergic reaction. Since Insulin Glargine is an exogenous substance to the body, the immune system can react by producing antibodies which may end up causing a severe inflammatory response. Hence, the patient may die because of hypovolemic shock. It is thus crucial for the patient to inform the doctor about any forms of reactions that are associated with the use of the Insulin Glargine.
Application of the National Patient Safety Goals
When a patient is given a prescription of the Insulin Glargine, the nurse needs to ensure that the National Patient Safety Goals are achieved by educating the patient about the need to avoid practices that would cause lipodystrophy and infections.
Considerations Prior To and After Drug Administration
Before the nurse can administer the medication, it is vital to carry out tests such as the liver function test because Insulin Glargine is primarily metabolized in the liver. After drug administration, the nurse should follow up to ensure that lipodystrophy does not occur at the injection site. Additionally, the patient should be encouraged to inject at a different site in the abdomen every day. The levels of P450 also need to be carefully monitored because it affects the rate of metabolism.
References
Campbell, R. K., White, J. R., Levien, T., & Baker, D. (2001). Insulin glargine. Clinical therapeutics , 23 (12), 1938-1957.
Joshi, S. R., Parikh, R. M., & Das, A. K. (2007). Insulin-history, biochemistry, physiology and pharmacology. Journal-Association of Physicians of India , 55 (L), 19.
Wang, F., Carabino, J. M., & Vergara, C. M. (2003). Insulin glargine: a systematic review of a long-acting insulin analogue. Clinical therapeutics , 25 (6), 1541-1577.
