Talk:Insulin glargine

notes

glucose levels rise during the night due to increased cortisol secretion, diabetics usually wake up hyperglycaemic, not hypo, so NPH has a peak at the right time...

-That sounds completly wrong. I ALWAYS wake with lower blood sugar values compared to last night.

Both situations are common for different reasons. A peakless basal is generally favorable because it is more predictable and simplifies management.

The above may be true for type 2 patients, but for type 1 diabetics glucose levels are well known to "rise with the sun", resulting in the "dawn phenomenon." My understanding is that this is, at least in part, due to growth hormone, which is released just before waking. At any rate, because non-diabetics maintain normal glucose while fasting, even as they wake and for the hours thereafter when type 1 diabetics have their glucose levels rise, it would seem that non-diabetic basal insulin levels rise during the morning.

For type 1 diabetics to maintain normal glucose (while not eating), the basal insulin action profile needs to increase during this dawn phenomenon period, so that glucose does not rise with the sun, as it does not in non-diabetics. This is important because only with such a variable basal insulin action profile is it possible to estimate the bolus insulin needed for a meal without the bias that would otherwise result (from basal insulin action that did not maintain euglycemia absent the perturbation of food and its attendant bolus insulin).

In my own experience, adjusting basal insulin infusion hourly with an insulin pump while fasting all day, basal insulin action during the day varies by about two to one, with the highest levels needed in the morning, and the lowest in the afternoon. According to the only study on the subject http://www.ncbi.nlm.nih.gov/pubmed/15955383 there is a variation in the timing and degree of difference in the maximum and minimum basal need according to age (youngsters have a larger growth hormone surge), but the general pattern is the same for all type 1 patients, and it is NOT steady or "peakless."

In short, glargine is probably not a good "basal insulin" for use by type 1 patients, though NPH may be inappropriate for those (youngsters) who can't take it late enough to avoid it leading to hypoglycemia before the dawn phenomenon kicks in. For them, a pump would be the best alternative, apart from the cost.

At any rate, it's a shame the label "basal insulin" has been applied to glargine and detemir, because their peakless nature renders them non-physiologic. Only an insulin pump can provide a perfect basal insulin action profile, and only NPH has the gentle peak required for a true basal insulin (when taken at the right time). TID NPH insulin administration (needed for overlapping 24 hour coverage) is a pain in practice, unfortunately. DRLWorthington (talk) 09:24, 27 September 2014 (UTC)

Fair use rationale for Image:Glargine 02a.jpg

Image:Glargine 02a.jpg is being used on this article. I notice the image page specifies that the image is being used under fair use but there is no explanation or rationale as to why its use in this Wikipedia article constitutes fair use. In addition to the boilerplate fair use template, you must also write out on the image description page a specific explanation or rationale for why using this image in each article is consistent with fair use.

Please go to the image description page and edit it to include a fair use rationale. Using one of the templates at Wikipedia:Fair use rationale guideline is an easy way to insure that your image is in compliance with Wikipedia policy, but remember that you must complete the template. Do not simply insert a blank template on an image page.

If there is other fair use media, consider checking that you have specified the fair use rationale on the other images used on this page. Note that any fair use images uploaded after 4 May, 2006, and lacking such an explanation will be deleted one week after they have been uploaded, as described on criteria for speedy deletion. If you have any questions please ask them at the Media copyright questions page. Thank you.

BetacommandBot 05:33, 16 September 2007 (UTC)

WikiProject class rating

This article was automatically assessed because at least one WikiProject had rated the article as start, and the rating on other projects was brought up to start class. BetacommandBot 16:28, 10 November 2007 (UTC)

Merge of Sections

I believe that the sections "6 Possible cancer link" and "7 Studies concerning cancer link" should be merged, given the recent reports of new studies. I'll do this in a while if there is no commentRoss-c (talk) 08:02, 12 June 2012 (UTC)

edit war

I think this is the disputed content. Let's discuss.

A positional statement has been articulated with great defensive support that long acting insulins, which include insulin glargine, do not appear much better than traditional neutral protamine Hagedorn [NPH insulin|(NPH) insulin]] in spite of the long-acting insulin's somewhat greater market cost with respect to traditional insulins such as NPH and Regular. As of 2010, their market value is higher than Regular and NPH insulin which have been on the market for much longer. Although some evidence has been presented suggesting that it is unclear if there is a difference in hypoglycemia and there is not enough data to determine any differences with respect to long term outcomes, there is a large on-line and off-line diabetic community that successfully uses insulin glargine to manage their diabetes, and consider it to be a better option than those insulins that have been on the market for longer. Because the insulin analog glargine is almost peakless, and insulin peaks have been demonstrated to produce both hypoglycemia and appetite increase, it is logically, and has also been shown by experience to be, a good candidate once-a-day replacement for twice daily NPH in type I diabetics who have problems with hypoglycemia (particularly nocturnal) and also for those individuals who are in schools or other situations where they may not be able to interrupt their day to have a snack or timed meal when other intermediate-acting insulins would peak. Because of the appetite increasing properties of insulin peaks, a long-acting insulin is also a good insulin candidate for obese insulin-dependent diabetics when supplemented with a shorter acting insulin for meals. Additionally, the insulin analog glargine, because it is almost peakless, may allow individuals who would like to fast for religious reasons (Lent, Yom Kippur, or Ramadam) to perform their fasts

• comment: although the 2 sources appear to meet WP:MEDRS, the rest of this paragraph appears to be unreferenced opinion. Lesion (talk) 00:10, 14 September 2013 (UTC)

Yes the two refs were there originally. The issue is the unreffed text. Doc James (talk · contribs · email) (if I write on your page reply on mine) 13:14, 14 September 2013 (UTC)

pipeline

User:NickCT - this piece gives a sense of the current insulin pipeline. I don't know why you are amplifying Sanofi's press release in WP, nor why you describe development of this combination drug, which started in 2003 per this Biospace piece. That article and this source describe why Sanofi is pushing this so hard (their patent on their insulin is expiring, and this is a typical line extension play) and how regulators have looked at this so far (not positively). Jytdog (talk) 19:47, 20 September 2016 (UTC)

Link Removed

I removed a link to a site purportedly comparing insulin detemir with insulin glargine: entitled "Comparing Insulins Detemir and Glargine in Type 2 Diabetes: More Similarities than Differences" It went to a site that was apparently no longer active. Or, at least, one did not end up at the URL in the link, but rather at another site devoted to opioids. As such, this was false advertising, as well as a security risk. Mrs rockefeller (talk) 23:12, 6 February 2017 (UTC)

Contradiction: "It is [not] typically the recommended long acting insulin in the United Kingdom."

The second sentence of the article is "It is typically the recommended long acting insulin in the United Kingdom." The last sentence under "Medical Uses" is "It is not typically the recommended long acting insulin in the United Kingdom."

Both sentences refer to [7], the September 2018-March 2019 edition of the British National Formulary. There is a note with the footnote mark on the first sentence noting this contradiction.

This may be an artifact of the edit war referred to above. Perhaps someone with access to [7] could resolve this? -- motorfingers : Talk 00:13, 16 November 2021 (UTC)

Daily dosage

The article currently states that type I diabetics take Insulin Glargine once a day, in the morning. I'm LADA, and I take it twice a day, with half of my daily dose in the morning before breakfast and the other half at bedtime. I don't want to get into an edit war, or an argument over this, so I'd prefer that somebody with more knowledge of the subject would edit the line in question to reflect the fact that most, but not all type I diabetics take it once a day, with a small number taking it twice to smooth out the effects. JDZeff (talk) 19:44, 10 February 2023 (UTC)

Need elaboration of wordings

"The admission was prolonged on 9 June 2005." Can anybody help explain the meaning of the wordings? I couldn't obtain info from the citation to know what the wordings tried to convey. Thanks. ThomasYehYeh (talk) 11:47, 6 January 2024 (UTC)