Overview
This lecture explains key features of long-acting insulins (glargine and detemir), their clinical use, dosing pattern, and mixing rules.
Long-Acting Insulin Drugs
- Long-acting insulins include glargine and detemir.
- Cathedral insulation symbolizes insulin; long pieces represent long-acting duration.
- Gargoyle in cathedral represents glargine; gargoyle sounds like glargine.
- Determined detective represents detemir; detective sounds like detemir.
- Glargine brand name in practice: Lantus; exams usually use generic name.
- Detemir brand name in practice: Levemir; exams usually use generic name.
Long-Acting Insulin Summary Table
| Property | Glargine | Detemir |
|---|
| Type | Long-acting insulin | Long-acting insulin |
| Common brand name | Lantus | Levemir |
| Dosing frequency | Usually once daily, often evening | Usually once daily, often evening |
| Peak | No pronounced peak | No pronounced peak |
| Duration of action | About 24 hours (one day) | About 24 hours (one day) |
| Mixing with other insulin | Cannot be mixed in same syringe | Cannot be mixed in same syringe |
Pharmacologic Features and Clinical Use
- Long-acting insulins are usually given once a day, typically in the evening.
- They have no peak; they provide a slow, steady effect over about 24 hours.
- They maintain a baseline insulin level in absence of meals or glucose spikes.
- They counteract the natural rate of glucose release by the liver.
- Most diabetics use combination therapy: long-acting for baseline control.
- Rapid-acting insulins are added to manage blood glucose spikes after meals.
Administration and Mixing Rules
- Long-acting insulins cannot be mixed in the same syringe with other insulins.
- Each long-acting insulin dose must be drawn up in its own syringe only.
- If both long-acting and rapid-acting insulin are needed, give two injections.
- Using separate injections ensures each insulin works properly in the body.
Key Terms & Definitions
- Long-acting insulin: Insulin formulation with slow onset and ~24-hour duration, no pronounced peak.
- Glargine: Long-acting insulin (brand Lantus) used for baseline blood glucose control.
- Detemir: Long-acting insulin (brand Levemir) used for baseline blood glucose control.
- Basal insulin: Background insulin that controls blood glucose between meals and overnight.
- Rapid-acting insulin: Insulin used to control blood glucose spikes associated with meals.