Talk:Insulin glargine

message: 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)
thread_title: notes

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BetacommandBot 05:33, 16 September 2007 (UTC)
thread_title: Fair use rationale for Image:Glargine 02a.jpg

message: 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)
thread_title:  WikiProject class rating

message: 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)
thread_title:  Merge of Sections 

message: 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)
replies: text: 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)
thread_title:  edit war 

message: 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)
thread_title: pipeline

message: 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)
thread_title: Link Removed

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

message: 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)
thread_title:  Daily dosage 

message: "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)
thread_title:  Need elaboration of wordings