PEBC: What You Need to Know: Basal Insulins

Examples: insulin degludec (Tresiba), insulin glargine (Lantus, Toujeo), insulin detemir (Levemir), insulin NPH (Humulin N)

Duration of Action:

Tresiba>Toujeo, Lantus, Levemir>NPH

These insulins are designed to provide long durations of effect; hence called "basal" insulins to mimic the constant low level of insulin during the whole day

Dosing:

-subcutaneous injection once to twice daily (most patients will be once daily. NPH and Levemir generally needs twice daily dosing because of short duration of action)

-larger doses may need to be split up into two doses

-most patients will administer once daily dosing at bedtime

*only insulin NPH requires resuspension by inverting and rolling*

Adverse Effects:

-NPH has a peak concentration, compared to no peaks with the other insulins. Hence, hypoglycemia is possible, especially with NPH

-weight gain

-lipodystrophy (remember to rotate injection sites)

Interactions:

-Increased hypogylcemia risk when combined with other diabetic agents, especially GLP-1 agonists (ex. liraglutide), sulfonylureas (ex. gliclazide), meglitinides (ex. repaglinide)

-Glitazones: may increase heart failure and fluid retention risk. Hence, contraindicated with rosiglitazone, caution with pioglitazone