Name of Medicine
Insulin glargine
Presentation
- Optisulin 3mL cartridge contains 3mL of insulin glargine 100 units/mL.
- Optisulin 10mL vial contains 10mL of insulin glargine 100 units /mL.
- Optisulin pre-filled pen contains 3mL of insulin glargine 100 units /mL.
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- AllStar and AllStar Pro which deliver Optisulin in 1 unit dose increments; or
- Junior STAR which delivers Optisulin in 0.5-unit dose increments from 1 unit.
- ClikSTAR which delivers Optisulin in 1 unit dose increments.
Key Practice Points
Therapeutic Indications:
- Insulin glargine is for once-daily subcutaneous administration in the treatment of type 1 diabetes in adults and children and type 2 diabetes in adults who require insulin for the management of hyperglycaemia.
For the latest PBS indications for glargine please see
https://www.pbs.gov.au/medicine/item/9039R
Dose:
- Optusilin is an insulin analogue, equipotent to human insulin, with a prolonged duration of action that allows once daily dosing. It should be given subcutaneously once a day. It, at the same time every day (without regard to food).
- Optusilin is not intended for intravenous administration.
- Although absorption of Optisulin does not differ between abdominal, thigh or deltoid subcutaneous injection sites, as with all insulins, injection sites must be rotated from one injection to the next. Note: MedsCheck or Diabetes MedsCheck with counselling on rotation of injection site and the importance in the prevention of lipodystrophy. Referral to healthcare team for education if not rotating injection site. <
- Renal impairment: Insulin requirements may be reduced due to impaired insulin metabolism. This may inn turn lead to a decrease in insulin requirements. Note: MedsCheck or Diabetes MedsCheck with referral for annual cycle of care to check renal function.
- Hepatic impairment: Although no studies have been performed, insulin requirements maybe diminished due to reduced capacity for gluconeogenesis and reduced insulin metabolism. Note: MedsCheck or Diabetes MedsCheck with referral for annual cycle
Elderly:
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li>Paediatric use: Optisulin can be safely administered to paediatric individuals > 6 years of age.
Contraindications:
- Hypersensitivity to glargine or any active ingredient.
Precautions:
- Optisulin is not the insulin of choice for the treatment of ketoacidosis. Instead, intravenous human insulin is recommended in such cases. Optisulin must not be diluted or mixed with any other insulin or solution.
- Optisulin is not intended for intravenous administration. The prolonged duration of activity of insulin glargine is dependent on subcutaneous injection.
- As with all insulins, Optisulin may differ in its duration of action in each individual. This is dependent on many factors including (but not limited to) blood supply, temperature, physical activity, age, and length of diabetes. Note: MedsCheck or Diabetes MedsCheck to educate on what to be aware of and referral to healthcare team for sick day management plan.
- Insulin requirements may be altered during intercurrent conditions such as illness, emotional disturbance, or stress. Note: MedsCheck or Diabetes MedsCheck to educate on what to be aware of and referral to healthcare team for sick day management plan.
Adverse Effects:
- Hypoglycaemia: Hypoglycaemia is the most common adverse effect of insulins. As with all insulins, particular caution (including intensified blood glucose monitoring) should be exercised in individuals who are at greater risk of clinically significant sequelae from hypoglycaemic episodes. The prolonged effect of subcutaneous insulin glargine may delay recovery from hypoglycaemia. Note: MedsCheck or Diabetes MedsCheck with counselling on side effect profile and how hypoglycaemia is part of the side effect profile. If happening regularly consider referral to healthcare team for dose adjustment. Referral for blood glucose monitoring referral to healthcare team, information on side effect profile and counselling that hypos are a part of the side effect profile and if happening regularly may need to see prescriber for dose adjustment.
- Eyes: A marked change in glycaemic management may cause temporary visual impairment, due to temporary alteration in the turgidity and refractive index of the lens. As with all insulin regimens, intensification of insulin therapy with abrupt improvement in glycaemic management maybe associated with temporary visual impairment or worsening of retinopathy. However, long-term improved glycaemic management decreases the risk of progression of retinopathy. Note: Diabetes Medscheck with education and referral to healthcare team as required.
- Injection site and allergic reactions: As with any insulin therapy, lipodystrophy may occur at the injection site and delay insulin absorption. Other injection site reactions with insulin therapy include redness, pain, itching, hives, swelling and inflammation. Note: Diabetes Medscheck with education about side effects and referral to healthcare team to establish correct injection technique.
Pharmacokinetic Properties Summary
Metabolism: Insulin glargine is rapidly metabolized at the carboxyl terminus of the beta-chain with formation of two active metabolites M1 (21 -gly-insulin) and M2 (21 -gly-des-30 -thr-insulin). In plasma, the principal circulating compound is the metabolite M1.
More Information
For more detailed information on this product please consult the product information
https://www.ebs.tga.gov.au/ebs/picmi/picmirepository.nsf/pdf?OpenAgent&id=CP-2011-PI-01768-3