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Insulin glargine is a synthetic version of human insulin that is FDA-approved to treat adults and children with type 1 diabetes and adults with type 2 diabetes to improve and maintain glycemic control. Insulin glargine is a long-acting insulin injected once daily and provides a basal insulin level throughout the day. Regimens often combine it with rapid-acting insulin to obtain optimal glycemic control. The insulin should not be used to treat diabetic ketoacidosis, as short-acting insulin is preferred. This activity will cover the indications, mechanism of action, adverse effects, contraindications, monitoring, and toxicity of insulin glargine pertinent for healthcare professionals. Objectives: Identify the mechanism of action of insulin glargine. Determine the contraindications of insulin glargine. Apply the appropriate monitoring for insulin glargine. Communicate some interprofessional team strategies for improving care coordination and communication to advance treatment with insulin glargine and improve outcomes. Access free multiple choice questions on this topic.

Overdose of insulin glargine leads to hypoglycemia, which can be severe and persistent due to the long-acting nature of this insulin. In the case of mild hypoglycemia, carbohydrate intake is typically sufficient to restore euglycemia. The patient should ingest 15 grams of carbohydrates, wait 15 minutes, and recheck their blood glucose level. If it remains hypoglycemic, the procedure is repeated. In the case of severe hypoglycemia or if there is a reason that oral intake is not possible, then injectable glucagon is an option. Another option typically reserved for severe hypoglycemia in the hospital or EMS setting is intravenous dextrose. From published reports, dextrose infusion alone was sufficient to correct hypoglycemia. The long-acting nature of the insulin must also merit consideration; dextrose infusions may need to be repeated beyond the predicted 24-hour lifetime of the medication.[12][13][14]

The increasing rates of type 2 diabetes and the relative paucity of endocrinologists mean that initiating glucose control in uncomplicated type 2 diabetes should be part of the routine practice of interprofessional healthcare teams. Ideally, these teams would comprise clinicians (MDs, DOs, NPs, PAs), practice nurses, pharmacists, and certified diabetes educators. Some obstacles to implementing such care within a primary interprofessional team include ambiguity of roles, uncertainty of competency, and poor communication. For example, there is some ambiguity in the role of the primary care versus specialist clinician in initiating insulin and determining which patients do or do not meet the criteria of 'complicated.' Furthermore, there are misunderstandings regarding the ability to administer, educate, and adjust insulin between clinicians, practice nurses, and diabetes nurse educators. Finally,  poor communication between professional categories can lead to inadequate care, such that physicians communicate better with other physicians than with practice nurses, etc. Overcoming the abovementioned obstacles can lead to better patient outcomes and improved safety. This study has some limitations due to its use of a convenience sample of providers. Also, the study focused on provider factors that affect patient outcomes and did not consider any factors that may have impacted patient outcomes.[15] However, all of these factors point towards interprofessional team management of diabetes in general and the use of insulin glargine specifically, driving better patient outcomes.