The need to control hyperglycemia is extremely important; to ensure the absorption of glucose from the blood. In the absence of this absorption, there is a likelihood of blood sugar increasing to levels that are regarded as extremely high. The outcome of this is fatigue, impact on vision, headache and an abnormal increase in thirst. This could then progress to other conditions including ketoacidosis, which is essentially a condition that is life threatening in nature. In addition to this, there is the possibility of other lifelong complications including stroke, elevated risk of heart attack and possible diabetic neuropathy. Various medications are presently available as basal insulin; the following sub sections explain all about one formulation including details of possible insulin glargine side effects. This will help users be aware of, and prevent possible undesirable outcomes.

Overview of insulin glargine

Belonging to the category of long-acting basal insulin, the medication is used in treating hyperglycemia in patients diagnosed with diabetes mellitus. Hyperglycemia occurs in both Type 1 and Type 2 diabetes, and insulin is used to manage and control high blood sugar levels.  The long-acting medication has a mechanism of action that triggers actions similar to that of naturally produced human insulin in the pancreas. This in turn facilitates glucose metabolism, that ensures absorption of blood glucose, thereby stabilizing blood glucose levels. Typically, the pancreas releases insulin after the intake of food, and this ensures that blood glucose is absorbed into other organs, tissues, muscles. This in turn ends up as glycogen after transformation, and glycogen is the first stored energy source used by the body for various actions.

The medication works for almost one day, and is known as basal insulin due to the mechanism of action that releases low concentration levels of insulin to stabilize blood sugar. Depending on the condition, basal insulin may be prescribed with bolus insulin to fully stabilize blood sugar levels. By virtue of being a long-acting medication, insulin glargine is administered once a day, in the night as a subcutaneous injection. As mentioned earlier, insulin glargine is used for treating type 1 and 2 diabetes in adults and type 1 diabetes in children above the age of six.

Ideal dosage – the ideal dosage of the medication is determined by various factors such as the weight of the patient, the intensity of the condition, blood sugar levels before and after initial dosages, and history of blood sugar. Patients are typically started off on a lower dosage, that is gradually increased to the levels that deliver the desired outcomes. Lower dosages also help in identifying or ascertaining if the medication causes any side effects.

Documented and known insulin glargine side effects

All medications come with the possibility of undesirable effects or outcomes, other than the desired outcomes. Insulin glargine is not an exception and by virtue of being a medication that may be used for a very long time, and lifelong in some instances, the possibilities of side effects are stronger. Unwanted effects are either mild, moderate in nature or serious, adverse in nature. Typically, the mild or moderate effects are known to be more commonly occurring in nature, while the serious or adverse effects are known to be relatively rare in occurrence. The mild effects generally do not require any medical intervention, while the serious effects may require urgent medical attention at a healthcare facility depending on the intensity and nature of the effect.

It is also a known fact that there are users of medications who may not experience any side effects whatsoever, and it is therefore wrong to assume that everyone would experience undesirable effects. The actual effects, in terms of intensity, duration and type depends on various factors, such as the dosage, the condition being treated, overall health, age, presence of other medical conditions and other medications in use. The following is a list or compilation of some of the commonly reported effects that have been directly attributed to the medication. This is neither a complete list, nor is it exhaustive; the purpose is to offer a broad reference of the possible unwanted outcomes. The undesirable outcomes of the medication are classified into commonly reported effects, serious effects and allergic reactions as listed below.

Commonly occurring effects from insulin glargine

Outcomes that are commonly occurring in nature include the usual reactions that are experienced at the site of injection, such as a pain or reddish appearance or itching sensation. Other effects include changes in the thickness of the skin around the site of injection, in a condition that is medically known as lipodystrophy, apart from unusual tenderness around the site of injection. Other commonly reported outcomes of the medication include swelling around the limb extremities, and exposure to possible respiratory infections, apart from a lowering of blood sugar levels. Individuals are also known to end up with an increase in weight when on the medication.

Serious effects from insulin glargine

Effects that are classified as serious in nature include a reduction in potassium levels, in a condition known as Hypokalemia, overall weakness, and abnormal tiredness/fatigue. Patients are also known to experience muscle cramps when on the medication apart from changes in heart beat rhythm. In such instances, the heart beat may either change to a racy rhythm, or may be slower than usual, and for some patients it could be an uneven rate of heart beat. Serious insulin glargine side effects include loss of movement in a part of the body, while some may experience respiratory failure. This condition is extremely serious in nature and requires intervention at the earliest.

Allergies due to insulin glargine

Allergic reactions attributed to the medication include mild reactions such as outbreak of rashes on the skin, and itching sensation. The individual may experience unusual warmth on the skin that may also turn reddish in appearance. It is important to be constantly aware of the risks of serious effects, despite rare incidence of serious reactions to the medication. For instance, patients and caregivers are to look for any form of swelling beneath the skin, that may be seen on the eyelids, the lips, or limb extremities. Swelling may also occur on the throat or the mouth. Any difficulty in breathing is to be considered as a tell-tale symptom of serious allergic reaction, and this needs to be treated immediately to prevent the condition from turning serious.

Drug interactions of insulin glargine  

Medications also come with the possibility of drug interactions with other medications, that include prescription and OTC formulations. Attributed to the mechanism of action or the properties of active compounds, these interactions may also be experienced with supplements, or herbal remedies or alternative treatments. Unlike side effects of medications that may be experienced differently by different users, the outcomes of drug interactions are mostly the same for users. This is because of the nature of drug interactions. For instance, when two drugs or substances interact, any of the following outcomes are possible. Either of the two medications/substances may end up with stronger outcomes or beyond expected outcomes, or either of the two may also witness a reduction in expected potency. There is also the possibility of stronger side effects of one or both the medications, as a result of the interaction.

Diabetic medications

Insulin glargine may interact with certain other medications for diabetes and may increase the exposure to risk of hypoglycemia. It is necessary to ensure that the dosage of either or both the medications are altered/reduced to prevent this outcome. It will also be necessary for patients to periodically monitor blood sugar levels to handle sudden and extreme reduction in blood sugar levels. Medications that are likely to trigger interactions include insulin aspart, insulin lispro, metformin and pramlintide.  Additionally, the medication may also interaction thiazolidinediones class of diabetic medications. The outcomes could aggravate the risk of heart failure in patients with the condition, or could also expose a patient to heart failure. Medications of this category include rosiglitazone and pioglitazone.

Blood pressure drugs

Insulin glargine may also interact with drugs prescribed for blood pressure, by elevating the risk of hypoglycemia. Go prevent any unusual or abnormal reduction in blood sugar levels, the right protocol is to reduce or alter the dosage of either or both the medications. Additionally, the patient is also expected to have his/her blood sugar levels periodically monitored to ensure that the levels are normal. One of the risks of this interaction is the masking of the usual symptoms of low blood sugar levels. As patients are unlikely to experience or observe the side effects, this may expose the individual to greater risk of hypoglycemia. Medications of this category include lisinopril, benazepril, captopril, enalapril, candesartan apart from valsartan.

Other drug interactions

The basal insulin is also likely to cause interactions with medications such as antipsychotics that may reduce the efficacy of insulin glargine, which in turn may cause a spike in blood sugar levels. Other interactions include corticosteroids that may also reduce the potency of the basal insulin.

How to deal with low blood sugar levels

As outlined earlier, one of the possible insulin glargine side effects is lowered blood sugar levels. Here are simple tips and methods that can be used to increase and stabilize blood sugar levels. Options include intake of easily digestible food products that are known to trigger a rapid spike in blood sugar levels. This includes crackers, candy, sugar and honey. Another easy option is commercially available glucose tablets that can increase blood sugar levels.  Individuals who frequently experience this dip in blood sugar levels may request and receive glucagon prescriptions that are proven to increase the levels quickly.

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