Assessing insulin effectiveness at the end of the day: Once-daily versus twice-daily insulin glargine injection


Objective: Evidence supporting the twice-daily administration of insulin glargine as an approach to address its waning effectiveness at the end of a 24 hour period is sparse. We hypothesized that insulin concentrations determined during the last four hours of a 24 hour period would be greater when identical doses of insulin glargine were administered twice-daily as compared to once-daily among type 1 diabetes patients. Research Methods: Ten subjects with insulin deficient type 1 diabetes were admitted for two 38-hour studies at least one week apart. Patients received full-dose insulin glargine once daily at 0800 and half-dose insulin glargine twice-daily at 0800 and 2000 for at least one week in random order prior to overnight studies. Overnight glucose was stabilized with intravenous insulin on the evening prior to study, and subjects fasted and did not receive short acting insulin during the study period. Insulin concentrations were assessed every 30 minutes with an ultrasensitive assay between study hours 20 and 24. Results: Insulin concentrations for the final four hours of study period did not differ between once-daily and twice-daily insulin glargine administration (p = 0.38). Home glucose testing results and overnight plasma glucose concentrations did not differ between study conditions. Conclusions: These results demonstrate that insulin concentrations are equivalent during the last four hours of a 24-hour period when insulin glargine is administered once- or twice-daily. These findings do not support a role for twice-daily insulin glargine in the management of patients with type 1 diabetes.

Share and Cite:

R. Burge, M. , R. Schroeder, E. and Mitchell, S. (2012) Assessing insulin effectiveness at the end of the day: Once-daily versus twice-daily insulin glargine injection. Journal of Diabetes Mellitus, 2, 203-207. doi: 10.4236/jdm.2012.22032.

Conflicts of Interest

The authors declare no conflicts of interest.


[1] Hirsch, I. (2005) Insulin analogues. The New England Journal of Medicine, 352, 174-183. doi:10.1056/NEJMra040832
[2] Lepore, M., Pampanelli, S., Fanelli, C., et al. (2000) Pharmacokinetics and pharmacodynamics of subcutaneous injection of long-acting human insulin analog glargine, NPH insulin, and ultralente human insulin and continuous subcutaneous infusion of insulin lispro. Diabetes, 49, 2142-2148. doi:10.2337/diabetes.49.12.2142
[3] Heinemann, L., Linkeschova, R., Rave, K., et al. (2000) Time-action profile of the long-acting insulin analog insulin glargine (HOE901) in comparison with those of NPH insulin and placebo. Diabetes Care, 23, 644-649. doi:10.2337/diacare.23.5.644
[4] Clement, S. and Bowen-Wright, H. (2002) Twenty-four hour action of insulin glargine (Lantus) may be too short for once-daily dosing: A case report. Diabetes Care, 25, 1479-1480. doi:10.2337/diacare.25.8.1479-a
[5] American Diabetes Association. (2008) Standards of medical care in diabetes—2008. Diabetes Care, 31, S12-S54.
[6] Owen, W.E. and Roberts, W.L. (2004) Cross-reactivity of three recombinant insulin analogues with five commercial insulin immunoassays. Clinical Chemistry, 50, 257-259. doi:10.1373/clinchem.2003.026625
[7] Albright, E.S., Desmond, R. and Bell, D.S.H. (2004) Efficacy of Conversion from bedtime NPH insulin injecttion to onceor twice-daily injections of insulin glargine in type 1 diabetic patients using basal/bolus therapy. Diabetes Care, 27, 632-633. doi:10.2337/diacare.27.2.632
[8] Ashwell, S.G., Gebbie, J. and Home, P.D. (2006) Twicedaily compared to once-daily insulin glargine in people with type 1 diabetes using meal-time insulin aspart. Diabetic Medicine, 23, 879-886. doi:10.1111/j.1464-5491.2006.01913.x

Copyright © 2024 by authors and Scientific Research Publishing Inc.

Creative Commons License

This work and the related PDF file are licensed under a Creative Commons Attribution 4.0 International License.