detail of long acting insulin analogues

Here's a detailed explanation of long-acting insulin analogues based on the provided context and recent updates:

Long-Acting Insulin Analogues:

Long-acting insulin analogues are designed to provide a steady, low level of insulin throughout the day, typically lasting up to 24 hours or more. This is achieved by modifying the insulin molecule to slow its absorption and prolong its action. Here are some key examples and their properties:

1. Insulin Glargine (Lantus, Toujeo, Basaglar, Semglee)
2. Duration: ~24 hours (Lantus), up to 36 hours (Toujeo, which is a concentrated formulation at 300 units/mL)
3. Peak: No pronounced peak (relatively constant action)
4. Onset: ~1 hour
5. Structure: Modified by replacing asparagine at position 21 with glycine and adding two arginines at the C-terminus of the B chain
6. Note: Toujeo is a concentrated formulation (300 units/mL) with a flatter, more stable action profile compared to glargine U-100 (source: https://empendium.com/mcmtextbook/interviews/endocrinology/341919)

1. Insulin Detemir (Levemir)
2. Duration: ~12–24 hours
3. Peak: ~6–14 hours
4. Onset: ~1–2 hours
5. Structure: Modified by removing the B30 threonine and adding a C14 fatty acid chain

1. Insulin Degludec (Tresiba)
2. Duration: >24 hours (up to 42 hours)
3. Peak: No pronounced peak (relatively constant action)
4. Onset: ~1 hour
5. Structure: Modified by removing the B30 threonine and adding a C14 fatty acid chain with a 16-carbon gamma chain (forms a stable multi-hexamer upon injection)

1. Insulin Glargine 300 units/mL (Toujeo)
2. As mentioned earlier, this is a concentrated formulation of insulin glargine with a flatter and more stable action profile compared to the U-100 formulation.

Recent Updates on Long-Acting Insulin Analogues:

• Concentrated long-acting insulin analogues (200 IU/mL and 300 IU/mL) are increasingly being used in type 2 diabetes to reduce injection volume and potentially improve glycemic control. For instance, Toujeo (glargine 300 units/mL) has been shown to reduce nocturnal hypoglycemia compared to glargine 100 units/mL (source: https://empendium.com/mcmtextbook/interviews/endocrinology/341919).

• Long-acting insulin analogues were added to the WHO Essential Medicines List in 2021, acknowledging their importance in diabetes management (source: https://www.t1international.com/blog/2025/04/09/EMLupdate/).

Clinical Use:

• Typically injected once or twice daily, depending on the specific analogue and individual patient needs.

• Often used in combination with rapid-acting or short-acting insulins to manage both basal and prandial insulin needs.

• Dosage is individualized based on factors such as blood glucose levels, insulin sensitivity, and lifestyle.

Safety Considerations:

• All insulins carry a risk of hypoglycemia, so monitoring and titration are essential.

• Some analogues, like degludec, have a reduced risk of nocturnal hypoglycemia compared to other basal insulins, which may be beneficial for certain patients.

• Always consider individual patient factors such as allergies, renal/hepatic function, and pregnancy status when prescribing.