Introduction
Toujeo (insulin glargine) is a long-acting basal insulin analog indicated for the management of type 1 and type 2 diabetes mellitus in adults and pediatric patients. It is formulated at a higher concentration (300 units/mL) compared to standard insulin glargine (100 units/mL), providing a more prolonged and stable pharmacokinetic profile with reduced peak activity.
Mechanism of Action
Toujeo exerts its glucose-lowering effects through the same mechanism as endogenous insulin. It binds to insulin receptors on target cells (primarily muscle, fat, and liver tissues), facilitating cellular glucose uptake, promoting glycogen synthesis, inhibiting gluconeogenesis, and suppressing lipolysis and proteolysis. The higher concentration results in a smaller injection volume and slower absorption from subcutaneous tissue, leading to a more gradual release into circulation and a flatter, more prolonged pharmacokinetic profile compared to insulin glargine 100 units/mL.
Indications
- Treatment of type 1 diabetes mellitus in adults and pediatric patients aged 6 years and older
- Treatment of type 2 diabetes mellitus in adults
Dosage and Administration
Initial Dosing:- Type 1 diabetes: Initiate approximately one-third of the total daily insulin requirements as Toujeo, with the remainder as rapid-acting insulin divided between meals
- Type 2 diabetes: Start with 0.2 units/kg or 10 units once daily
- Administer subcutaneously once daily at the same time each day
- Rotate injection sites within the same region (abdomen, thigh, or deltoid)
- Use only with Toujeo SoloStar prefilled pen
- Do not mix with other insulins or dilute
- Renal impairment: Requires careful glucose monitoring and dose adjustment
- Hepatic impairment: Requires careful glucose monitoring and dose adjustment
- Elderly: May require more conservative dosing due to increased hypoglycemia risk
Pharmacokinetics
Absorption: Slowly absorbed from subcutaneous tissue with onset of action within 2-4 hours Distribution: Binds to insulin receptors; minimal plasma protein binding Metabolism: Undergoes extensive metabolism in liver, kidney, and muscle tissues Elimination: Half-life approximately 18 hours; duration of action up to 36 hours Peak: No pronounced peak; provides relatively constant serum levels over 24 hoursContraindications
- Hypersensitivity to insulin glargine or any component of the formulation
- During episodes of hypoglycemia
Warnings and Precautions
Hypoglycemia: Most common adverse reaction; risk increased with renal/hepatic impairment, changes in meal patterns, exercise, and concomitant glucose-lowering agents Hypokalemia: May cause potassium shifts leading to hypokalemia Lipodystrophy: May occur at injection sites; rotate injection sites Weight gain: Can occur with insulin therapy Fluid retention: May cause edema, particularly with rapid improvement in glycemic control Allergic reactions: Both local and systemic reactions possible Medication errors: Higher concentration requires attention to avoid dosing errorsDrug Interactions
Drugs that may increase hypoglycemia risk:- Oral antidiabetic agents
- ACE inhibitors
- Disopyramide
- Fluoxetine
- MAO inhibitors
- Pentoxifylline
- Propoxyphene
- Salicylates
- Somatostatin analogs
- Sulfonamide antibiotics
- Corticosteroids
- Danazol
- Diuretics
- Estrogens
- Glucagon
- Isoniazid
- Niacin
- Phenothiazines
- Protease inhibitors
- Somatropin
- Sympathomimetic agents
- Thyroid hormones
Adverse Effects
Common (>10%):- Hypoglycemia
- Injection site reactions (redness, swelling, itching)
- Weight gain
- Allergic reactions
- Lipodystrophy
- Peripheral edema
- Hypokalemia
- Severe hypoglycemia requiring assistance
- Anaphylaxis
Monitoring Parameters
- Blood glucose levels (fasting and postprandial)
- HbA1c every 3 months until stabilized
- Hypoglycemia symptoms and awareness
- Injection site examination
- Renal and hepatic function in patients with impairment
- Serum potassium in at-risk patients
- Weight changes
- Signs of fluid retention
Patient Education
- Administer once daily at the same time each day
- Never share insulin pens, even with clean needles
- Proper injection technique and site rotation
- Recognition and management of hypoglycemia
- Importance of regular blood glucose monitoring
- Never skip meals when using insulin
- How to manage sick days
- Carry glucose source and medical identification
- Storage requirements (refrigerate unopened pens, room temperature for in-use pens for up to 56 days)
- When to seek medical attention (severe hypoglycemia, allergic reactions)
- Importance of comprehensive diabetes management including diet and exercise
References
1. FDA. Toujeo Prescribing Information. 2021. 2. Rosenstock J, et al. Diabetes Care. 2015;38(4):637-643. 3. Riddle MC, et al. JAMA. 2017;318(1):45-56. 4. Home PD, et al. Diabetes Obes Metab. 2018;20(4):889-897. 5. American Diabetes Association. Standards of Medical Care in Diabetes—2023. Diabetes Care. 2023;46(Suppl 1):S1-S291. 6. Becker RH, et al. Diabetes Obes Metab. 2015;17(8):734-741. 7. Davies MJ, et al. Diabetes Obes Metab. 2016;18(4):401-409.
This information is intended for educational purposes only and should not replace professional medical advice. Always consult with a healthcare provider for personalized medical guidance.