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Abasaglar ® (basal insulin glargine)
This information is intended for UK registered healthcare professionals only in response to your search for information. For current information for all Lilly products, including Summaries of Product Characteristics, Patient Information Leaflets and Instructions for Use, please visit: www.medicines.org.uk
How to switch from or to Abasaglar® (insulin glargine) or other insulins from Eli Lilly and Company?
We summarize the current recommendations on insulin switching with a focus on doses and other relevant considerations.
Table of content
What guidelines have been identified?
- What are the available recommendations on switching between insulin products?
- 20 % dose reduction as a general recommendation
- Unit-per-unit switching of bolus insulins
- Switching of basal insulins
Which situations require further considerations?
What guidelines have been identified?
We have searched for official guidelines on switching between insulin products. The following guidelines have been identified:
- Information Regarding Insulin Storage and Switching Between Products in an Emergency | FDA1
- Switching between Insulin Products in Disaster Response Situations | ADA2
Local guidelines on switching between insulin products should be followed where available.
Guidance information is supported by relevant dosing information from summary of product characteristics, with a focus on insulins from Eli Lilly and Company.
What are the available recommendations on switching between insulin products?
Transferring a patient to another type or brand of insulin should be done under strict medical supervision, because any change may result in the need for a change in dosage.3-10
Close monitoring of blood glucose and adjustment in insulin dose may be needed in the transition period.1 The change in insulin need might affect the first injection only, or it may be gradual change over several weeks or months.11
The recommendations for dosing during switch range from a general 20 % dose reduction 2 up to switches on a unit-per-unit basis.1 In a 20 % dose reduction, 10 units of previous insulin would be switched to 8 units of new insulin. When switching unit-per-unit, 10 units are switched to 10 units. Generally, bolus insulins are more likely to allow a unit-per-unit switch, while switches of long-acting insulins often need a more specific review of recommendations, see below.1,2
Insulin pump, pregnancy, dialysis, high insulin doses suggesting an impact of insulin antibodies, or other situations may require a more careful evaluation of switching.1,2
20 % dose reduction as a general recommendation
As a general recommendation, the insulin dose is reduced by 20 % when switching to another insulin with limited monitoring capabilites. The dose reduction helps to avoid hypoglycaemia. A short-term, mild hyperglycaemia might result until the dose is further adjusted and the patient is back to a normal routine and insulin regimen. The 20 % reduction helps switching between2
- Short-acting insulins
- Intermediate and long-acting insulins
- Pre-mixed insulins.
Unit-per-unit switching of bolus insulins
For the switch of a mealtime insulin,
For full information on switching and posology please refer to the SmPC of the new insulin.
- Lyumjev SmPC mentions the possibility of switching on a unit-to-unit basis for conversions from another mealtime insulin to Lyumjev.10
Switching of basal insulins
Please consult the SmPC of the new insulin for relevant information on posology and prescription.
From NPH or Toujeo to Abasaglar
When switching from a treatment regimen with an intermediate or long-acting insulin to a regimen with Abasaglar, a change of the dose of the basal insulin may be required and the concomitant antidiabetic treatment may need to be adjusted (dose and timing of additional regular insulins or fast-acting insulin analogues or the dose of oral antidiabetic medicinal products).3
During the first weeks the reduction should, at least partially, be compensated by an increase in mealtime insulin, after this period the regimen should be adjusted individually.3
Close metabolic monitoring is recommended during the switch and in the initial weeks thereafter. With improved metabolic control and resulting increase in insulin sensitivity a further adjustment in dose regimen may become necessary. Dose adjustment may also be required, for example, if the patient's weight or life-style changes, change of timing of insulin dose or other circumstances arise that increase susceptibility to hypoglycaemia or hyperglycaemia.3
Patients with high insulin doses because of antibodies to human insulin may experience an improved insulin response with Abasaglar.3
Switch from twice daily NPH insulin to Abasaglar:
- To reduce the risk of nocturnal and early morning hypoglycaemia, patients who are changing their basal insulin regimen from a twice daily NPH insulin to a once daily regimen with Abasaglar should reduce their daily dose of basal insulin by 20 - 30 % during the first weeks of treatment.3
- Furthermore the patient should be aware that the prolonged effect of subcutaneous insulin glargine may delay recovery from hypoglycaemia.3
Switch from Toujeo to Abasaglar:
- Abasaglar and Toujeo (insulin glargine 300 units/ml) are not bioequivalent and are not directly interchangeable. To reduce the risk of hypoglycemia, patients who are changing their basal insulin regimen from an insulin regimen with once daily insulin glargine 300 units/ml to a once daily regimen with Abasaglar should reduce their dose by approximately 20 %.3
Abasaglar transition table
Reductions in the Abasaglar dose when transitioning from certain insulins will lower the likelihood of hypoglycemia.3,11
Please find a transition table in Transitioning From Another Basal Insulin to Abasaglar Therapy.
If transitioning from… |
To… |
Then, the recommended initial dose of Abasaglar … |
Example |
Lantus |
Abasaglar |
is the same as the Lantus dose. |
50 units of Lantus transitions to 50 units of Abasaglar |
Toujeo |
Abasaglar |
is 80 % of the Toujeo dose. |
50 units of Toujeo transitions to 40 units of Abasaglar |
twice-daily NPH insulin |
once-daily Abasaglar |
is 70 % - 80 % of the total daily NPH insulin dosage. |
25 units of NPH insulin every morning and 25 units of NPH insulin every evening, for a daily total of 50 units of NPH insulin, transitions to 35 units (70 % of the NPH insulin total daily dose) or 40 units (80 % of the NPH insulin total daily dose) of Abasaglar once daily |
an intermediate- or long-acting insulin other than Lantus |
Abasaglar |
may differ from the prior basal insulin dose and other concomitant antihyperglycemic medications may need to be adjusted. |
… |
Abbreviations: Abasaglar = Abasaglar® (insulin glargine) 100 units/mL; Lantus = Lantus® (insulin glargine) 100 units/mL; Toujeo = Toujeo® (insulin glargine) 300 units/mL.
From NPH to another NPH
From long-acting insulin to NPH
Because NPH insulin is usually administered 2x per day, patients switching from long-acting to NPH insulin should inject 1/2 basal dose with the first meal of the day and 1/2 dose with the second meal of the day.2
Which situations require further considerations?
Further consideration or consultation of specialist should be considered for
- switches from and to insulin glargine at a concentration of 300 units/ml, because insulin glargine at a concentration of 300 units/ml is not bioequivalent with insulin glargine at a concentration of 100 units/ml - please refer to the respective SmPC for further information.3
- patients with complicated insulin needs, e. g.2
- pregnancy,
- dialysis,
- insulin pump, or
- concentrated insulins (i.e., 200, 300 or 500 units/ml).
- patients with high insulin doses because of antibodies to human insulin, as these patients might experience an improved insulin response with the new insulin.3
How should the patient administer the new insulin?
To allow a successful switch of insulin, the patient should know why the switch is needed, and any concern the patient might have should be addressed.
Furthermore, the patient should get the relevant information for correct and safe use, such as
- how the insulin looks like,
- how to inject and how to use the device,
- onset of insulin effect, peak action and total duration of action, corresponding to
- when to inject,
- when to eat and
- when to expect and how to manage hypoglycaemia
The insulins from Eli Lilly and Company are usually available for administration with pre-filled pens (KwikPen) and/or cartridges for re-usable pen; some insulins are also available in vials.3-10
Treatment decision
The transition from one insulin to another remains an individual decision and the prescribing information of the applicable insulins and the pharmacokinetic/pharmacodynamic profiles should be considered. For full prescribing information please refer to the Summary of Product Characteristics (SmPC) of the new insulin.
References
1Food and Drug Administration (FDA). Information regarding insulin storage and switching between products in an emergency.https://www.fda.gov/drugs/emergency-preparedness-drugs/information-regarding-insulin-storage-and-switching-between-products-emergency. Updated September 19, 2017. Accessed December 22, 2022.
2Information for Health Care Professionals Switching between Insulin Products in Disaster Response Situations Approved by the American Diabetes Association, the Endocrine Society and JDRF. https://diabetes.org/sites/default/files/2019-08/switching-between-insulin.pdf. Updated August 2018. Accessed December 22, 2022.
3Abasaglar [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
4Humalog [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
5Humalog Mix25 [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
6Humalog Mix50 [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
7Humulin S [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
8Humulin M3 [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
9Humulin I [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
10Lyumjev [summary of product characteristics]. Eli Lilly Nederland B.V., The Netherlands.
11Data on file, Eli Lilly and Company and/or one of its subsidiaries.
12HumaPen® Savvio [instructions for use]. Eli Lilly Nederland B.V., The Netherlands.
Appendix - Insulins in overview
Insulin from Eli Lilly and Company |
Other brand in the respective group of insulin |
Fast-acting analogues |
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Fast-acting human insulin |
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Intermediate-acting human insulin |
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Long-acting analogue |
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Pre-mixed insulin (intermediate- combined with fast-acting) |
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Pre-mixed insulin (intermediate- or long- combined with fast-acting) |
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This list might be incomplete. Not all products may be marketed. Insulin products combined with GLP-1 receptor agonists have not been included.
Information on insulin effect including onset, peak and duration of action is available in section 5 of the respective summary of product characteristics.
Date of Last Review: 09 January 2023