Table 5.
Basal insulins
| Insulin classification | Duration of action | CV safety | Risk of nocturnal hypoglycemia | Considerations | |
|---|---|---|---|---|---|
| Intermediate-acting | NPH | ~ 18 h | – | +++ | Needs resuspension Administered usually twice daily |
| Long-acting | Detemir | 16–24 h | – | ++ | Administered once or twice daily |
| Gla-100 | ~ 24 h | Demonstrated (neutral) | ++ | Administered once daily, same time of day Available in a fixed-ratio combination with lixisenatide |
|
| Next generation | Gla-300 (U300) | ~ 30 hb | Demonstrateda (neutral) | + | Smaller volume (U300) Administered once daily Flexible + |
| Degludec (U100, U200) | ~ 30 hb | Demonstrated (neutral) | + | Option smaller volume (U200) Administered once daily Flexible ++ U100 available in a fixed-ratio combination with liraglutide |
|
Duration of action and considerations: http://guidelines.diabetes.ca/fullguidelines/chapter12; [14, 29, 68–78]. Degludec and Gla-300 studies: [18, 20–28, 30–32, 70, 79, 80]
Gla-100 glargine 100 U/mL, Gla-300 glargine 300 U/mL
+ Insulins with low risk of hypoglycemia; ++ Insulins with moderate risk of hypoglycemia; +++ Insulins with higher risk of causing hypoglycemia
aBased on results from ORIGIN with Gla-100
bPK/PD studies at 0.4 U/kg