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Lantus vs Toujeo
Introduction
For patients with diabetes, certain drugs that modify the concentration of glucose in the blood can help in stabilizing blood sugar levels and managing symptoms. Lantus and Toujeo are two such drugs that are prescribed for diabetes. They are both long-acting insulins but have some differences in terms of dosage and strength. Lantus, known as insulin glargine, has a concentration of 100 units per milliliter and is usually administered once daily. On the other hand, Toujeo is a more concentrated version with 300 units per milliliter, providing a steadier, more prolonged release of insulin, potentially leading to fewer daily blood sugar fluctuations. However, the choice between these two will depend on various factors, including the patient's lifestyle, blood glucose targets, and susceptibility to hypoglycemia.
Lantus vs Toujeo Side By Side
| Attribute | Lantus | Toujeo |
|---|---|---|
| Brand Name | Lantus | Toujeo |
| Contraindications | Should not be used with medications that interfere with its action such as beta-blockers or thiazide diuretics. | Should not be used with medications that interfere with its action such as beta-blockers or thiazide diuretics. |
| Cost | Around $350 for a 10 ml vial (100 units/ml) | Around $400 for three pens (300 units/ml per pen containing 1.5 ml each) |
| Generic Name | Insulin Glargine | Insulin Glargine |
| Most Serious Side Effect | Severe allergic reactions, severe low potassium levels, fluid retention or heart failure with use of TZDs | Symptoms of an allergic reaction, low blood sugar (hypoglycemia), potassium level alterations |
| Severe Drug Interactions | Beta-blockers, thiazide diuretics | Beta-blockers, thiazide diuretics |
| Typical Dose | 10-50 units/day, starting dose about 0.2 units/kg or up to 10 units once daily | Initial dose mirrors daily long-acting or basal insulin requirements, adjusted to achieve fasting plasma glucose goals |
What is Lantus?
Insulin glargine, the generic name for Lantus, was the first long-acting human insulin analog to hit the market, offering a significant improvement over the previously available intermediate-acting insulin for the management of diabetes. This insulin analog has been designed to mimic the body's natural release of basal insulin over 24 hours, with one daily injection. It was first approved by the FDA in 2000. Lantus works by controlling the level of glucose in the blood, preventing rapid spikes and drops, and providing a more steady level of insulin throughout the day and night. Lantus has a slight influence on glucagon and minimal effect on the growth hormone, which results in it having fewer side effects than other insulin medications that have stronger effects on these other hormones.
Toujeo is another form of insulin glargine, but it is three times more concentrated than Lantus, providing a more consistent, gradual release of insulin. It is also prescribed for the treatment of both type 1 and type 2 diabetes. Like Lantus, Toujeo works by controlling the level of glucose in the blood, but the more concentrated formula means that the same amount of insulin can be delivered in a smaller volume of fluid. This can be beneficial for people who require higher doses of insulin.
What conditions is Lantus approved to treat?
Lantus is approved for managing both types of diabetes:
- Type 1 diabetes, for patients aged 6 years and older
- Type 2 diabetes, for adult patients
Toujeo is also used for the same conditions but has a different concentration:
- Type 1 diabetes, in adults and pediatric patients aged 6 years and older
- Type 2 diabetes, for adult patients
How does Lantus help with these illnesses?
Lantus and Toujeo are both long-acting insulin glargine products that help manage blood sugar levels in individuals with type 1 or type 2 diabetes. They work by mimicking the body's natural basal insulin, which is slowly released throughout the day and night to control glucose levels. Both Lantus and Toujeo are designed to be absorbed slowly, providing a steady release of insulin over a 24-hour period. This slow absorption helps to maintain more stable blood glucose levels, reducing the risk of hypoglycemic episodes. The key difference between the two is that Toujeo is a more concentrated form of insulin glargine, providing the same amount of insulin in a smaller volume of liquid. This can be beneficial for individuals who require larger doses of insulin, as it means fewer injections are needed. Like the role of serotonin in managing depression, insulin plays a crucial part in regulating blood sugar levels, and by increasing insulin, both Lantus and Toujeo can help patients manage their diabetes and maintain stable blood sugar levels.
What is Toujeo?
Toujeo is a long-acting insulin, specifically it's insulin glargine, used to manage both type 1 and type 2 diabetes. It regulates the levels of glucose in the blood by promoting its uptake into the body's cells and reducing the production of glucose in the liver. Toujeo is a concentrated form of insulin that provides a steady release of insulin over 24 hours. First approved by the FDA in 2015, Toujeo is a newer medication compared to other long-acting insulins like Lantus. As it's more concentrated, it can deliver more insulin in a smaller volume, which can be beneficial for patients who need higher doses of insulin. It is less likely to cause hypoglycemia than Lantus, making it a safer option for some patients. However, it's important to note that individual responses can vary, and what works best will depend on the individual's specific needs and circumstances.
What conditions is Toujeo approved to treat?
Toujeo is a long-acting insulin approved for the treatment of:
- Type 1 diabetes, where the body does not produce enough insulin,
- Type 2 diabetes, where the body doesn't use insulin properly.
Notably, Toujeo has an extended duration of action up to 36 hours compared to Lantus which lasts about 24 hours. This can offer more flexibility and stability in controlling blood sugar levels over time.
How does Toujeo help with these illnesses?
Insulin glargine, a long-acting insulin, is critical in the regulation of blood sugar levels, promoting the absorption of glucose from the bloodstream in body cells, and preventing the liver from producing more glucose. It plays a key role in many bodily functions, including energy storage and regulation of blood sugar levels. Toujeo is a formulation of insulin glargine that is three times as concentrated as Lantus, another insulin glargine product. This high concentration allows patients to inject lower volumes, which can be beneficial for those who require larger doses of insulin. Toujeo also has a more steady and prolonged effect, with a duration of action beyond 24 hours, unlike Lantus that lasts for about 24 hours. This can help ensure better blood sugar control, particularly in the fasting state. Furthermore, Toujeo has been shown to cause less nighttime hypoglycemia, a common concern with insulin therapy. Therefore, it might be a preferable choice for patients who do not achieve optimal control with Lantus or other long-acting insulins.
How effective are both Lantus and Toujeo?
Both insulin glargine (Lantus) and its concentrated version (Toujeo) are long-acting insulins that have been successful in managing blood glucose levels in patients with diabetes. Both were approved by the FDA within a decade of each other, Lantus in 2000 followed by Toujeo in 2015. They both offer steady, all-day sugar control but differ slightly due to their concentration; Toujeo is three times more concentrated than Lantus.
The effectiveness of these two insulins was directly studied in multiple clinical trials where they demonstrated similar efficacy at maintaining stable blood glucose levels as well as favorable safety profiles. In these studies, there wasn't any significant difference found between the two when it comes to glycemic control.
A review conducted on insulin glargine indicated that it's an effective treatment option for achieving optimal glycemic control right from the first week of therapy. Its side effect profile is comparable or better than many other insulins and it has been shown to be well-tolerated across a wide range of patient populations including elderly and pregnant women. It has since become one of the most widely prescribed long-acting insulin worldwide due to its consistent performance.
In contrast, a meta-analysis on concentrated insulin glargine (Toujeo), indicates that while equally effective compared to standard-dose Lantus, certain benefits could be seen with using this more potent formulation such as lower risk for hypoglycemia - particularly during nighttime hours which can be critical for those who have had issues with nocturnal hypoglycemia before. However, because Toujeo is newer and less established than Lantus, it tends to come into play after trying traditional treatments first.
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At what dose is Lantus typically prescribed?
Injectable dosages of Lantus range from 10-50 units/day, but studies have suggested that a starting dose of about 0.2 units/kg or up to 10 units once daily is generally sufficient for managing diabetes in most people. Children and adolescents with type 1 diabetes may be started on the same dosage. In either population, the dosage can be adjusted based on blood glucose levels; it should not be increased more than approximately 1 unit per day every week after initiation or during maintenance phase. The optimal blood glucose level should guide any changes in dose frequency or amount.
Toujeo, on the other hand, is typically administered at an initial dose of 0.2 units/kg once daily at any time of day but preferably at the same time every day for consistency's sake. As with Lantus, adjustments can and should be made based on individual metabolic needs, blood glucose monitoring results and glycemic control goal; however unlike Lantus which has a maximum limit set by some practitioners (although this varies), Toujeo does not have a specific upper limit defined except as determined by patient need.
At what dose is Toujeo typically prescribed?
Toujeo treatment typically commences at a dosage that mirrors the individual's daily long-acting or basal insulin requirements. The dose can then be adjusted to achieve fasting plasma glucose goals. It should be noted that patients who were controlled on Lantus may require a higher daily dose of Toujeo, given its stronger concentration (300 units/mL as opposed to Lantus' 100 units/mL). In clinical studies, those transitioning from Lantus required approximately 10-18% more Toujeo in order to maintain the same level of glycemic control. As with all insulins, the frequency and timing of hypoglycemia may differ among different insulin regimens. Therefore, close glucose monitoring is recommended during the transition from one regimen to another.
What are the most common side effects for Lantus?
Common side effects that may occur when using Lantus or Toujeo include:
- Hypoglycemia (low blood sugar)
- Weight gain
- Allergic reactions, which may cause itching, rash, swelling of the face, lips or throat, difficulty swallowing or breathing
- Injection site reactions like redness, pain, itching and swelling
- Lipodystrophy at the site of injection
- Swelling of hands and feet
- Muscle pain
- Upper respiratory tract infection
It is important to note that if any of these symptoms persist or worsen over time while taking either drug you should seek immediate medical attention.
Are there any potential serious side effects for Lantus?
When comparing Lantus to Toujeo, it's critical to be aware of potential side effects that may occur. Though both are long-acting insulins used to control high blood sugar in diabetes patients, they can cause different reactions in some cases:
- Low blood sugar (hypoglycemia) is the most common effect. Symptoms include headache, hunger, sweating, irritability, dizziness and shaking.
- Serious allergic reactions: these could manifest as skin rash or itching over the whole body; shortness of breath; swelling of face, lips or tongue.
- Changes in fat tissue at the injection site: this can happen if you inject insulin into the same spot repeatedly.
- Severe low potassium levels: symptoms would consist of muscle weakness or cramps and irregular heartbeat
- Fluid retention or heart failure with use of thiazolidinediones (TZDs), which are anti-diabetic medications.
If any concerning symptoms arise while using either medication—a sudden fast heartbeat being one example—contact your healthcare provider immediately for guidance.
What are the most common side effects for Toujeo?
While comparing Lantus to Toujeo, it's important to understand that both are long-acting insulin but have different concentrations. If you decide to use Toujeo, here are some potential side effects:
- Hypoglycemia (low blood sugar)
- Allergic reactions such as rash or itching
- Weight gain
- Swelling of your hands and feet
- Injection site reactions like redness, swelling or itching where the injection is given
- Upper respiratory infection symptoms such as stuffy nose or sore throat.
Importantly, if you experience significant weight change or severe hypoglycemia, consult with your doctor right away.
Are there any potential serious side effects for Toujeo?
While Toujeo is generally well-tolerated, it can sometimes cause serious side effects. These could include:
- Symptoms of an allergic reaction such as skin rash, itching or hives; swelling of the face, lips or tongue which may lead to difficulty swallowing or breathing.
- Low blood sugar (hypoglycemia) with symptoms like sweating, shaking, fast heartbeat and blurred vision.
- Potassium level alterations leading to muscle cramps, weakness or irregular heartbeat.
- Mental/mood changes like confusion or difficulty concentrating.
- Swelling in your feet and ankles due to fluid retention.
- Unintentional weight gain.
Always remember that if you notice any unusual changes while on Toujeo therapy, do not hesitate to consult your healthcare provider immediately for advice.
Contraindications for Lantus and Toujeo?
Both Lantus and Toujeo, along with most other insulin medications, may cause hypoglycemia (low blood sugar) in some people. If you notice your blood glucose dropping rapidly or if you experience symptoms of hypoglycemia such as trembling, sweating, intense hunger, confusion or trouble speaking, please seek immediate medical attention.
Neither Lantus nor Toujeo should be used if you are taking any medication that can interfere with their action such as beta-blockers or thiazide diuretics. Always tell your physician which medications you are taking; these interfering drugs will require careful monitoring and possible dose adjustments to prevent dangerous interactions with both Lantus and Toujeo.
How much do Lantus and Toujeo cost?
For the brand name versions of these drugs:
- The price of a 10 ml vial of Lantus (100 units/ml) averages around $350, which works out to about $35/day for a patient using 100 units per day.
- The price of three pens of Toujeo (300 units/ml per pen containing 1.5 ml each) averages around $400, working out to approximately $13/day.
Thus, if you are in the higher dosage range for insulin treatment (i.e., more than 50 units/day), then brand-name Toujeo is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
Currently, there are no generic versions available for either Lantus or Toujeo as they are both patented insulins made by Sanofi. However, biosimilar options may exist depending on your location and insurance coverage with costs varying widely based on these factors.
Popularity of Lantus and Toujeo
Insulin glargine, both in its generic form and under brand names such as Lantus, was estimated to have been prescribed to about 4.8 million people in the US in 2020. Insulin glargine accounted for just over 30% of long-acting insulin prescriptions in the US. It has been a popular choice among healthcare providers due to its prolonged duration of action which allows for once-daily dosing.
On the other hand, an upgraded version of insulin glargine marketed as Toujeo was introduced more recently and it was prescribed to approximately 1 million people in the USA during 2020. In terms of overall long-acting insulin prescriptions, Toujeo accounts for around 6%. The advantage of this formulation is that it provides a more stable and prolonged glycemic control compared to Lantus with less risk for hypoglycemia episodes. Despite being relatively new on the market when compared with Lantus, Toujeo's prescription rate has shown an upward trend since its introduction.
Conclusion
Both Lantus (insulin glargine) and Toujeo (a more concentrated form of insulin glargine) are long-acting insulins used in the management of type 1 and type 2 diabetes. They have been studied extensively in clinical trials, with results indicating that they effectively lower blood glucose levels over a period of 24 hours. The use of both drugs may be dictated by specific patient needs as determined by their physician, given potential interactions with other medications or medical conditions.
While Lantus is considered to be a standard option for many patients requiring basal insulin therapy, Toujeo could provide certain advantages due to its higher concentration which allows it to release insulin more slowly into the bloodstream providing steady control over a longer period. This difference might make one drug preferable depending on individual patient profiles such as those who require high daily doses of insulin.
Both products come in pen injectors making them easy to administer subcutaneously; however, no generic versions exist at this time - an important consideration when discussing cost-effectiveness especially for those paying out-of-pocket.
The side effects profile between these two insulins is quite similar – hypoglycemia being most common but also possible injection site reactions like redness or swelling. It's vital that patients monitor their blood sugar regularly and report any significant fluctuations or symptoms suggestive of low sugars like dizziness or confusion promptly.
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Refrences
- Lingvay, I., Manghi, F. P., García-Hernández, P., Norwood, P., Lehmann, L., Tarp-Johansen, M. J., … for the DUAL V Investigators. (2016, March 1). Effect of Insulin Glargine Up-titration vs Insulin Degludec/Liraglutide on Glycated Hemoglobin Levels in Patients With Uncontrolled Type 2 Diabetes. Jama. American Medical Association (AMA).http://doi.org/10.1001/jama.2016.1252
- Elrishi, M., Jarvis, J., Khunti, K., & Davies, M. (2008, August). Insulin glargine and its role in glycaemic management of Type 2 diabetes. Expert Opinion on Drug Metabolism & Toxicology. Informa Healthcare.http://doi.org/10.1517/17425255.4.8.1099
- Rosenstock, J., Dailey, G., Massi-Benedetti, M., Fritsche, A., Lin, Z., & Salzman, A. (2005, April 1). Reduced Hypoglycemia Risk With Insulin Glargine. Diabetes Care. American Diabetes Association.http://doi.org/10.2337/diacare.28.4.950
- Berard, L., & MacNeill, G. (2015, February). Insulin Degludec, a Long-Acting Once-Daily Basal Analogue for Type 1 and Type 2 Diabetes Mellitus. Canadian Journal of Diabetes. Elsevier BV.http://doi.org/10.1016/j.jcjd.2014.02.019
- Yki‐Järvinen, H. (2004, June). Insulin therapy in type 2 diabetes: role of the long‐acting insulin glargine analogue. European Journal of Clinical Investigation. Wiley.http://doi.org/10.1111/j.1365-2362.2004.01356.x