Toujeo A New/Old Type of Insulin
Oct 14, 2015
By Trevor Shewfelt, Pharmacist at the Dauphin Clinic Pharmacy
What's in a name? That which we call a rose by any other name would smell as sweet; so Romeo would, were he not Romeo call'd, retain that dear perfection which he owes without that title. Romeo, doff thy name. Juliette figures that it doesn't matter that Romeo is a Montague, the sworn enemies of her family the Capulet's. She loves him anyway, and love conquers all. Well, names do matter and, spoiler alert, things don't end well for Juliette and Romeo. I don't know if Romeo's name was the cause of the tragedy, but I think it is fair to say if Juliette held out for Harry Smith things might have gone better.
It fascinates me when it is decided that we can change the name of something without unintended consequences. In pharmacy world, we measure insulin in units. A unit of insulin is 1/100th of a millitre. It doesn't matter if you are talking about Toronto insulin, NPH insulin, 30/70 mixed insulin, lispro insulin, glargine insulin, or detemir insulin they all have 100 units of insulin in 1 mL. Toujeo insulin is going to be different.
Before we get to how Toujeo is different, lets do a diabetes review. In Type 1 diabetes, the body cant produce any insulin. Type 1 diabetics must inject insulin or die. Insulin acts like a key to open doors in the cells to let sugar in. Without insulin keys, there is no way to open the doors in the cells. The sugar stays in the blood stream. That means the blood sugar level stays high, but the cells have no energy to use. Type 2 diabetes is a little different. The pancreas produces insulin. It may even produce higher than normal amounts of insulin. The problem seems to be with the little locks on the sugar doors in the cells. The little locks seem to have gotten rusty. Even if insulin keys go into the locks, the keys cant turn and the doors wont open. We call this insulin resistance, and we think this is the main problem in Type 2 diabetes.
In Type 1 diabetes we must inject insulin. In Type 2 diabetes, insulin is not a necessity, but an option. We can treat Type 2 diabetes with pills that act like WD-40 to help those insulin resistant locks to open. Or, with enough insulin keys, we can force those rusty locks open by injecting insulin. One form of insulin both Type 1 and Type 2 diabetics use is glargine insulin.
Toujeo is a new form of glargine insulin. Glargine insulin might be familiar to some of you, as it is the ingredient in Lantus. Lantus is a long acting insulin. Lantus has 100 units of glargine per 1 mL. Toujeo has 300 units of glargine per 1 mL. That has some obvious advantages. If you are on a large number of units of insulin, you need to inject less volume of Toujeo under your skin than you would with Lantus. That should be more comfortable. The volume difference is quite striking when you see it. If you squirt 60 units of Lantus and 60 units of Toujeo onto a plate, the bubble of Toujeo is 1/3 the size of the Lantus bubble.
Toujeo seems to have some less obvious advantages. Toujeo seems to last longer than Lantus. Lantus is supposed to last for a full 24 hours. However some patients found it didn't. Some patients have to inject Lantus twice a day to control their blood sugars, instead of once. Toujeo is supposed to last for closer to 30 hours. That should mean some people who had to give two injections a day on Lantus might be able to get down to one injection per day on Toujeo.
The change in volume of the unit of Toujeo from 100 units per mL to 300 units per mL still worries me a bit. Toujeo only comes in a disposable pen that is calibrated for the Toujeo sized unit. It doesn't come in cartridge you can put in a reuseable pen or in a vial that can be drawn up with a syringe. That way it should be very difficult for someone to accidentally use a pen or syringe calibrated for 100 units per mL and inadvertently give themselves 3 times more insulin than they thought they were. But the change in unit size still worries me. I've seen people decide to draw insulin out of their pen with a syringe before. With every other type of insulin, that is no problem. With Toujeo, the results could be very harmful.
Neither a borrower nor a lender be; for loan oft loses both itself and friend, and borrowing dulls the edge of husbandry. This above all- to thine own self be true, and it must follow, as the night the day, thou canst not then be false to any man. To thine own self be true sounds like good advice, but the speaker, Polonius, is not a hero in Hamlet. He is telling his son to guard his reputation because appearances are more important than actions or inner character. That is almost the polar opposite to what people think about when they put To Thine Own Self Be True on a tee shirt. Having a more concentrated glargine insulin sounds like a good idea, but I hope the change in volume of the unit doesn't come back to bite us in the butt.
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The information in this article is intended as a helpful guide only. It is not intended to be used as a substitute for professional advice. If you have any questions about your medications and what is right for you see your doctor, pharmacist or other health care professional.
Canadian Diabetes Association www.diabetes.ca