What is long-acting insulin?

Updated: Oct 04, 2017
  • Author: Mini A Mathew, DO, PharmD; Chief Editor: George T Griffing, MD  more...
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The long-acting insulin analogs were made with recombinant DNA technology. Insulin glargine (Lantus) is made by replacing the asparagine by glycine in the A-chain and adding 2 arginines at the C-terminus of the B-chain. When injected into subcutaneous tissue, this forms microprecipitates, which then delays absorption from the injection site. Insulin detemir (Levemir) is manufactured by elimination of the amino acid threonine at position B30 and the addition of a 14-carbon fatty acid chain at position B29. Insulin detemir is also slowly absorbed from the injection site; in addition, it is also reversibly bound to albumin in the blood, which further prolongs its action and clearance. [1]

Of the two that are currently available, insulin glargine is considered long-acting, and insulin detemir is considered intermediate-to-long acting. Insulin detemir may have to be given twice a day because it may wear off before the subsequent dose. [8] The long-acting insulins, in addition to having a long duration of action, do not have a pronounced peak effect. Some European studies have shown an association of increased risk of cancer with insulin glargine, as opposed to other insulins. [9] Although this may be alarming, these studies have not been convincing.

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