Toujeo vs Lantus Solostar - The differences are minute but may be of immense significance in certain patients. Insulin Glargine U-300, available by the brand name of Toujeo is the concentrated form of Insulin Glargine U-100 (Lantus Solostar).

• U-100 means 100 units per ml

• U-300 means 300 units per ml

• U-500 means 500 units per ml.

This means that U-300 is 3 times more concentrated than U-100. Similarly, U-500 is 5 times more concentrated than U-100. The U-300 and U-500 glargine insulins are prepared for those patients who require a higher dose. However, with the change in the concentration of insulin glargine, some of its other properties have also changed.

What are the advantages of Insulin Glargine U-300 over Lantus Solostar ( Glargine U-100)?

The same insulin is present in both Lantus (Glargine U-100) and Toujeo (U-300), hence there is essentially no variation in the chemical formulation.  The following, however, are some key distinctions between Toujeo and Lantus.

• Volume of insulin needed to administer is lesser three times than Toujeo.

  • This results in very few local side effects.
  • Thus, patients on higher doses of insulin are more likely to benefit from Toujeo than Lantus.
  • Contrary to that, patients requiring minute doses may be best managed with Lantus insulin.

• Insulin Glargine U-100 needs to be given at a fixed time of the day.

  • However, Insulin Glargine U-300 (Toujeo Insulin) may be given 2 - 4 hours earlier or later than the specified time.
  • This allows a little flexibility in the timings of insulin injection especially in individuals with a disturbed routine.

• Insulin glargine U-100, like other insulins, when given in higher doses (more than 40 - 60 units) in a single injection may affect its efficacy.

  • This is called the bubble effect.
  • Therefore, patients whose insulin dose exceeds 40 - 60 units should either split the dose into two as morning and evening doses or should split the insulin and inject it into different sites.
  • The "Bubble effect" is not seen with Insulin Glargine U-300 (Toujeo). Patients can, therefore, inject higher doses as a single once-daily injection.

• Toujeo Vs Lantus - Is there any difference in the Prices [Ref]?

  • Lantus Solostar injection costs $34.03 per 100 units (per ml)
  • Toujeo Solostar injection costs $103.65 per 300 units (per mL)
  • If the unit to unit cost is compared;
    • 100 units of Lantus insulin cost $34.03 while 100 units of Toujeo costs $34.55
    • So per unit difference in the cost is not great.

My experience with Glargine U-300 (Toujeo) and empagliflozin:

This is a 52 years of age patient with type 2 diabetes mellitus weighing 74 kgs. She presented with blood sugars ranging from 170 - 250 mg/dl in the fasting state and 200 - 400 mg in the prandial (Post-meals) state. She was using:

• Tablet Janumet (Sitagliptin and metformin) 50/500 mg twice daily

• Injection Lantus (Glargine U-100) 34 units twice daily.

Her primary concern was uncontrolled blood sugars.

After counseling regarding a 30-minutes exercise and adequate diabetic diet, I changed her medications to:

• Tab. Diampa-M ( Empagliflozin and metformin) to 12.5/1000 mg after breakfast

• Tab. Janumet (Sitagliptin and metformin) 50/1000 mg after dinner, and

• Inj. Toujeo (Glargine U-300 instead of Lantus) 40 units at bedtime.

Her weight dropped to 64 Kgs. She lost 10 kgs over 8 months. her blood sugars remained below 150 mg/dl in the prandial state and less than 120 mg/dl in the fasting state. She was very satisfied with her blood glucose readings.

However, she was unhappy with the weight loss!!

What should I do?

1. Should I stop empagliflozin as it may be causing the weight loss?

2. Should I reduce the metformin dose?

3. Or Should I continue the same treatment and just counsel her about the benefits of weight loss in her case.

4. Toujeo Vs Lantus - What is your experience?