AUTHOR:-DR PREMANIDHI PANDA,M.D(MED),HON PHD IN DIABETES(USA),MRCP,FRCP
Prof. Panda DIABETES CENTRE,INDIA
WEBSITE URL:www.drpandadiabetes.com

INTRODUCTION:- Diabetes mellitus, often simply referred to as diabetes—is a group of metabolic diseases in which a person has high blood sugar, either because the body does not produce enough insulin, or because cells do not respond to the insulin that is produced.
In 2000, according to the World Health Organization, at least 171 million people worldwide suffer from diabetes, or 2.8% of the population. Its incidence is increasing rapidly, and it is estimated that by 2030, this number will almost double. The greatest increase in prevalence is, however, expected to occur in Asia and Africa, where most patients will probably be found by 2030  The increase in incidence of diabetes in developing countries follows the trend of urbanization and lifestyle changes, perhaps most importantly a "Western-style" diet.
Type II diabetes is a progressive disease . It requires two to three drug combinations produce good effects and less side effects. Type 2 diabetes is a condition of relative or absolute insulin deficiency. consists of an array of dysfunctions characterized by hyperglycemia and resulting from the combination of resistance to insulin action, inadequate insulin secretion, and excessive or inappropriate glucagons secretion. It is with both Micro vascular & macro vascular complications Consequently, insulin replacement becomes a common and essential therapy in these individuals. Insulin therapy in type 2 diabetes can range from a single injection to basal-bolus replacement regimens with multiple daily injections. Insulin glargine is a soluble long-acting insulin analog that is widely used in clinical practice for basal insulin replacement.
My  study  based on when Oral hypoglycemic drug fails to  reduce the blood sugar level the  Glarigine has got more importance then usual  Mixed Insulin.

INTENT: Intent of the  study done By  Author from 2012 January to  DECEMBER 2012over a period of  One year   over 500 Cases Type –II  Diabetes  shows tremendous result in  reduction of blood sugar, Maintenance of Blood sugar  very stable as compared to  with   Glargine  Subcutaneously  along with three drug therapy (Glimeperide,Metformin 500mg & Piogliazone /Voglibose  whose Blood sugar has not been controlled who are under Uncontrolled  blood sugar  with Three Oral Hypoglycemic Drugs .It shows good glycemic control Constant  maintenance of HBA1C 5.8  to 6.5 range. Reduction in Lipid Profile Serum Cholesterol ,  Serum  Triglyceride,LDL& VLDL.

BRIEF DESCRIPTION:- Insulin glargine, marketed by Sanofi-Aventis under the name Lantus, is a long-acting basal insulin analogue, given once daily to help control the blood sugar level of those with diabetes. It consists of microcrystals that slowly release insulin, giving a long duration of action of 18 to 26 hours, with a "peakless" profile (according to the insulin glargine package insert). Pharmacokinetic ally, it resembles basal insulin secretion of non-diabetic pancreatic beta cells. Sometimes, combinationGlimeperide,Metformin&Pioglitazone/Voglibose with Uncontrolled Diabetes.There is requirement of Insulin to control blood sugar.In comparison giving two or three times I choose Use of Glarigine
Insulin single dose with 18-26hrs activity found to be more effective.That too Indians are afraid of Taking Insulin.
In my study I have taken in my convenient dose in sliding scale not 0.5units/Kg body weight.
<150 Nil
150-170 2Units
170-190 4Units
190-210 6Units SO ON
In my study I have never found any hypoglycemia except one who has taken small diet than Usual diet. There was tremendous result in with blood sugar,HBA1C,Lipid Profile.

IN MY STUDY:-When I have used three drugs regimen Glimiperide ½+Metformin+Pioglitazone or Voglibose when FBS remain within 140-200 & 2hr PPBS within 160-280.I started in addition Glarigin
After which there was tremendous decrease in blood sugar in my own Sliding scale rather than Usual glarigine research dose 0.5Units/Kg Body Weight. In my study Over 500 cases given for period of one year.FBS remain 80-116mg/dl.2Hr PPBS 100-160mg/dl.HBA1C remain 5.6to6.4.Cholesterol,Triglyceride remain normal although with anti cholesterol like Atorvastatin or rosevastatin along with Finofibrate given to the patient with dyslipedimia.
Although Common side effects include pain, redness, swelling or itching at the injection site. But In my study I have never got anysideeffects.Only one case I found Morning hypoglycemia.
CONCLUSION:-
Use of insulin glargine(LANTUS) by giving subcutaneously compared with Without Lantus with three drugs to be continued as before is associated with less nocturnal hypoglycemia and lower post-dinner glucose levels. These data are consistent with peak less and longer duration of action of insulin glargine compared without Lantus . Achievement of acceptable average glucose control requires titration of the insulin dose to an FBG target 110mg/dl. These data support use of insulin glargine (LANTUS)in insulin combination regimens in type 2 diabetes Who those are not controlled with Thee drug Regimen. Patients with shorter duration T2DM better achieved target A1C levels. A single subcutaneous injection of glargine at a dose as per my sliding scale can acutely reduce glucose, HBA1C, and LIPID PROFILE levels for 24 h in obese insulin-resistant type 2 diabetic individuals. Glargine lowers blood glucose by mainly inhibiting EGP with limited effects on stimulating glucose disposal. Large doses of glargine have minimal effects on glucose flux and retain a relatively hepatospecific action in type 2 diabetes. Numerous studies have investigated the clinical efficacy of insulin glargine in both type 1 and type 2 diabetes. Glargine has been found to lower A1C, provide effective basal insulin replacement, and reduce the risk of hypoglycemia.
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14:-Glarigine Wikipedia
Biography

DR PREMANIDHI PANDA,M.D(MED),HON PhD IN DIABETES,MRCP,FRCP has completed his M.B.B.S at the age of 24 years from Berhampur University, India and postdoctoral studies,M.D(MED) from UTKALUniversity School of Medicine. He is the director of Prof. Panda DIABETES INSTITUTE,INDIA, a premier DIABETES HOSPITAL CUM RESEARCH CENTRE,INDIA.He has worked in TISCO HOSPITAL,INDIA,BENGHAZI MEDICAL(LIBYA),MEDWIN HOSPITAL With Repute.He has been awarded as “INDIA’s BEST DOCTOR AWARD:-2013(DIABETES)” BY MEDGATE TODAY SURVEY.He Has been Awarded MRCP,FRCP BY ROYAL COLLEGE OF PHYSICIAN AND SURGEON. He has published more than 20 papers in reputed journals and serving as Director of Prof. Panda DIABETES INSTITUTE,INDIA. He has been awarded several National & International awards contribution in diabetes.