Lantus® (insulin glargine [rDNA origin] injection) is a new true once a day background insulin from Aventis Pharmaceuticals. It represents a remarkable breakthrough in that it is the first insulin to offer truly flat insulin levels through the entire day for most users. It can be used by people with Type 1 or Type 2 diabetes who are six years old or older. Considered an alternative to an insulin pump, it is the first long-term insulin that has a predictable and consistent insulin activity.
Tips For Starting
- Morning or night? Aventis recommends taking Lantus at bedtime. Lantus' actual duration of action is 18 to 26 hours. Although the timing varies from indiviual to individual, it appears to be consistent in the same indiviual. The advantage to bedtime dosing is that for most people any gap in Lantus' activity would happen after dinner and this gap could be covered with a little extra Humalog or Novolog in the dinner injection.
- Whether you take it at bedtime or breakfast, it helps to be consistent about timing, so pick a time when you will remember to take the injection at the same time each day.
- A good way to eliminate any gaps in insulin delivery, whether caused by a duration of action less than 24 hours or by erratic timing of injections is to split the Lantus dose equally into 2 injections a day given at breakfast and at dinner or bedtime. This smoothes out the sometimes erratic insulin levels that may occur with once a day dosing.
- Lantus is a clear insulin which is unlike other long-acting insulins (Lente, NPH, Ultralente) that are all cloudy. Although the bottles have a different shape, some users have already injected a bedtime dose of Humalog rather than Lantus! Be very careful not to confuse Lantus with Humalog and other clear insulins.
- DO NOT MIX Lantus with any other insulin. Do not even reuse a syringe in Lantus that has come in contact with another insulin.
- Lantus becomes inactivated if it comes in contact with even small amounts of other insulins. This makes it appear hazy. Never use any Lantus that is not crystal clear.
- Lantus cannot replace the need for Humalog or another fast insulin to cover carbs in meals. However, occasionally in people with Type 2 diabetes, when the before breakfast blood sugar is normalized with Lantus, a premeal medication like Starlix, Prandin, or even Precose may be able to control the post meal blood sugars.
How Do I Know When I'm On The Right Dose?
One really nice feature of Lantus is that it makes finding the correct dose easy. Because of its very stable 24 hour action, the dose is gradually increased until the fasting or before breakfast blood sugar has been normalized. If low blood sugars occur during the night and they are not being caused by a dose of fast acting insulin taken during the evening hours, the dose of Lantus would be gradually reduced until the lows stop.
Similar to the basal rate of an insulin pump, the Lantus dose can be checked by skipping a meal during the day, but the real test for whether the dose is accurate comes from stable, flat overnight blood sugars.
Once the Lantus dose has been determined, the doses of premeal Humalog, Novalog, Starlix, etc. would then be adjusted to keep postmeal blood sugars normal. With a stable background insulin, carb counting becomes especially helpful as a way to decide on the insulin dose before each meal.
How Lantus Works
This insulin analog was designed to have low solubility in water at a neutral pH, such as that found in body fluids and other insulins. Lantus becomes completely soluble only at an acid pH of 4. Once this is injected under the skin, the acidic solution is neutralized leading to the formation of microprecipitates. The microprecipitates allow small amounts of insulin to be released slowly, resulting in a relatively constant concentration/time profile over 22 hours +/- 4 hours with no pronounced peak in activity.
Lantus was modified to allow this precise action. Normal insulin has two protein chains called A and B that have two zinc crosslinks between them. Lantus differs from other insulins in that one asparagine at position A21 of the A chain is replaced by glycine, and two arginines have been added added to one end of the B-chain.
Occasionally, the acidic nature of this insulin may cause mild discomfort at the injection site in some individuals. This does not appear serious enough to cause users to discontinue the insulin.
Like Humalog, Lantus is structurally different from human insulin, but it appears to rarely cause an immune or allergic response. Like any insulin allergy, the response can range from a mild local itching to a severe allergic reaction with swelling of the tongue, inability to breath and shock or death if rapid treatment is not found.
Lantus should be used with great caution and only under the supervision of a physician during pregnancy or prior to pregnancy.
How Often Does Lantus Fail To Work?
How many people fail to respond to Lantus is unknown. The vast majority of users get a consistent action from this insulin every day. However, Aventis' clinical studies did pick up some individuals who had marked differences in the action time for Lantus from one day to the next. In rare individuals, its action time was as short as 11 hours, but it is unknown why this difference occurs.
Lantus may not work for everyone, but for the vast majority who are willing to take an extra injection or two a day in order to get terrific control, this insulin is definitely worth a try.
Levemir Info Coming Soon!
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