How Does Lantus Work Overnight

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Started Lantus - Didn't Work Overnight?

I took my first dose of Lantus last night at bedtime and it didn't seem to make a whit of difference overnight. I am already on Metformin, Januvia, and Avandia, so we were going to start insulin and see if I could drop some of the other meds. I only took 10 units - is that a small dose? I am a large person - 5'10" and 235 pounds. My bedtime bg was 116, 1:00 am was 113, 4:00am was 150 and fasting was 159. Is there a chance that I will need to take the Lantus a while before it starts working, or will I need to increase the dose. I was all prepared for nighttime lows, but not this... I don't like listing illnesses, but do so in the hopes of finding the ellusive "link" between all this stuff: T2 diabetes, hypertension, hypothyroidism (autoimmune), generalized dystonia, hypokalemia, hypomagnesemia, GERD, anemia, RLS - any ideas? D.D. Family T2 for 24 years, pumping 3/07/07,no complications Check with your doctor, but the usual case is to very very gradually increase the dose, until you get it right. You'd best call for clarification on what your doctor wants you to do. I thought I read in the info that I got with my Lantus Solostar pen, that 10 units is the usual 'starting' dose. -Mott Continue reading >>

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  1. Michel

    Major study shows that, Tresiba (insulin degludec), compared to Lantus (insulin glargine), generates less overall episodes of hypoglycemia, and a bit more than half as many night-time episodes of hypoglycemia (the most dangerous). Significantly fewer patients on Tresiba experience severe hypoglycemia compared to Lantus. Trials were run for both Type 1 and Type 2 diabetes patients.
    It occurs to me we never quoted the results of the SWITCH 1 & 2 trials on the forum! There were published on July 4, 2017 on JAMA. So here goes.
    Novo Nordisk ran these trials between 2014 and 2016, in about 90 different locations, with a total of about 1,200 patients. The two trials were double-blind, randomized crossover trials:
    double-blind means that neither the patients nor the medical staff know who is taking what drug;
    randomized means that the patients are randomly assigned a trial group;
    crossover means that there are two phases, and that each batch of patients runs through both drugs, one in each phase.
    These types of trials establish causality, and are pretty good at ruling out many sources of bias and error: they are the best type of trials you can run!
    SWITCH 1 focused on patients with Type 1 diabetes. SWITCH 2 focused on patients with Type 2 diabetes. The results of both trials were similar. In both cases:
    the overall rate of hypoglycemia was lower for Tresiba (2201/100PYE [Person year’s exposure] vs 2463/100PYE for Lantus in SWITCH 1, 186 vs 265 in SWITCH 2);
    the night-time rate of hypoglycemia was significantly lower for Tresiba (277/100PYE vs 468/100PYE for Lantus in SWITCH 1, 55 vs 94 in SWITCH 20)
    fewer patients on Tresiba experienced severe hypoglycemia (10% vs 17% on Lantus in SWITCH 1, 1.6% vs 2.4% in SWITCH 2).
    The SWITCH 1 trial write-up in JAMA:

    Effect of Insulin Degludec vs Insulin Glargine U100 on Hypoglycemia in Type 1...
    This crossover nonineriority trial compared the effects of insulin degludec with insulin glargine U100 in reducing on rates of symptomatic hypoglycemic episodes among adult patients with type 1 diabetes.
    The SWITCH 2 trial write-up in JAMA:

    Effects of Insulin Degludec vs Glargine U100 on Hypoglycemia in Patients With...
    This randomized crossover clinical trial compares the effects of insulin degludec vs insulin glargine U100 on rates of hypoglycemia in patients with type 2 diabetes mellitus (T2DM).

  2. Chris

    Very interesting results. I hadn’t heard of these trials, so I appreciate you bringing them forward. Additionally, it makes sense that Type 2’s would have less hypo events, but it is shocking to me that it would be a 10 fold difference.

  3. docslotnick

    @Michel Thank you for pointing out these important studies.
    The results are much of what I would have expected, given the dynamics of the two drugs.
    The degludac and the glargine were given as once daily injections, randomized morning or evening. But from my experience (and many others) glargine does not have a true 24 hour activity in many cases. It also does not exhibit a flat activity profile, having peaks and valleys during its activity. Once a day titration can easily lead to overdosage, which in turn would lead to hypoglycemic episodes.
    In real life, this is complicated by the fact that a good number of glargine users split the daily dosage in half, taking injections both morning and evening.

    Degludac, on the other hand, truly is a 24 hour insulin with no peaks or valleys. Because it is easier to titrate because of this, there is less likelihood of overdosage, hence less likelihood of hypoglycemic episodes.

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