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Can Lantus Be Given During Pregnancy

Lantus (insulin Glargine) Dose, Indications, Adverse Effects, Interactions... From Pdr.net

Lantus (insulin Glargine) Dose, Indications, Adverse Effects, Interactions... From Pdr.net

Hormone secreted by pancreatic beta-cells of the islets of Langerhans and essential for the metabolism and homeostasis of carbohydrate, fat, and protein. Insulin glargine is a once-daily basal insulin analog without pronounced peaks. BASAGLAR, Lantus, Lantus SoloStar, Toujeo SoloStar BASAGLAR/Lantus/Lantus SoloStar/Toujeo SoloStar Subcutaneous Inj Sol: 1mL, 100U, 300U For the treatment of type 1 diabetes mellitus and type 2 diabetes mellitus. For the treatment of type 1 diabetes mellitus. Subcutaneous dosage (100 units/mL, i.e., Lantus, Basaglar) Initially, administer one-third of the total daily insulin requirements/dose subcutaneously once daily. Titrate dosage to achieve blood glucose control and A1C goals in conjunction with a short-acting insulin. Give the dose at the same time every day, at any time. Administration in the morning may avoid nocturnal hypoglycemia. When transferring from once daily NPH insulin, the dose is usually not changed. However, when transferring from twice-daily NPH insulin to insulin glargine, the total daily dose of NPH insulin (or other twice daily basal insulin) should be reduced by 20% and administered as single dose once daily. When transferring from once-daily Toujeo to once-daily Lantus or Basaglar, the recommended initial Lantus or Basaglar dose is 80% of the Toujeo dose that is being discontinued. Thereafter, the dosage of insulin glargine should be adjusted to response. Children and Adolescents 6 years and older Insulin requirements are highly variable and must be individualized based on patient-specific factors and type of insulin regimen. During partial remission phase, total combined daily insulin requirement is often less than 0.5 units/kg/day. Prepubertal children (outside the partial remission phase) usually require 0.7 to Continue reading >>

Levemir Approved For Diabetes During Pregnancy, Usa

Levemir Approved For Diabetes During Pregnancy, Usa

The U.S. Food and Drug Administration (FDA) has just approved Levemir®, an insulin detemir [rDNA origin] injection, as the first and only basal insulin analog for Pregnancy Category B classification, which indicates that Levemir® does not pose a higher risk of harm for the unborn when used in pregnant women with diabetes. The drug is manufactured by Novo Nordisk. Until now, the standard of care for diabetes in pregnancy has consisted of NPH, i.e. human insulin, however this has now changed, with Novo Nordisk being the only company that is able to provide a complete portfolio of insulin analogs with Pregnancy Category B classification. FDA approval was granted following a review of a large, randomized controlled trial that involved 310 pregnant women with type 1 diabetes, which assessed Levemir's® safety and efficacy compared with NPH insulin. The results demonstrated that women who were administered with Levemir® had a comparable reduction in A1C at gestational week 36 and lower fasting plasma glucose levels at gestational weeks 24 and 36 than women who received NPH. The researchers noted no difference in results regarding Levemir's® overall safety profile during pregnancy, its outcomes or the health of the fetus and newborn. Lois Jovanovič, MD, MACE, Chief Scientific Officer at Sansum Diabetes Research Institute in Santa Barbara, California remarked: "It is exciting that the FDA has granted approval for this new category rating for Levemir®. For women who are pregnant, diabetes can be extremely challenging; they must be even more diligent and careful when monitoring blood sugar levels than before they were pregnant. This approval provides patients with a long-acting insulin analog option that can help them manage their blood sugar." About 1.85 million women of c Continue reading >>

Diabetes Management Guidelines

Diabetes Management Guidelines

Endocrine Society Guideline on Diabetes and Pregnancy Source: Blumer I, Hadar E, Hadden DR, et al. Diabetes and pregnancy: an Endocrine Society clinical practice guideline. J Clin Endocrinol Metab. 2013;98(11):4227-4249. Available here. Refer to source document for full recommendations, including strength of recommendations and quality of evidence. Jump to a topic or click back/next at the bottom of each page Antihyperglycemic Therapy During Pregnancy Insulin therapy Long-acting insulin detemir Initiate during pregnancy in women who require insulin therapy and for whom appropriate doses of NPH insulin have caused/may cause hypoglycemia* Continue if used successfully prior to pregnancy* Insulin glargine Continue if used successfully prior to pregnancy† Rapid-acting insulin lispro and aspart Use in preference to regular soluble insulin‡ Continuous SC insulin infusion Recommended when treatment has been prior to pregnancy§ Do not initiate during pregnancy unless other insulin strategies – including multiple daily doses of insulin – tried and unsuccessful† Insulin glargine is classified as FDA Pregnancy Category C and should only be used during pregnancy if the potential benefit justifies the potential risk to the fetus *Less strong recommendation, very high quality evidence †Less strong recommendation, low quality evidence ‡Less strong recommendation, moderate quality evidence §Strong recommendation, moderate quality evidence Noninsulin therapy Glyburide May be used as alternative to insulin in women with GDM who do not achieve sufficient glycemic control after 1-week trial of medical nutrition therapy and exercise* Exceptions, in which case insulin is preferred therapy:* Diagnosis of GDM before 25 weeks FPG >110 mg/dL (6.1 mmol/L) Metformin Use only for wo Continue reading >>

Lantus (insulin Glargine)

Lantus (insulin Glargine)

What is it used for? How does it work? Lantus vials, Lantus SoloStar pre-filled pens and Lantus penfill cartridges (for use with ClikSTAR or Autopen 24 pens) contain the active ingredient insulin glargine. They are used to treat diabetes. People with diabetes have a deficiency or absence of a hormone manufactured by the pancreas called insulin. Insulin is the main hormone responsible for the control of sugar (glucose) in the blood. People with type one diabetes need to have injections of insulin to control the amount of glucose in their bloodstream. Insulin injections act as a replacement for natural insulin and allow people with diabetes to achieve normal blood glucose levels. Insulin injections work in the same way as natural insulin, by binding to insulin receptors on cells in the body. Insulin causes cells in the liver, muscle and fat tissue to increase their uptake of glucose from the bloodstream. It also decreases the production of glucose by the liver, and has various other effects that lower the amount of glucose in the blood. Lantus contains a type of insulin called insulin glargine. This is known as a long-acting insulin. When injected under the skin it starts working within two to three hours and produces a steady effect for 25 hours. It is used to help provide background control of blood glucose throughout the day. Insulin glargine is normally used in combination with a short-acting insulin, which is given before meals to control the increasing blood glucose levels after eating. It is important to monitor your blood glucose regularly and adjust your insulin dose as required. Your doctor or diabetic team will explain how to do this. Keeping your blood glucose level as close to normal as possible, and not too high or too low, significantly reduces the risk of Continue reading >>

Insulin Glargine Safety In Pregnancy

Insulin Glargine Safety In Pregnancy

Go to: Abstract Insulin glargine (Lantus) is an extended-action insulin analog with greater stability and duration of action than regular human insulin. The long duration of action and decreased incidence of hypoglycemia provide potential advantages for its use in pregnancy. However, the placental pharmacokinetics of insulin glargine have not been studied. Therefore, the objective of this study was to determine whether insulin glargine crosses the human placenta using the human perfused placental lobule technique. Placentae were obtained with informed consent after elective cesarean section delivery of noncomplicated term pregnancies. Insulin glargine, at a therapeutic concentration of 150 pmol/l (20 μU/ml) was added to the maternal circulation. Additional experiments were carried out at insulin glargine concentrations 1,000-fold higher than therapeutic levels (150, 225, and 300 nmol/l). A subsequent perfusion for which the maternal circuit remained open and insulin glargine was continuously infused at 150 pmol/l was completed for further confirmation of findings. The appearance of insulin glargine in the fetal circulation was analyzed by a chemiluminescence immunoassay. Results from perfusions carried out at therapeutic concentrations (150 pmol/l) of insulin glargine showed no detectable insulin glargine in the fetal circuit. After perfusion with very high insulin glargine concentrations of 150, 225, and 300 nmol/l, the rate of transfer remained low at 0.079 ± 0.01, 0.14, and 0.064 pmol · min−1 · g tissue−1, respectively. Maternal to fetal transport of insulin glargine Experiment no. Maternal concentration (pmol/l) Lobule weight (g) Fetal concentration (pmol/l) Rate of transfer (pmol · min−1 · g tissue−1) 1 150 15.17 Below LOQ — 2 150 9.8 Below LOQ — Continue reading >>

Taking Insulin During Pregnancy

Taking Insulin During Pregnancy

When your blood glucose levels stay raised despite meal planning and physical activity, insulin must be added to your management plan to keep you and your baby healthy. Pregnancy requires that your body produce extra amounts of insulin. Insulin is a hormone that is made by the pancreas. If your pancreas does not make enough insulin, injections can help you meet the need. Your health care provider and diabetes educator will teach you how to inject insulin safely and comfortably. Determining the right insulin and dosage Tip Keep a record of the type and amount of insulin you take. It is important that you know and remember your insulin type every time you speak with a health care provider. Your health care provider will decide what kind of insulin is right for you, how much to use and when you should take it, based on: your weight (which changes weekly) how far along your pregnancy is your meal plan your most recent blood glucose levels Sometimes, you may need more than one type of insulin. Different types of insulin work at different speeds, and your health care provider may combine insulins to achieve the best results for you. Time-action of different insulins Insulins Starts working Peaks Stops working Rapid acting: Humalog® (lispro) NovoLog® (aspart) Apidra® (glulisine) 5 to 15 minutes 1 to 2 hours 2 to 4 hours Intermediate acting: NPH (N) 2 to 4 hours 4 to 8 hours 10 to 16 hours Basal*: Lantus® (glargine) Levemir® (detemir) 2 hours No peak 24 hours *Lantus® and Levemir® cannot be mixed with any other insulin. How to help insulin work best Take your insulin at the same times each day as directed. Talk with your health care provider if you feel sick. Follow any instructions your health care provider gives you. Don't change your meal plan, physical activity, pres Continue reading >>

Choosing An Injection Site

Choosing An Injection Site

Do not take Lantus® during episodes of low blood sugar or if you are allergic to insulin or any of the inactive ingredients in Lantus®. Do not share needles, insulin pens, or syringes with others. Do NOT reuse needles. Before starting Lantus®, tell your doctor about all your medical conditions, including if you have liver or kidney problems, if you are pregnant or planning to become pregnant or if you are breast-feeding or planning to breast-feed. Heart failure can occur if you are taking insulin together with certain medicines called TZDs (thiazolidinediones), even if you have never had heart failure or other heart problems. If you already have heart failure, it may get worse while you take TZDs with Lantus®. Your treatment with TZDs and Lantus® may need to be changed or stopped by your doctor if you have new or worsening heart failure. Tell your doctor if you have any new or worsening symptoms of heart failure, including: Sudden weight gain Tell your doctor about all the medications you take, including OTC medicines, vitamins, and supplements, including herbal supplements. Lantus® should be taken once a day at the same time every day. Test your blood sugar levels while using insulin, such as Lantus®. Do not make any changes to your dose or type of insulin without talking to your healthcare provider. Any change of insulin should be made cautiously and only under medical supervision. Do NOT dilute or mix Lantus® with any other insulin or solution. It will not work as intended and you may lose blood sugar control, which could be serious. Lantus® must only be used if the solution is clear and colorless with no particles visible. Always make sure you have the correct insulin before each injection. While using Lantus®, do not drive or operate heavy machinery until Continue reading >>

Using Insulin In Pregnancy: Fda Approves Levemir

Using Insulin In Pregnancy: Fda Approves Levemir

Novo Nordisk’s Levemir (insulin detemir) has been classified as Category B for pregnant women. “This is the most thrilling news since the discovery of insulin,” says Dr. Lois Jovanovic, CEO and Chief Scientific Officer of the Sansum Diabetes Research Institute and world-renowned expert in diabetes and pregnancy. “I am thrilled.” Given that Dr. Jovanovic is so unequivocally positive, the news deserves a bit more explanation for those of us who aren’t experts and aren’t pregnant. Levemir is the first long-acting insulin other than NPH to be classified as Category B. But what exactly does that mean? And why are we so worried about insulin in pregnancy anyway? The FDA, Dr. Jovanovic explains, needs to make sure drugs taken by women during pregnancy are safe for the baby, and not going to cause any birth defects or abnormalities. The FDA therefore assigns drugs to a category that indicates how they should be used in pregnancy. Category A drugs are things like vitamins—not just okay to use, but actually good for the pregnant woman and the fetus. Category B drugs are not necessarily positive for pregnancy, but all animal and human studies must indicate that the drug is safe for the mother and the baby. Category C drugs are not known to cause birth defects, but have not been sufficiently tested in humans to really be certainly safe. Up until now, untested insulin analogues, and all long-acting insulin analogues other than NPH, fell into Category C—not known to be harmful, but not known to be safe either. Now, normal, non-diabetic women produce their own insulin, and that insulin is obviously safe for fetuses. What, then, makes insulin analogues different and riskier? The answer is that insulin analogues may behave similarly to human insulin in the body, but th Continue reading >>

Lantus

Lantus

Lantus is a prescription medication used to treat type 1 and type 2 diabetes. Lantus is a long-acting form of insulin and works by replacing the insulin that is normally produced by the body and by helping the body to use sugar for energy. It also stops the liver from producing more sugar. This medication comes in an injectable form and is usually used once daily. Common side effects include low blood sugar, redness and skin thickening at the injection site, and weight gain. Lantus is a prescription medication used to treat people with type 1 and type 2 diabetes for the control of high blood sugar. Lantus may be used along with fast-acting insulin or oral medications to control blood sugar. This medication may be prescribed for other uses. Ask your doctor or pharmacist for more information. Lantus can cause hypoglycemia (low blood sugar), hyperglycemia (high blood sugar), allergy, and skin reactions. Hypoglycemia (low blood sugar): Early warning signs of hypoglycemia may be different, less noticeable or not noticeable at all in some people. That is why it is important to check your blood sugar as you have been advised by your doctor. Symptoms of hypoglycemia may include: anxiety, irritability, restlessness, trouble concentrating, personality changes, mood changes, or other abnormal behavior tingling in your hands, feet, lips, or tongue dizziness, light-headedness, or drowsiness nightmares or trouble sleeping headache blurred vision slurred speech palpitations (fast heart beat) sweating tremor (shaking) unsteady gait (walking). If you have hypoglycemia often or it is hard for you to know if you have the symptoms of hypoglycemia, talk to your doctor. Mild to moderate hypoglycemia is treated by eating or drinking carbohydrates, such as fruit juice, raisins, sugar candies, Continue reading >>

Safety Of Insulin Glargine Use In Pregnancy

Safety Of Insulin Glargine Use In Pregnancy

The study was done to compare the safety of using Glargine in place of NPH insulin…. The prevalence of diabetes in women of childbearing age is increasing. As such, the number of pregnancies complicated by diabetes will inevitably increase. New insulin analogues such as the long-acting analogue insulin glargine may represent beneficial treatment options in pregnancy by ensuring that patients achieve excellent glycemic control without risk of maternal hypoglycemia. The study was done to determine the fetal safety of insulin glargine use in the treatment of diabetes in pregnancy compared with NPH insulin therapy. A systematic review and meta-analysis was performed of all original human studies that reported neonatal outcomes among women with pregestational or gestational diabetes who were managed with either insulin glargine or NPH insulin during pregnancy. A systematic literature search was conducted from 1980 to June 1, 2010. Outcomes included large size for gestational age, macrosomia, neonatal hypoglycemia, neonatal intensive care unit admissions, birth trauma, congenital anomalies, preterm delivery, perinatal mortality, respiratory distress, and hyperbilirubinemia. Relative risk ratios and weighted mean differences were computed with 95% confidence intervals. Eight studies reporting on a total of 702 women with pregestational or gestational diabetes in pregnancy treated with either insulin glargine (n = 331) or NPH insulin (n = 371) met the inclusion criteria. There were no statistically significant differences in the occurrence of fetal outcomes studied with the use of insulin glargine compared to NPH insulin. Several new insulin analogues have become available during the past decade, yet data on the fetal safety of insulin glargine are scarce. By avoiding high pe Continue reading >>

Insulin For Gestational Diabetes - What It Is And How It Works

Insulin For Gestational Diabetes - What It Is And How It Works

Where blood sugar levels cannot be lowered and stabilised enough through dietary and lifestyle changes, or through using medication such as Metformin, some ladies will be required to use insulin for gestational diabetes. Insulin is a hormone in the body produced by the pancreas. Your body uses insulin to move the sugar (glucose) obtained from food and drink from the bloodstream into cells throughout the body. The cells are then able to use the sugar for energy. Here are the most commonly asked Q&A on insulin for gestational diabetes from our Facebook support group Why do I need to take insulin for gestational diabetes? If lower blood sugar levels cannot be reached through diet, exercise and medication such as Metformin, then many will be required insulin for gestational diabetes. If blood sugar levels remain high, then the diabetes is not controlled and can cause major complications with the pregnancy and baby. If your levels are rising out of target range, your own insulin production may need to be topped up at the meal time. You may need to take insulin at one or all of your meals. Sometimes the insulin you produce in-between your meals and overnight may also require a top up. This may mean that you require an extra slower-release insulin at bedtime and/or in the morning. Some consultants will prescribe insulin on diagnosis of gestational diabetes on the basis of your GTT results or following other complications relating to gestational diabetes. For the majority, you will be given some time to try diet and exercise changes and then medication such as Metformin before insulin is introduced as a way to help lower and control your levels. NICE guidelines for timing and use of insulin for gestational diabetes 1.2.19 Offer a trial of changes in diet and exercise to women w Continue reading >>

Insulin Glargine During Pregnancy

Insulin Glargine During Pregnancy

Insulin Glargine during Pregnancy [bold]Body: [/bold]The long-ac [bold]Body: [/bold]The long-acting analog Glargine is a new insulin with 24-h persistence. This peakless action profile accounts for stable daily plasma glucose profile significant risk reduction for nocturnal hypoglycemia. Only a few reports have described the use of insulin glargine during human pregnancy, so its use is not recommended at present. This observational, multi-centre (three) trial studied the maternal and perinatal outcome of Glargine Insulin and Human long-acting Insulin (Protaphan). Forty-seven consecutive pregnant subjects with type 1 diabetes using Insulin Glargine before conception during 2003-2005 were studied. The control group consisted of 50 pregnant subjects using long-acting insulin (Protaphan) at the same time and who were matched for age, parity, duration of diabetes and diabetes complications. All women injected short-acting insulin analogues before meals. There was no difference for gestational age at delivery, pregnancy complications and perinatal outcome (weight of the new-born, shoulder dystocia, respiratory distress, infections, first plasma glucose after birth). One newborn (Glargine group) had congenital malformation (anencephaly). None of the women experienced significant progression of retino- nor nephropathy. Although mean glycemic control (HbA1c) was similar at first trimester of pregnancy ( 6.9 % in Protaphan group and 7.4% in Glargine group) the decrease from first trimester to third trimester was greater in Glargine Insulin group compared to Protaphan group (P=0.04). There was a tendency towards lower number of hypoglycemic episodes in the Glargine group (11/47) than in the Protaphan group ( 21/50)(P=0.07). In conclusion, treatment with Glargine insulin during pre Continue reading >>

Insulin Glargine Safety In Pregnancy

Insulin Glargine Safety In Pregnancy

Abstract OBJECTIVE Insulin glargine (Lantus) is an extended-action insulin analog with greater stability and duration of action than regular human insulin. The long duration of action and decreased incidence of hypoglycemia provide potential advantages for its use in pregnancy. However, the placental pharmacokinetics of insulin glargine have not been studied. Therefore, the objective of this study was to determine whether insulin glargine crosses the human placenta using the human perfused placental lobule technique. RESEARCH DESIGN AND METHODS Placentae were obtained with informed consent after elective cesarean section delivery of noncomplicated term pregnancies. Insulin glargine, at a therapeutic concentration of 150 pmol/l (20 μU/ml) was added to the maternal circulation. Additional experiments were carried out at insulin glargine concentrations 1,000-fold higher than therapeutic levels (150, 225, and 300 nmol/l). A subsequent perfusion for which the maternal circuit remained open and insulin glargine was continuously infused at 150 pmol/l was completed for further confirmation of findings. The appearance of insulin glargine in the fetal circulation was analyzed by a chemiluminescence immunoassay. RESULTS Results from perfusions carried out at therapeutic concentrations (150 pmol/l) of insulin glargine showed no detectable insulin glargine in the fetal circuit. After perfusion with very high insulin glargine concentrations of 150, 225, and 300 nmol/l, the rate of transfer remained low at 0.079 ± 0.01, 0.14, and 0.064 pmol · min−1 · g tissue−1, respectively. CONCLUSIONS Insulin glargine, when used at therapeutic concentrations, is not likely to cross the placenta. Several new long-acting insulin analogs, such as glargine and detemir, are currently available f Continue reading >>

Meta-analysis Of Maternal And Neonatal Outcomes Associated With The Use Of Insulin Glargine Versus Nph Insulin During Pregnancy

Meta-analysis Of Maternal And Neonatal Outcomes Associated With The Use Of Insulin Glargine Versus Nph Insulin During Pregnancy

Copyright © 2012 Jacques Lepercq et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Abstract As glargine, an analog of human insulin, is increasingly used during pregnancy, a meta-analysis assessed its safety in this population. A systematic literature search identified studies of gestational or pregestational diabetes comparing use of insulin glargine with human NPH insulin, with at least 15 women in both arms. Data was extracted for maternal outcomes (weight at delivery, weight gain, 1st/3rd trimester , severe hypoglycemia, gestation/new-onset hypertension, preeclampsia, and cesarean section) and neonatal outcomes (congenital malformations, gestational age at delivery, birth weight, macrosomia, LGA, 5 minute Apgar score 7, NICU admissions, respiratory distress syndrome, neonatal hypoglycemia, and hyperbilirubinemia). Relative risk ratios and weighted mean differences were determined using a random effect model. Eight studies of women using glargine (331) or NPH (371) were analyzed. No significant differences in the efficacy and safety-related outcomes were found between glargine and NPH use during pregnancy. 1. Introduction An estimated 4% of pregnancies in the United States are complicated by diabetes [1]. Whether due to preexisting type 1 or type 2 diabetes mellitus (pregestational) or diabetes that developed during pregnancy (gestational), hyperglycemia during pregnancy is associated with increased risk of various maternal and fetal complications. Subclinical increases in fasting blood glucose levels as little as 6.9 mg/dL and elevated postprandial plasma glucose levels have been associated with Continue reading >>

High-alert Medications - Lantus (insulin Glargine)

High-alert Medications - Lantus (insulin Glargine)

The leaflets are FREELY available for download and can be reproduced for free distribution to consumers. Or, if you are a facility or organization, you can order professional pre-printed leaflets shipped directly to you. Extra care is needed because Lantus is a high-alert medicine. High-alert medicines have been proven to be safe and effective. But these medicines can cause serious injury if a mistake happens while taking them. This means that it is very important for you to know about this medicine and take it exactly as directed. Top 10 List of Safety Tips for Lantus When taking your medicine 1. Know your insulin. Lantus is a long-acting insulin that should be injected below the skin once daily as directed by your doctor. On rare occasions, your physician may direct you to take Lantus two times daily. Take Lantus the same time every day. 2. Prepare your insulin. A rapid- or short-acting insulin is often prescribed with Lantus. However, Lantus should never be mixed in the same syringe with other insulins before injection. Do not vigorously shake insulin before use. 3. Don't reuse or recycle. Dispose of used syringes/needles, pens, and lancets in a sealable hard plastic or metal container (e.g., empty detergent bottle, sharps container from your pharmacy). When the container is full, seal the lid before placing it in the trash. Do not reuse or recycle syringes/needles or lancets. 4. Don't share. Even if you change the needle, sharing an insulin pen or syringe may spread diseases carried in the blood, including hepatitis and HIV. To avoid serious side effects 5. Avoid mix-ups. List If you use more than one type of insulin, make sure each vial or pen looks different to avoid mix-ups. Lantus is a long-acting insulin that may look like a rapid- or short-acting insulin. For Continue reading >>

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