Lantus (insulin Glargine) Not Only For Bedtime?
Physicians are pursuing several different possibilities of dosing that deviate from the FDA-approved instructions for Lantus dosing. Lantus is approved only for bedtime dosing. That’s because the pre-approval studies were conducted only using bedtime dosing, therefore the FDA approved the drug that way. But from experience, patients can also use Lantus in the morning. Lantus is a “peakless” insulin…giving steady concentrations throughout the day. But for some patients, it doesn’t last the full 24 hours. Morning dosing might be preferred for these patients. That way, Lantus wears off at night when insulin requirements are lower. Some patients use BID dosing if Lantus doesn’t last all day. Explain that the big advantage to Lantus is once daily dosing. Lantus (insulin glargine) is a recombinant human insulin analog with a duration of action up to 24 hours.1 The microprecipitates that are formed in the subcutaneous tissue after injection slow the absorption of Lantus and provide a relatively constant level of insulin over 24 hours without a pronounced peak.1 This prolonged effect over 24 hours enables it to be administered once daily. Lantus is FDA approved for once-daily subcutaneous administration at bedtime for adults and children six years of age and older with type 1 diabetes mellitus or adults with type 2 diabetes mellitus who require basal (long-acting) insulin for the control of hyperglycemia.1 When changing a patient (child >6 years or adult) from intermediate- or long-acting insulin to Lantus, the amount of short-acting insulin or oral antidiabetic agent may need to be adjusted. In premarketing studies, for patients using once-daily NPH or Ultralente insulin, the initial dose of Lantus was not changed. For patients using twice-daily NPH insulin, the in Continue reading >>
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The Effects Of Transition From Bedtime To Morning Glargine Administration In Patients With Poorly Regulated Type 1 Diabetes Mellitus: Croatian Pilot Study
Go to: Abstract The objective of this study was to compare differences in glucoregulation, frequency of hypoglycemic episodes, glucose variability and lipid profiles of inpatients with poorly regulated type 1 diabetes mellitus (T1DM) after evening versus morning glargine application. Methods Eighteen patients with poorly regulated T1DM, glycated hemoglobin (Hba1c) levels ≥7% and frequent nocturnal and/or morning hypoglycemic episodes were included in this study. There was a 12-week screening phase where patients continued their usual insulin regimen and were encouraged to achieve optimal glycemic control; however, all patients maintained HbA1c values ≥7% and continued to have frequent nocturnal and/or morning hypoglycemic events and were therefore transitioned to morning application of insulin glargine for 12 weeks. The primary outcome was to investigate changes in HbA1c values 12 weeks after the transition. The secondary outcome was to evaluate the effect of transition on glucose variability, incidence of hypoglycemic episodes, insulin doses, lipid profile and weight. Data were analyzed using paired Student’s t test and Pearson correlation. Results After the transition, there was no significant change in total daily dose of basal insulin (p 0.114) and the average body weight remained unchanged, while significant reduction of HbA1c was present (8.02 ± 0.5 vs. 7.4 ± 0.3%) (p < 0.01) resulting in a decrease in nocturnal and daytime hypoglycemic episodes per month per person (p < 0.01). Parameters of glucose variability (glycemic standard deviations and J-index) were also improved after transition period (p < 0.01). As for the lipid profile, increase of high-density lipoprotein cholesterol and decrease of triglycerides (p < 0.01) were noticed, while other lipid par Continue reading >>
Exorcising The Specter Of Overnight Hypoglycemia
For millions of people with diabetes who take insulin or medicines that stimulate the pancreas to release more insulin, hypoglycemia (low blood glucose) is an ever-present threat lurking in the shadows. And few things instill more fear in parents of children with diabetes and partners of adults with diabetes — not to mention people with diabetes themselves — than hypoglycemia that occurs in the middle of the night. Most people feel confident in their ability to deal with lows that occur while they are awake. The symptoms, even if subtle, can usually be recognized in time to down some rapid-acting carbohydrate and fix the problem. But the very thought of dropping low while sleeping gives many a feeling of complete helplessness. Will the symptoms be strong enough to wake me? Will I have the ability to get up and treat it? Or will I just lie there, unable to do anything about it? Sometimes people are completely oblivious to periods of low blood glucose that occurred while they were sleeping. The only clues left behind might be sheets or pajamas that are soaked with sweat or a rebound high blood glucose level the following morning. Although rare, there have been deaths reported that resulted from hypoglycemia that occurred while sleeping. The reason those deaths are rare is that the body usually reacts to low blood glucose by producing adrenaline, which causes profuse sweating, shaking, and a strong or rapid heartbeat. This will almost always awaken a person who is experiencing hypoglycemia or alert that person’s partner. Adrenaline also stimulates the liver to release some of its stored-up glucose (called glycogen) into the bloodstream. When low blood sugar continues over an extended period, a seizure may occur. The seizure will often alert family members, roommates, Continue reading >>
NOTICE: This Consumer Medicine Information (CMI) is intended for persons living in Australia. (lant-us) What is in this leaflet It does not contain all the available information. It does not take the place of talking to your doctor, pharmacist or diabetes educator. All medicines have risks and benefits. Your doctor has weighed the risks of you using Lantus against the benefits they expect it will have for you. If you have any concerns about using this medicine, ask your doctor or pharmacist. What Lantus is used for Lantus is used to reduce high blood sugar (glucose) levels in people with diabetes mellitus. Lantus is a modified insulin that is very similar to human insulin. It is a substitute for the insulin produced by the pancreas. Lantus is a long-acting insulin. Your doctor may tell you to use a rapid-acting human insulin or oral diabetes medication in combination with Lantus. Ask your doctor if you have any questions about why Lantus has been prescribed for you. Before you use Lantus When you must not use Lantus Some of the symptoms of an allergic reaction may include: If you have a lot of hypos discuss appropriate treatment with your doctor. After the expiry date printed on the pack or if the packaging is torn or shows signs of tampering. If you use Lantus after the expiry date has passed, it may not work as well. If it has expired or is damaged, return it to your pharmacist for disposal. If the product appears cloudy, discoloured or contains particles, or if the injection pen/cartridge/vial appears damaged. If you are not sure whether you should start using this medicine, talk to your doctor. There is no experience with the use of Lantus in children less than 6 years. Before you start to use Lantus Tell your doctor if you have allergies to any other medicines, foo Continue reading >>
Lantus Side Effects
Generic Name: insulin glargine (IN su lin GLAR gine) Brand Names: Basaglar KwikPen, Lantus, Lantus Solostar Pen, Toujeo SoloStar What is Lantus? Lantus (insulin glargine) is a man-made form of a hormone that is produced in the body. Insulin is a hormone that works by lowering levels of glucose (sugar) in the blood. Insulin glargine is a long-acting insulin that starts to work several hours after injection and keeps working evenly for 24 hours. Lantus is used to improve blood sugar control in adults and children with diabetes mellitus. Lantus is used to treat type 1 or type 2 diabetes in adults, and type 1 diabetes children who are at least 6 years old. Some brands of insulin glargine are for use only in adults. Carefully follow all instructions for the brand of insulin glargine you are using. Important information You should not use Lantus if you are having an episode of hypoglycemia (low blood sugar), or if you are in a state of diabetic ketoacidosis. Never share a Lantus injection pen or cartridge with another person. Sharing injection pens or cartridges can allow disease such as hepatitis or HIV to pass from one person to another. Lantus is only part of a complete program of treatment that may also include diet, exercise, weight control, foot care, eye care, dental care, and testing your blood sugar. Follow your diet, medication, and exercise routines very closely. Changing any of these factors can affect your blood sugar levels. Before taking this medicine You should not use Lantus if you are allergic to insulin, or if you are having an episode of hypoglycemia (low blood sugar). Lantus is not approved for use by anyone younger than 6 years old, and should not be used to treat type 2 diabetes in a child of any age. To make sure Lantus is safe for you, tell your docto Continue reading >>
Lantus (insulin Glargine) Side Effects
What Is Lantus (Insulin Glargine)? Lantus is the brand name of insulin glargine, a long-acting insulin used to treat adults and children with type 1 diabetes mellitus and adults with type 2 diabetes mellitus to control high blood sugar. Lantus replaces the insulin that your body no longer produces. Insulin is a natural substance that allows your body to convert dietary sugar into energy and helps store energy for later use. In type 2 diabetes mellitus, your body does not produce enough insulin, or the insulin produced is not used properly, causing a rise in blood sugar. Like other types of insulin, Lantus is used to normalize blood sugar levels. Controlling high blood sugar helps prevent kidney damage, blindness, nerve problems, loss of limbs, and sexual dysfunction. Proper control of diabetes has also been shown to reduce your risk of a heart attack or stroke. Lantus is meant to be used alongside a proper diet and exercise program recommended by your doctor. Lantus is manufactured by Sanofi-Aventis. It was approved for use by the Food and Drug Administration (FDA) in 2000 as the first long-acting human insulin administered once a day with a 24-hour sugar-lowering effect. Lantus Warnings You will be taught how to properly inject this medication since that is the only way to use it. Do not inject cold insulin because this can be painful. Always wash your hands before measuring and injecting insulin. Lantus is always clear and colorless; look for cloudy solution or clumps in the container before injecting it. Do not use Lantus to treat diabetic ketoacidosis. A short-acting insulin is used to treat this condition. It is recommended that you take a diabetes education program to learn more about diabetes and how to manage it. Other medical problems may affect the use of this Continue reading >>
Working 12hr Night Shift Need Some Advice On Taking Insulin!!
Working 12hr night shift need some advice on taking insulin!! Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. Working 12hr night shift need some advice on taking insulin!! I just started a new job working night shift 7p-7a, 4 on then 4 off. I have been on night shift in the past and would always eat my meal around 12 or 1 am w/ my novolog. The problem w/ this job is you have to eat when you can and can't take a sit down lunch. I eat my dinner or breakfast you could call it aroung 6pm before I head to work taking my novolog w/ that meal, then my lantus at 11pm, but I don't know if I should just snack through work and then eat my 2nd meal when I get home from work at 8am. I want to know if this is ok to do because I would be giving myself about 6-8 units of novolog w/ my 8am meal then going to bed 2 hrs later? Someone please help me, I dunno what to do!? I've worked nights before too. I think no matter what you do, it's going to be hard... ideally you could take your insulin and eat whenever you want to. (But we all know it never works that way.) I'm a little confused about your eating situation at work, but I think what would be best for you would be to most closely mimic what you would be doing during a day shift at night. I see that you're also worried about taking Novalog to soon before bed? That's probably okay, as long as you are waiting those 2 hours and if you have to make any corrections, you may want to wake up after that and test. Me too, Ive worked night shifts and if you are extremely busy and not allowed to have a proper meal break then im afraid your sugar levels suffer greatly and it sux!! the only way to do things and have a Continue reading >>
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Lantus Problems And Going Round In Circles
And on and on and on... When we began writing about our experiences of living with Diabetes it was, at least in part, in response to a nasty overnight hypo brought on (I suspect) by the action of Lantus glargine. From some reading I have done since it appears I am not alone in this. That there are other people with diabetes using Lantus and injecting their dose at night time (recommended by the manufacturer and for most people the best option) who find they sometimes go low overnight, or wake up low in the morning. One of the difficulties in managing diabetes with MDI (multiple daily injection) basal-bolus is that if you don't get your basal (background) dose correct then everything else becomes incredibly difficult to manage. You have no firm footing on which to start your day. I think the late-at-night injection timing is suggested because it puts Lantus's onset period (perhaps an hour two until full strength) at a time when you have finished eating for the day and are usually if not actually asleep, then pretty much at rest. When I moved my injection to the morning, though my overnight levels were suddenly very steady and reliable, I had problems with high blood glucose spikes after breakfast. In response I began to split the dose, morning and evening, having a little just before bed, and the rest at breakfast. My hope was that this would spread the activity more evenly over the day. Sadly though, after a few months I can see that this has caused more problems, and not really solved anything. I found I was waking up low again, or waking slightly clammy having gone hypo overnight. On several occasions my liver then took matters into its own hands and began dumping glucagon into my bloodstream as it's own emergency measure. I would wake high, inject rapid-acting insuli Continue reading >>
Does Lantus Or Levemir Only Work For The Night For You?
Does Lantus or Levemir only work for the night for you? Registration is fast, simple and absolutely free so please,join our community todayto contribute and support the site. This topic is now archived and is closed to further replies. Does Lantus or Levemir only work for the night for you? How long does Lantus or Lev work for you at night? 1. How long does Lantus or Lev work for you at night? I find it lasts me 8-9 hours, ie no basal midmorning. (around 7u) Bernstein has an "approximate action times of preferred insulins" in his book The complete diabetes solution, in which the action time for Levemir or Lantus, (put in the same category) is: 18 hours if injected in the morning; 8-9 hours if injected at bedtime (apparent). This apparent phenomenon of Lantus or Levemir action being cut in half if at night, is quite surprising to me! I hadn't heard much about it out there, despite that if it was the case, people (especially insulin dependents) would be in a whole world of hot water with no basal action during the day. Yet have taken, and do know that people take their long acting at night, without that seeming to be a common occurrence. Maybe it shows just how little I know - educate me, please. Now, he mentions in a general footnote, that variability is expected especially with dosages larger than 7 units. One has to assume, he doesn't mean THAT much variability, if it just deserves a small footnote. Maybe a couple of hours or so either way? Is the impression that gives me. So I'm interested in the question, if you do or have taken Lev/Lantus at night, do you find it's completely gone by the morning? Or does it last somewhat longer? How long, do you think/is your guess? I've included a very rough separation of doses in the answer, so we might get a feel if maybe those Continue reading >>
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Managing Low Blood Sugars Overnight
Low blood sugars (hypoglycemia) can be, at most, life threatening and, at the very least, an annoyance. In general, they’re pretty disruptive to your life! Lows that happen at night, when you are asleep, can be especially frightening. What is a severe low? A severe low is defined as hypoglycemia that a person is unable to treat themselves. That is, they can’t recognize that they are low and treat it with a fast-acting carbohydrate. If you sleep alone, and there is no one to help you recognize a low, it is generally recommended that you maintain a higher average blood sugar overnight if severe lows are a risk. Lows can happen in type 1 and type 2 diabetes. The inability to recognize a low is more common if you have longstanding diabetes. For more information about why you should be concerned about low blood sugars, read Lori Berard’s expert blog. Find your threshold Low blood sugars are generally described as those that are less than 4.0 mmol/L. However, some people tell me that they may feel low at 5.0 mmol/L, while others say they don’t feel low even when their blood sugar is 2.8 mmol/L. So, the first thing to figure out is, what your blood sugar number or threshold is when you are feeling low To do that, it is important to check your blood sugar when you are low so that you know at what number you usually feel a low (day and night). Sometimes, the threshold may be higher if your blood sugar is dropping quickly; this means that a 5.0 mmol/L on its way down to 3.0 mmol/L may feel very different than a 5.0 mmol/L that’s rising to 8.0 mmol/L. Conversely, if you are not feeling low until your blood sugar is less than 3.0 mmol/L, you don’t have much of a buffer for being able to think straight and be able to treat the low before it becomes so low that you are un Continue reading >>
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. -Motto of the 1st Regiment of Foot aka The Royal Scots 10 units was just a "starting" point. Were you told to increase by any amount about every 3 days? I know when I was on Lantus I had to increase by X number of units every 3 days until my fasting numbers were in range. I also had to do the same with the Novolog at meal times. Cozmore pump Started 3/22/07 using Novolog Continue reading >>
Multiple Dose Insulin In Type 2 Diabetes
Introduction Levemir (Detemir) & Lantus (Glargine) & quick-acting insulin before meals This page is aimed at people with type 2 diabetes needing multiple dose insulin (basal bolus). If you have a fair amount of insulin from your pancreas still, you will not need this intensive insulin regime, and may just need tablets or once daily insulin as opposite. If your type 2 diabetes is quite severe, and you have very little remaining insulin, then your diabetic control is similar to type 1 diabetes. This page discusses intensive insulin control, and this is taken further in the insulin dose adjustment pages above. You naturally need to speak to your diabetes nurse and doctor for individual advice. If you have no or very little remaining insulin from you pancreas, and are prone to hypos, then your diabetes is nearly equivalent to the type 1 diabetes patient, and you may benefit from the same intensive insulin 'regime'. This is discussed on this page below and the adjusting insulin dose pages taken from the DAFNE Program. Complex insulin regimes do lead to better glucose control, fewer hypos, and better weight control than twice daily insulin (NEJM 2009). Controversies First The two long acting insulins are Levemir (detemir) or Lantus (glargine). Levemir is shorter acting, with a peak 9-12 hours. Lantus generally has no peak in the first 24 hours, and its action may take 3 days to complete. Therefore anyone with a slightly irregular lifestyle in theory will be better off using twice daily Levemir rather than once daily Lantus. At present, this decision is usually made by diabetes doctors and nurses. If you do use once daily Lantus, and your glucose levels fluctuate, then you should consider twice daily Levemir instead. Second Another controversy is the use of analogue insulins s Continue reading >>
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Taking Lantus®, Taking Action: Watch Real Success Stories
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 >>
Basal Insulins | Diabetesnet.com
Lantus and Levemir are long-acting insulins that supply the background insulin needed to supply cells with glucose around the clock while preventing release of excess glucose from the liver and excess fat from fat cells. The waking glucose level best measures the activity of these insulins. All Type 1s and many Type 2s also require a faster insulin (Humalog, Novolog, or Apidra) to cover meals and lower any high glucose. Some Type 2s who have adequate insulin production do well with one of these long-acting insulins, plus oral medications or a daily or weekly injection of a GLP-1 agonist. Lantus insulin (glargine) made by Sanofi-Aventis is promoted as a once a day background insulin. However, many users find that it does not last a full 24 hours for them and these users often notice a peak in activity about 6-8 hours after the injection. If once a day injection is giving you good control, there is no need to change and a bedtime injection is typically best. For others, splitting the dose and injecting twice a day (usually at breakfast and bedtime) often works better, lessens peaks and gaps in activity, and helps those who cannot inject Lantus within one hour of the same time each day. Lantus is slightly acidic and some may notice slight discomfort at the injection site. Levemir insulin (detemir) made by Novo Nordisk works for about 18 hours and may have a peak in activity 4-6 hours after the injection. It is taken twice a day. Different people react to each insulin differently. The best advice is trying the other insulin if one does not seem to be working well for you. Both insulins generally work quite well, but neither can be mixed in a syringe with fast-acting insulin, and neither should ever be used in an insulin pump. Keep in mind that an older insulin called NPH c Continue reading >>
Night Shifts | Diabetes Forum The Global Diabetes Community
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community I was wondering if anyone with type 1 has a job where night shifts are compulsory and how they manage it with diabetes? Is it possible? It's some years since I worked nights but having type 1 diabetes doesn't stop you from doing shift-work. I do regular night shifts (5 x 12.5 hour shifts in a row every 5 weeks and 4 weeks of 12.5 days (3 or 4/week) When I was on MDI I was on levemir twice a day, 10 units in the morning and 14 at night, during my week of nights I flipped the doses around. I'm now on a pump and the process is a lot easier, I have a different profile set up for nights. It's all perfectly doable however I wish it wasn't coz I HATE night shifts! Yeah i dit night shifts for two years. And also swap around morning and evening doses. Rest was all the same like when working days I work shifts some nights some days and some twilights which can start at 3pm and finish at 3am they mess me up as am now asleep when should be having my levimer haven't quite figured out how to tackle it yet, I also hate night shifts I work shifts some nights some days and some twilights which can start at 3pm and finish at 3am they mess me up as am now asleep when should be having my levimer haven't quite figured out how to tackle it yet, I also hate night shifts Are you on one or two injections a day for your levemir? If one then you could take it early evening, this way you'll always be awake and provided you can fit the injection dose into your work schedule (when on twilight shift) it should sort your problem out, if your on two injections a day then it might be worth changing to another basal insulin such as Lantus or Tresiba, Lantus is taken once a day (but som Continue reading >>