How Long Should Insulin Be Used Once A Vial Is Started?
Editor’s comment: The commentary by Dr. Grajower has such important clinical relevance that responses were invited from the three pharmaceutical companies that supply insulin in the U.S. and the American Diabetes Association, and all of these combined in this commentary. The commenting letter and individual responses were authored separately and are completely independent of each other. Diabetic patients treated with insulin, whether for type 1 or type 2 diabetes, are prone to often unexplained swings in their blood glucose. These swings can vary from dangerously low to persistently high levels. Most diabetic patients, and most physicians, will adjust insulin regimens so as to avoid hypoglycemia at the expense of hyperglycemia. Among the “textbook” reasons for variable glucose responses to any given insulin regimen are 1) site of administration, 2) exercise, 3) bottles not adequately mixed before drawing the insulin (for NPH, Lente, or Ultralente), and 4) duration of treatment with insulin (1). A new insulin was marketed by Aventis Pharmaceuticals about 1 year ago, insulin glargine (Lantus). The manufacturer seemed to stress that patients not use a started bottle of this insulin for >28 days (2). Two patients of mine highlighted this point. L.K. is a 76-year-old woman with type 2 diabetes, diagnosed at 55 years of age, and treated with insulin since age 56. Her insulin regimen was changed to Lantus at night together with Novolog before meals. She monitors her blood glucose four times a day. She used a bottle of Lantus until it ran out; therefore, a bottle lasted for 2 months. Her recent HbA1c was 7.6%. I retrospectively analyzed her home glucose readings by averaging her fasting blood glucose levels for the first 15 days of a new bottle and the last 15 days of tha Continue reading >>
How Long Does A Lantus Shot Stay In The System?
Question Originally asked by Community Member jnhealth How Long Does A Lantus Shot Stay In The System? Answer Jnhealth- Lantus is a 24 hour steady release effect. Lantus can be given in a single shot and some people may have to split the dose, ie am and pm. Cherise Community Moderator You should know Answers to your question are meant to provide general health information but should not replace medical advice you receive from a doctor. No answers should be viewed as a diagnosis or recommended treatment for a condition. Answered By: Cherise Nicole Continue reading >>
Toujeo Vs Lantus, Toujeo Costs, Insulin Glargine
Toujeo vs Lantus, Toujeo Costs, Insulin Glargine Doctablet Diabetes , Endocrinology , Everything About Insulin , Medicine Its understandable if you are wondering about the difference between Lantusand Toujeo. After all, both Lantus and Toujeo contain the same insulin , called insulin glargine. Insulin glargine was introduced in the year 2000. This was a huge advancement because it was the first long-acting basal insulin. Before the development of insulin glargine, doctors did not have many types of insulins to choose from. Glargine (the insulin in both Lantus and Toujeo) is an insulin analoguemeaning it has been modified from regular insulin to change its structure and the way it is absorbed. Insulin glargine is still available in its original formulation as Lantus, most commonly prescribed as the Lantus Solostar pen. Insulin is classically prescribed at a very specific concentration called U-100. The U stands for units. The 100 stands for the number of units present in the liquid (1 milliliter ). U-100 insulin has 100 units in 1 milliliter. U-100 is also referred to as regular insulin, but this can be confusing since many different types of insulin come in this concentration. Fast forward a decade and a half later, and insulin glargine (originally Lantus) has reinvented itself. Toujeo (U-300) insulin glargine was approved by the FDA in late February of 2015, making it the first long-acting concentrated insulin available on the market. It is available in insulin pen form only as the Toujeo SoloStar. What researchers discovered was that if they made glargine more concentrated, it lasts slightly longer in the body. Thats right, Toujeo IS GLARGINE, just in the concentrated form of U-300. This means Toujeo is three times more concentrated than Lantus. Some people think Tou Continue reading >>
What Is Lantus Insulin Glargine?: Onset, Peak Time And Duration
What is Lantus Insulin Glargine? Lantus is a long acting insulin that helps blood glucose get into the cells for energy. Lantus is the brand name of insulin glargine. Insulin glargine works by lowering high blood glucose levels in people with diabetes. It replaces the insulin we naturally make. Insulin is a natural hormone that helps our body to convert glucose into energy and store glucose in the form of glycogen for later use. People who are diabetic cannot make enough insulin or use it properly. As a result, glucose cannot be used or stored properly, which leads to a build up of glucose in the bloodstream. Injecting insulin glargine can help lower blood glucose to normal level. This medication is used to treat type 2 diabetes in adults and type 1 diabetes in adults and children who have reached the age of 6 years. Lantus onset, peak time and duration Lantus or insulin glargine refers to a man made hormone that is naturally produced in the body. This medication is used to treat both type 1 and type 2 diabetes. Lantus onset refers to how quickly insulin glargine starts to work in the body. As a long acting insulin, the medication onset is about one and a half hours and can last up to 24 hours. The drug peak refers to how long it takes before this medication achieves the maximum effects in the body. The lantus peak is 6 hours. Insulin glargine is a part of a treatment program that includes diet, exercise, weight control and testing your blood glucose. Make sure you follow the program as it is instructed by your doctor Storage Lantus should be stored in its original container and kept away from heat and light. You are not supposed to freeze this medication. In case of frozen lantus, you should throw it away. Ask your doctor how to properly dispose the medication. Do not Continue reading >>
What Are The Possible Side Effects Of Insulin Glargine (lantus, Lantus Opticlik Cartridge, Lantus Solostar Pen)?
LANTUS® (insulin glargine) Injection DESCRIPTION LANTUS (insulin glargine injection) is a sterile solution of insulin glargine for subcutaneous use. Insulin glargine is a recombinant human insulin analog that is a long-acting, parenteral blood-glucose-lowering agent [see CLINICAL PHARMACOLOGY]. Insulin glargine has low aqueous solubility at neutral pH. At pH 4 insulin glargine is completely soluble. After injection into the subcutaneous tissue, the acidic solution is neutralized, leading to formation of microprecipitates from which small amounts of insulin glargine are slowly released, resulting in a relatively constant concentration/time profile over 24 hours with no pronounced peak. This profile allows oncedaily dosing as a basal insulin. LANTUS is produced by recombinant DNA technology utilizing a non-pathogenic laboratory strain of Escherichia coli (K12) as the production organism. Insulin glargine differs from human insulin in that the amino acid asparagine at position A21 is replaced by glycine and two arginines are added to the C-terminus of the B-chain. Chemically, insulin glargine is 21A-Gly-30Ba-L-Arg-3030b-L-Arg-human insulin and has the empirical formula C267H404N72O78S6 and a molecular weight of 6063. Insulin glargine has the following structural formula: LANTUS consists of insulin glargine dissolved in a clear aqueous fluid. Each milliliter of LANTUS (insulin glargine injection) contains 100 Units (3.6378 mg) insulin glargine. The 10 mL vial presentation contains the following inactive ingredients per mL: 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, 20 mcg polysorbate 20, and water for injection. The 3 mL prefilled pen presentation contains the following inactive ingredients per mL: 30 mcg zinc, 2.7 mg m-cresol, 20 mg glycerol 85%, and water for inje Continue reading >>
Lantus Side Effects Center
Lantus (insulin glargine [rdna origin]) Injection is a man-made form of a hormone that is produced in the body used to treat type 1 (insulin-dependent) or type 2 (non insulin-dependent) diabetes. The most common side effects of Lantus is hypoglycemia, or low blood sugar. Symptoms include: hunger, sweating, irritability, trouble concentrating, rapid breathing, fast heartbeat, seizure (severe hypoglycemia can be fatal). Other common side effects of Lantus include pain, redness, swelling, itching, or thickening of the skin at the injection site. These side effects usually go away after a few days or weeks. Lantus should be administered subcutaneously (under the skin) once a day at the same time every day. Dose is determined by the individual and the desired blood glucose levels. Lantus may interact with albuterol, clonidine, reserpine, or beta-blockers. Many other medicines can increase or decrease the effects of insulin glargine on lowering your blood sugar. Tell your doctor all prescription and over-the-counter medications and supplements you use. Tell your doctor if you are pregnant before using Lantus. Discuss a plan to manage blood sugar with your doctor before becoming pregnant. Your doctor may switch the type of insulin you use during pregnancy. It is unknown if this drug passes into breast milk. Insulin needs may change while breastfeeding. Consult your doctor before breast-feeding. Our Lantus (insulin glargine [rdna origin]) Injection Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication. This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088. Continue reading >>
Is There A Maximum Insulin Glargine (lantus) Dose?
Is there a maximum insulin glargine (Lantus) single-injection dose? Anecdotally, I have heard that patients receiving more than 50 units should split the dose from daily dosing to twice-daily. What’s the evidence? The question of a maximum insulin glargine dose is not straightforward because it encompasses several issues: How long does insulin glargine last? Does it ever need to be given twice-daily? Is there a difference in efficacy between daily and twice-daily insulin glargine dosing? Can you administer more than 50 units of insulin glargine as one single injection? Pharmacodynamics and Duration of Insulin Glargine In theory, insulin glargine should last a full 24 hours without a significant peak effect. Glargine forms a depot effect because it is only soluble at an acidic pH.1 In the vial (pH 4), the drug is completely soluble. Once injected, the solution is neutralized to biologic pH (7.4), which causes the insulin molecules to precipitate. These microprecipitates slowly dissolve over a 24-hour period. This slow dissolution results in a slower onset and a lack of a peak effect compared to other insulins, as shown below: Efficacy of Daily versus Twice-Daily Lantus Administration Although insulin glargine should last a full 24 hours, there is some evidence that its duration of action may be reduced to 20-23 hours, particularly following injection due to its delayed onset of activity of about 3-5 hours.2 Currently, the best estimate is that 15-30% of type-I diabetics will have pre-injection hyperglycemia and may benefit from twice-daily dosing. The idea of twice-daily dosing was explored in an 8-week, open-label crossover trial of 20 patients with type-I diabetes.2 Patients received either 100% of a pre-determined dose daily (dinner) or 50% twice-daily (breakfast an 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 >>
Insulin Actions Times And Peak Times
A good way to improve your glucose levels is to track the peaks and drops in your glucose , so you can figure out why they happened and how to correct them. Once you identify glucose patterns (they ARE there!), you also want to understand when each of your insulins is active and when they typically stop lowering your glucose. This helps you adjust your doses or food intake to stop unwanted ups and downs in your readings. The table below shows the start, peak, and end times for various insulins with some explanations and typical uses for each. When Does My Insulin Peak and How Long Does It Last? designed to peak, covers meals and lowers high BGs Humalog , Novolog and Apidra insulins currently give the best coverage for meals and help keep the glucose lower afterward. Their glucose lowering activity starts to work about 20 minutes after they are taken, with a gradual rise in activity over the next 1.75 to 2.25 hours. Their activity gradually falls over the next 3 hours with about 5 to 6 hours of activity being common with these insulins.Although insulin action times are often quoted as 3-5 hours, the actual duration of insulin action is typically 5 hours or more. See our article Duration of Insulin Action for more information on this important topic. In general, "rapid" insulins are still too slow for many common meals where the glucose peaks within an hour and digestion is complete within 2-3 hours. The best kept secret on stopping post meal spiking is to eake the injection or bolus earlier before the meal and to eat slower low glycemic carbs. Regular insulin still carries its original name of "fast insulin" but its slower action often works better for people who take Symlin or for those who have gastroparesis (delayed digestion). It is also a great choice for those who 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 >>
Types Of Insulin
Insulin analogs are now replacing human insulin in the US. Insulins are categorized by differences in onset, peak, duration, concentration, and route of delivery. Human Insulin and Insulin Analogs are available for insulin replacement therapy. Insulins also are classified by the timing of their action in your body – specifically, how quickly they start to act, when they have a maximal effect and how long they act.Insulin analogs have been developed because human insulins have limitations when injected under the skin. In high concentrations, such as in a vial or cartridge, human (and also animal insulin) clumps together. This clumping causes slow and unpredictable absorption from the subcutaneous tissue and a dose-dependent duration of action (i.e. the larger dose, the longer the effect or duration). In contrast, insulin analogs have a more predictable duration of action. The rapid acting insulin analogs work more quickly, and the long acting insulin analogs last longer and have a more even, “peakless” effect. Background Insulin has been available since 1925. It was initially extracted from beef and pork pancreases. In the early 1980’s, technology became available to produce human insulin synthetically. Synthetic human insulin has replaced beef and pork insulin in the US. And now, insulin analogs are replacing human insulin. Characteristics of Insulin Insulins are categorized by differences in: Onset (how quickly they act) Peak (how long it takes to achieve maximum impact) Duration (how long they last before they wear off) Concentration (Insulins sold in the U.S. have a concentration of 100 units per ml or U100. In other countries, additional concentrations are available. Note: If you purchase insulin abroad, be sure it is U100.) Route of delivery (whether they a Continue reading >>
Long-acting Insulin: How It Works
When you eat, your pancreas releases a hormone called insulin. Insulin moves sugar (glucose) from your blood to your cells for energy or storage. If you take insulin, you may need some at mealtime to help lower your blood sugar after you eat. But even between meals, you need insulin in small amounts to help keep blood sugar stable. This is where long-acting insulin comes in. If you have diabetes, either your pancreas can’t produce enough (or any) insulin, or your cells can’t use it efficiently. To control your blood sugar, you need to replace or supplement the normal function of your pancreas with regular insulin injections. Insulin comes in many types. Each type differs in three ways: onset: how quickly it starts working to lower your blood sugar peak: when its effects on your blood sugar are strongest duration: how long it lowers your blood sugar According to the U.S. Food and Drug Administration (FDA), the five types of insulin are: Rapid-acting insulin: This type starts to work just 15 minutes after you take it. It peaks within 30 to 90 minutes, and its effects last for three to five hours. Short-acting insulin: This type takes about 30 to 60 minutes to become active in your bloodstream. It peaks in two to four hours, and its effects can last for five to eight hours. It is sometimes called regular-acting insulin. Intermediate-acting insulin: The intermediate type takes one to three hours to start working. It peaks in eight hours and works for 12 to 16 hours. Long-acting insulin: This type takes the longest amount of time to start working. The insulin can take up to 4 hours to get into your bloodstream. Pre-mixed: This is a combination of two different types of insulin: one that controls blood sugar at meals and another that controls blood sugar between meals. Lo Continue reading >>
Lantus® is a long-acting insulin analog indicated to improve glycemic control in adults and pediatric patients with type 1 diabetes mellitus and in adults with type 2 diabetes mellitus. Lantus® should be administered once a day at the same time every day. Limitations of Use: Lantus® is not recommended for the treatment of diabetic ketoacidosis. Contraindications Lantus® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin glargine or one of its excipients. Warnings and Precautions Insulin pens, needles, or syringes must never be shared between patients. Do NOT reuse needles. Monitor blood glucose in all patients treated with insulin. Modify insulin regimen cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. Do not dilute or mix Lantus® with any other insulin or solution. If mixed or diluted, the solution may become cloudy, and the onset of action/time to peak effect may be altered in an unpredictable manner. Do not administer Lantus® via an insulin pump or intravenously because severe hypoglycemia can occur. Hypoglycemia is the most common adverse reaction of insulin therapy, including Lantus®, and may be life-threatening. Medication errors, such as accidental mix-ups between basal insulin products and other insulins, particularly rapid-acting insulins, have been reported. Patients should be instructed to always verify the insulin label before each injection. Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue Lantus®, treat and monitor until symptoms resolve. A reduction in the Lantus® dose may be re Continue reading >>
Lantus: Side Effects, Ratings, And Patient Comments
occasional fits of excessive hunger - have been prepared for this by doctor and dieticians and have a course of action planned out; have used for about 5 years; have lost about 60 lbs and then have stayed at weight; Frustrated at times with quality control of pens - some jam; others appear not to be at the same solution level - and so make sure I have back up pens ready to warm up. I have worked with dieticians to remove everything from my house that I should not eat - I know when I've comforted myself with food during stress and when not to blame the Lantus. started at 12 units x 3 days went to 13units x3 days. Stopped taking on third 13 unit day(Supposed to increase to 14units) Blood sugar persistently went up. Before taking was in 2 to 300 range when I stopped it was over 600. Sr and team still insist that plants can't increase blood sugar because it is insulin. I will not take any more. Went back to Actos. Sill having spikes over 600. I have stage 4 kidney failure and am having great difficulty finding high protein food not full of salt. Any suggestions on a good drug to use? Easily go hypoglyemic if too active, severe joint pain all over body, itching, swollen stomach & weight gain, tingling in hands and crawling sensation on skin, regular nausea and headaches,bouts of severe shakes as if I'm hypoglycemic, but #'s are normal, Severe fatigue, occasional bouts of Vertigo so severe that cannot drive a car and must lean against walls to walk around at home. I've been on it for approx. 4 years and currently injecting 80 units @ bedtime -- Do not know what I am going to about all this, but now realize from this blog that it is all related to the Lantus LA. I have days when the joint pain is so sever I can barely walk or put on or take off my jacket. I have experienced e Continue reading >>
The Limitations Of Lantus
There's a common error revealed by many emails I get as well as what I see posted on discussion boards. It has to do with the failure of medical staff to explain to patients for whom Lantus is prescribed what it is that Lantus does and what it is that Lantus cannot do. Lantus is a basal insulin. Basal insulin are slow long-acting insulins that attempt to mimic a specific function of the healthy beta cell. Normal people's beta cells secrete tiny pulses of insulin every couple minutes throughout the day and night. These pulses allow healthy cells to take in blood sugar and use it any time they need to. This slow steady release of tiny bits of insulin is called Basal Insulin Release. It is a failed basal insulin Release that Lantus attempts to replace. But basal insulin production is a completely separate function from the much more powerful insulin release that happens when you eat foods that contain carbohydrates. That is because the influx of a large amount of carbohydrate into the digestive system stimulates two more insulin releases--first phase and second phase insulin release. These fast, large insulin releases are much more powerful than the tiny pulses of insulin produced during basal insulin release. The problem patients run into when they are prescribed Lantus is that they do not understand that there are these different kinds of insulin release and assume that if they are injecting insulin to replace the insulin their bodies no longer make, these injections should be enough to give them normal blood sugars. But if Lantus is what they are injecting, it will be impossible for most people with Type 2 to get normal blood sugars when they eat any significant amount of carbohydrate. Though they inject a large dose of Lantus, that Lantus will be absorbed very slowly o Continue reading >>