Switching Time Of Long Acting Insulin
Im having some unexplained Lows between the hours of 5pm-7pm. its a big pain in the butt because Im usually just arriving to the gym at this time and it gets in the way of my workout. My levels can be around 250, around 3-5pm, and ill typically avoid dosing because I know I am working out, and they still sometimes dip to 60s-70s sometimes around this time. I am having afternoon snacks etc that include complex carbs and protein. I give long acting insulin at 9pm at night. My levels in the morning however are usually a little higher (180 this morning). My doctor suggested that this might be related to the Peak of lantus insulin and that I might benefit by switching my long acting insulin dose to the AM instead of pm. Has anyone done this or experienced this low? As you know Nicole, the peaks for insulin vary from person to person and will over time change some. You will need to change somewhat and watch what happens to you - diabetes and insulin is NOT an exact science. But for you, Id be very cautions taking your long-lasting say at 7: 00 AM because now you appear to be having your 60 to 70 lows about 21 hours after you dose. Of course, these 6 to 7 PM low BG could be caused by insulin stacking - your lunch-time meal bolus. Im not a medical doctor, but may I suggest that you try your Lantus for a few days mid-morning and that may help and it may also take care of your wake-up highs. The bottom line: be cautious, make only one change at a time and analyze what happens - you sound very intelligent and that you have good common sense. I also wondered if it might be because of insulin stacking. I need to book an appointment with my endocrinologist (my family doctor suggested switching to AM). Ive been avoiding it because I dont like my endocrinologist very much (less unders Continue reading >>
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 >>
Lantus Dosage
Important Administration Instructions Administer LANTUS subcutaneously once daily at any time of day but at the same time every day. Prior to initiation of LANTUS, train patients on proper use and injection technique. Patient should follow the Instructions for Use to correctly administer LANTUS. Administer LANTUS subcutaneously into the abdominal area, thigh, or deltoid, and rotate injection sites within the same region from one injection to the next to reduce the risk of lipodystrophy [see Adverse Reactions (6.1)]. Visually inspect LANTUS vials and SoloStar prefilled pens for particulate matter and discoloration prior to administration. Only use if the solution is clear and colorless with no visible particles. Do not administer intravenously or via an insulin pump. Do not dilute or mix LANTUS with any other insulin or solution. General Dosing Instructions Individualize and adjust the dosage of LANTUS based on the individual's metabolic needs, blood glucose monitoring results and glycemic control goal. Dosage adjustments may be needed with changes in physical activity, changes in meal patterns (i.e., macronutrient content or timing of food intake), during acute illness, or changes in renal or hepatic function. Dosage adjustments should only be made under medical supervision with appropriate glucose monitoring [see Warnings and Precautions (5.2)]. Initiation of LANTUS Therapy In patients with type 1 diabetes, LANTUS must be used concomitantly with short-acting insulin.The recommended starting dose of LANTUS in patients with type 1 diabetes should be approximately one-third of the total daily insulin requirements. Short-acting, premeal insulin should be used to satisfy the remainder of the daily insulin requirements. Changing to LANTUS from Other Insulin Therapies If chan Continue reading >>
What Is The Most Important Information I Should Know About Insulin Glargine (lantus, Lantus Opticlik Cartridge, Lantus Solostar Pen)?
A A A Medications and Drugs Brand Names: Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen Generic Name: insulin glargine (Pronunciation: IN su lin AS part, IN su lin AS part PRO ta meen) What is the most important information I should know about insulin glargine (Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen)? What should I discuss with my healthcare provider before using insulin glargine (Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen)? What is insulin glargine (Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen)? Insulin glargine is a man-made form of a hormone that is produced in the body. It works by lowering levels of glucose (sugar) in the blood. Insulin glargine is a long-acting form of insulin that is slightly different from other forms of insulin that are not man-made. Insulin glargine is used to treat type 1 or type 2 diabetes. Insulin glargine may also be used for purposes not listed in this medication guide. What are the possible side effects of insulin glargine (Lantus, Lantus OptiClik Cartridge, Lantus Solostar Pen)? Get emergency medical help if you have any of these signs of insulin allergy: itching skin rash over the entire body, wheezing, trouble breathing, fast heart rate, sweating, or feeling like you might pass out. Hypoglycemia, or low blood sugar, is the most common side effect of insulin glargine. Symptoms include headache, hunger, weakness, sweating, tremors, irritability, trouble concentrating, rapid breathing, fast heartbeat, fainting, or seizure (severe hypoglycemia can be fatal). Carry hard candy or glucose tablets with you in case you have low blood sugar. Tell your doctor if you have itching, swelling, redness, or thickening of the skin where you inject insulin glargine. This is not a complete list of side effect 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 >>
Time Zones |
Travel increases the risk of hypoglycemia, especially if many time zones are crossed. Long-haul travel can also cause dehydration which can increase the potential for high blood sugar levels and possibly diabetic ketoacidosis. Here we provide guidelines for insulin users to discuss with their diabetes team. These are simple rules for individuals planning to travel across 5 or more time zones and who are using once or twice a day long-acting background (basal) insulin. As explained below, the adjustments you make will depend on the direction of travel. The day before departure, give the usual dose at the usual time of day When you begin traveling, keep your watch set to your departure time zone and give half of the normal dose at the usual time After giving this half dose, change your watch to the destination time (you can find this out from the flight attendant or from the world clock on your smartphone) According to your destination time zone, give the remaining half of the long-acting (basal) insulin at the same hour you are accustomed to giving insulin (e.g. if you usually take insulin at 8pm in Los Angeles, take your insulin at 8pm according to your new time zone) The next day keep to the destination time and give the usual full dosage at the usual time The day before departure, give the usual dose at the usual time of day Keep to the departure time and give a reduced dose at the usual time, the dose should be reduced by using the following formula Travel dose = usual dose x (0.9 number of time zones you are crossing by 24). As seen in the following example, dont forget to divide the number of time zones by 24 before subtracting that number from 0.9. After giving this reduced dose, change your watch to the destination time zone According to your destination time zo Continue reading >>
Insulin Glargine (rx)
Dosage Forms & Strengths injectable solution 100 units/mL (Lantus; 10mL vial) 100 units/mL (Lantus SoloSTAR; Basaglar KwikPen; 3 mL disposable prefilled pens) 300 units/mL (Toujeo; 1.5 mL SolosStar disposable prefilled pen) Note: Recent studies have suggested that glargine-300 extends blood glucose control well beyond 24 hr Type 1 or 2 Diabetes Mellitus Lantus and Toujeo are recombinant human insulin analogs indicated to improve glycemic control in adults with type 1 or 2 diabetes mellitus Dosing Considerations Indicated for once-daily SC administration; exhibits relatively constant glucose-lowering profile over 24 hr May be administered at any time during the day; should be administered SC once daily at the same time every day Dose must be individualized based on clinical response; blood glucose monitoring is essential in all patients receiving insulin therapy Patients adjusting the amount or timing of dosage should do so only under medical supervision with appropriate glucose monitoring In patients with type 1 diabetes, insulin glargine must be used in regimens with short-acting insulin Should not be administered IV or via an insulin pump; IV administration of the usual SC dose could result in severe hypoglycemia As with all insulins, injection sites should be rotated within the same region (abdomen, thigh, or deltoid) from one injection to the next to reduce the risk of lipodystrophy; no clinically relevant difference in insulin glargine absorption after abdominal, deltoid, or thigh SC administration As with all insulins, the rate of absorption and, consequently, the onset and duration of action may be affected by exercise and other variables (eg, stress, intercurrent illness, changes in coadministered drugs, meal patterns) Type 1 diabetes mellitus: Starting dose sho Continue reading >>
(insulin Glargine Injection) 300 Units/ml
Do not take Toujeo® if you have low blood sugar or if you are allergic to insulin or any of the ingredients in Toujeo®. Do NOT reuse needles or share insulin pens even if the needle has been changed. Before starting Toujeo®, 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 breastfeeding or planning to breastfeed. Continue reading >>
Changing Lantus Time
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Hello. As some of you may know ive been having problems with morning highs. 32 lantus and my sugar level shoots up in the night then 34 and I hypo. (it came down 5 units). Ive been to the hospital and they advised me to change my lantus from 11 at night to either breakfast or tea time. Im going to do it at tea time. They said I can split it up. Do half at 11pm then half in them morning. Then the second morning do it all in the morning. Could I do this for tea time, 1/2 at tea time tomorrow night then the other 1/2 5 hours later before bed. Then the night after just do all at 6PM? Try switching to morning or tea-time first using just a single dose and if that doesn't work then consider the split, I use to inject before bed but had a few night-time hypo's so my DSN suggested switching to 5-6pm instead, have to say it made a great difference and not had many problems since. Try switching to morning or tea-time first using just a single dose and if that doesn't work then consider the split, I use to inject before bed but had a few night-time hypo's so my DSN suggested switching to 5-6pm instead, have to say it made a great difference and not had many problems since. So give myself the full dose at 6pm tonight? (Last night I did it at 11PM) Im aware doing this my dosages will need to come down so I might not even inject for tea if its a small dosage as I have training at 8 and dont want to hypo. Ide rather run it a little too high for an hour or two if anything. So give myself the full dose at 6pm tonight? (Last night I did it at 11PM) Im aware doing this my dosages will need to come down so I might not even inject for tea if its a small dosage as I have t Continue reading >>
Ask D'mine: New Basal Insulin Toujeo, New Dosing Math
Welcome back to our weekly diabetes advice column, Ask D’Mine — with your host veteran type 1, diabetes author and educator Wil Dubois. This week, Wil looks at the newest basal insulin to hit the market: Sanofi's Toujeo (aka the Son of Lantus). It was newly approved by FDA early this year and launched in early April, and it can be a little confusing since the unit-dosing is a bit different from what we're used to. Don't worry, Wil's got this... {Have your own questions? Email us at [email protected]} Matthew, type 2 from Oregon, asks: I’m confused about the new basal insulin Toujeo, I understand that it is U-300 and therefore should be more “concentrated,” but when I went to the webpage for this product, it talked about how Toujeo is a 1:1 dosing and conversion from Lantus. I thought that the dose would actually be less as it’s more concentrated. I also read about how people actually required a higher dose of Toujeo to allow the same blood sugar control as with Lantus. How on earth does this all work?! [email protected] D’Mine answers: It’s fuzzy math, Mathew, but you chose the right person to ask. However, a warning: It’s impossible to give a concentrated answer about concentrated insulin! So OK, let’s concentrate (get it?!)… Most modern insulins are what we call U-100, which means that there are 100 units of insulin per milliliter of fluid. That’s what they mean by its concentration. Back in the day we also had U-20, U-40, and U-80 insulins. I also had it in my head that there was a U-60 at one time, but I may be wrong about that, as a quick Google search only turns up articles about the German Sub U-60, which apparently had one of the least distinctive war records of the Nazi fleet -- and no discussions of insulin. Anyway, back in the many-conce Continue reading >>
Important Safety Information For Soliqua® 100/33 (insulin Glargine & Lixisenatide Injection) 100 Units/ml & 33 Mcg/ml
What is the most important information I should know about SOLIQUA 100/33? Do not share your SOLIQUA 100/33 pen with other people, even if the needle has been changed. SOLIQUA 100/33 can cause serious side effects, including inflammation of the pancreas, which may be life-threatening. Before using SOLIQUA 100/33, tell your doctor if you have had pancreatitis, stones in your gallbladder, or a history of alcoholism. These medical problems may make you more likely to get pancreatitis. Stop taking SOLIQUA 100/33 and call your healthcare provider right away if you have pain in your stomach area (abdomen) that is severe, and will not go away. The pain may be felt in the back area. The pain may happen with or without vomiting. Who should not use SOLIQUA 100/33? Do not use SOLIQUA 100/33 if you are having an episode of low blood sugar or if you are allergic to insulin glargine, lixisenatide, or any of the ingredients in SOLIQUA 100/33. Tell your healthcare provider about all your medical conditions, including if you: have or have had problems with your pancreas, your kidneys, or your liver, stones in your gallbladder, or a history of alcoholism. have heart failure or other heart problems. If you have heart failure, it may get worse while you take TZDs (thiazolidinediones). have severe problems with your stomach, such as slowed emptying of your stomach or problems digesting food. are pregnant or breastfeeding or plan to become pregnant or to breastfeed. It is not known if SOLIQUA 100/33 will harm your unborn baby or pass into your breast milk. Tell your healthcare provider about all the medicines you take, including all prescription and over-the-counter medicines, vitamins, and herbal supplements. SOLIQUA 100/33 may affect the way some medicines work. Before using SOLIQUA 100/33 Continue reading >>
How To Change Lantus Injection Time(s)
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. I currently take 28u Lantus in the morning. MY FBGs have been averaging around 150, and my regular doctor thinks I should switch over to taking it in the evening. His new theory (based on a recent seminar he attended) is that your FBS make up 75% of your A1C (my latest is 7.9, which is up from the low 7s where it usually is). Therefore, the more important thing to do is get your FBG under control with the long acting insulin, and then use rapid (in my case, Humalog) as you would normally with meals and so on. This is the first I've heard the 75% thing, and it doesn't sound right to me, but this is what they preached at the seminar. So, he thinks I should switch to the evening, which makes sense regardless of the 75% thing. If I want to switch to evenings (with dinner), how do I go about it? Or should I do a split? (prefer not to) I think this number reflects the fact that bolus ratios, coverage of meals, is fairly easy to achieve - diet, exercise, med doage and timing. Basal rates can be much tougher, and their impact is not short term like bolusing, it has a 24 hour effect. FBG is used because it is the test most untainted by bolusing. I agree that if this number is correct, it's a good indicator your basals are at least close. I agree with their % rate for most diabetics. Flatliners are fairly easy to get right; they have few and minor fluctuations. However, add a big DP and it lowers the % rate as this adds a big spike not necessarily covered by the lantus or bolus, at least not well understood control. Usually it's built into the am bolus, but that forces the person to eat the same meal e Continue reading >>
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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Insulin Pen Safety
Insulin pens have become a popular way for diabetics to give themselves insulin. Insulin pens are available for multiple insulin types. However, as with any technology, pens can be misused leading to medication errors and inaccurate administration of insulin. Although an insulin pen is easy to use, certain precautions must be taken to assure proper use. Below is a list of safety tips to keep in mind when using an insulin pen: 1. Do not share your insulin pen with anyone: Insulin pens should never be used for more than one person. Using insulin pens on more than one person puts people at risk for infection with blood-borne pathogens such as hepatitis viruses and HIV, which causes AIDS, the agency warns. Infection can occur even if an insulin pen's needle is changed. We are aware of this happening in hospitals, where, for example, a nurse may not realize the risk. Pen needles are changed in between patients but the very same pen is used for multiple patients! This is dangerous because even if the needle is changed, it's still possible for insulin in the pen to become contaminated. Then, when subsequent patients are injected, there's a danger of passing along harmful bacterial or virus. 2. Do not withdraw insulin from an insulin pen cartridge Using insulin pens as "mini" insulin vials, by drawing up insulin into an insulin syringe, can lead to inaccurate dose measurement the next time the insulin pen is used for dose delivery. The reason for this is related to air entering the pen unintentionally, interfering with the proper mechanics of the pen. 3. Do not leave an open needle attached to an insulin pen Leaving an insulin needle attached to an insulin pen can lead to unintentional air entering into the insulin pen. If unintentional air enters into the insulin pen, it can c Continue reading >>
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So You’re Ready
Indication BASAGLAR is a long-acting insulin used to control high blood sugar in adults and children with type 1 diabetes and adults with type 2 diabetes. Limitation of Use Important Safety Information Do not take BASAGLAR during episodes of low blood sugar or if you are allergic to insulin glargine or any of the ingredients in BASAGLAR. Do NOT reuse needles or share insulin pens, even if the needle has been changed. Before starting BASAGLAR, 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 breastfeeding or planning to breastfeed. BASAGLAR should be taken once a day at the same time every day. Test your blood sugar levels while using insulin. 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. The most common side effect of insulin, including BASAGLAR, is low blood sugar (hypoglycemia), which may be serious and life threatening. Signs and symptoms may include dizziness or light-headedness, sweating, confusion, headache, blurred vision, slurred speech, shakiness, fast heartbeat, anxiety, irritability, mood change, or hunger. Do NOT dilute or mix BASAGLAR with any other insulin or solution. It will not work as intended and you may lose blood sugar control, which could be serious. BASAGLAR 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. BASAGLAR may cause serious side effects that can lead to death, such as severe allergic reactions. Get emergency help if you have: Heart failure can occur if you are taking insulin together w Continue reading >>
