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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Lantus - Morning Or Night?
Hello everyone. I'm 32 years old (33 this Friday), and, since I was diagnosed a day before my 20th birthday, I know that it has been 13 years since my diagnosis with Type 1 diabetes. For a long time I was on a normal NPH / Humalog regimen that seemed to work. About 18 months ago, though, that regimen broke down for whatever reason. During that 18 month period my endo and I watched my A1C go from a wonderful 6.2%, up through the 7's, and peak out at 8.1% before we knew that something had to change. That change was to go to a Lantus / Humalog regimen. I started it this week, and discovered that the only consistent time I could take the Lantus was upon waking in the morning. Through the day my numbers have now been great, anywhere from 85-120 consistently. However, I used to take a large NPH dose at night to cover my terrible dawn syndrome. Since taking the Lantus, that syndrome is back, often sending my BG's from 110 @ 3:00am, to 250-300 by 6:30am when I wake up. Should I switch taking the Lantus to the evening hours, or should I talk to my endo about splitting the dose, and/or adding NPH back into the mix (what's another shot when you're already taking 4/day right?) I'd like to get this fixed, since I'm very excited with the new numbers and can't wait for my next A1C test, but I'd hate it to be foiled by this darned dawn syndrome! Any help from you Lantus "pros" out there would be great. I can't claim to be a Lantus pro! I did take it for a long time and found the action pretty even through the 24 hours whether I had one or 2 shots. (Actually, it did tend to run short, maybe 20 hours for me, so the 1 shot was bad news for me). The flat action was actually diabolical for me, because I do not have flat needs through the day. So I understand how the flat action might be de Continue reading >>
Well, I never thought I’d say this, but it’s a great week to be a person with Type 1 diabetes. With all of the bad news surrounding the Type 2 drug Avandia (rosiglitazone), it’s a relief to know I don’t have to worry about it. I recommended you read my colleague Tara’s blog entry (“Type 2 Drug Avandia Linked to Increased Risk of Heart Attacks”) for the full story. That’s one of the first times in my life I’ve referred to someone as a colleague. What can I say? It’s just not a word in my describe-a-friend/coworker vocabulary. While all of the controversy surrounds Avandia, I’m way over in Type 1 land contemplating whether or not to lower my daily dose of Lantus (insulin glargine). I’ve just started a brand new bottle of Lantus and I’ve been taking my normal 15 units in the morning and then eating a rather normal breakfast and lunch, but I’m still going low in the midmorning and early afternoon. This happened Monday after eating Brussels sprouts and whole-wheat pasta for lunch and only taking one unit of rapid-acting NovoLog (insulin aspart) to help out the Lantus. I’ve known for a while that my body is sensitive to insulin, but lately it’s been a little more sensitive than usual. I took 13 units of Lantus yesterday and my blood glucose was 86 mg/dl before lunch. I often wonder how much of an adjustment two units of Lantus is. While I’m very much locked in on an insulin-to-carbohydrate ratio with my NovoLog, it’s a bit tricky to judge how much the longer-lasting insulins affect your blood glucose. Is there a chart for your Lantus dose? I seem to remember something from when I was diagnosed. I wonder what Google will tell me to do. I realize that Lantus doesn’t have a true peak the way some of the other insulins do, but sometimes it su Continue reading >>
Insulin: Morning Or Night?
My endocrinologist put me on Insulin today. He wants me to dose 14 units every night before bed (after I eat something of course). I would like to wait until morning due to the fact that I live alone now. When I was diagnosed I was living at home. Therefore, I knew if I ever went hypo there was somebody around. I would feel more safe dosing insulin if I know I'm going to always have my bag of glucose tabs on my person (and snacks) at all times. So, would it matter if I took my long acting insulin before breakfast in the morning? I've had near hypos before (on glimepride) and I don't want to be sleeping and a low hits and I'm by myself. I don't have a big Diabetes support network (with the exception of doctors and nurses). The only orals I am on are Metformin and the occasional dose of Glimepride (which I take before my biggest meal of the day. My endo has since taken me off that, as of today). My morning BG's have been, for the last two weeks, on average, consistently between 100 and 110 (which is really good). I'm not having any hyperglycemia issues waking up...or lying down. Due to the fact that I have been restricting carbohydrates I do worry more about going hypo. I'm just wondering if first thing in the morning would be a better option than late at night. Continue reading >>
Pharmacokinetics And Pharmacodynamics Of Insulin Glargine Given In The Evening As Compared With In The Morning In Type 2 Diabetes
OBJECTIVE To compare pharmacokinetics (PK) and pharmacodynamics (PD) of insulin glargine in type 2 diabetes mellitus (T2DM) after evening versus morning administration. RESEARCH DESIGN AND METHODS Ten T2DM insulin-treated persons were studied during 24-h euglycemic glucose clamp, after glargine injection (0.4 units/kg s.c.), either in the evening (2200 h) or the morning (1000 h). RESULTS The 24-h glucose infusion rate area under the curve (AUC0–24h) was similar in the evening and morning studies (1,058 ± 571 and 995 ± 691 mg/kg × 24 h, P = 0.503), but the first 12 h (AUC0–12h) was lower with evening versus morning glargine (357 ± 244 vs. 593 ± 374 mg/kg × 12 h, P = 0.004), whereas the opposite occurred for the second 12 h (AUC12–24h 700 ± 396 vs. 403 ± 343 mg/kg × 24 h, P = 0.002). The glucose infusion rate differences were totally accounted for by different rates of endogenous glucose production, not utilization. Plasma insulin and C-peptide levels did not differ in evening versus morning studies. Plasma glucagon levels (AUC0–24h 1,533 ± 656 vs. 1,120 ± 344 ng/L/h, P = 0.027) and lipolysis (free fatty acid AUC0–24h 7.5 ± 1.6 vs. 8.9 ± 1.9 mmol/L/h, P = 0.005; β-OH-butyrate AUC0–24h 6.8 ± 4.7 vs. 17.0 ± 11.9 mmol/L/h, P = 0.005; glycerol, P < 0.020) were overall more suppressed after evening versus morning glargine administration. CONCLUSIONS The PD of insulin glargine differs depending on time of administration. With morning administration insulin activity is greater in the first 0–12 h, while with evening administration the activity is greater in the 12–24 h period following dosing. However, glargine PK and plasma C-peptide levels were similar, as well as glargine PD when analyzed by 24-h clock time independent of the time of administra 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 >>
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 >>
Frequently Asked Questions
The Dumbest & Smartest Things A Doctor Ever Told Me I eat a low fat diet, so why is my cholesterol level still high? Why are my blood sugars higher in the morning than when I go to bed the night before? This typically occurs due to the dawn phenomenon. The dawn phenomenon is the rise in blood glucose levels in the dawn (that is, the morning) due to excessive release of glucose from the liver into the blood. Here is a graph of a person’s blood glucose readings measured with a device (a “continuous glucose monitor”) that automatically measures the body’s glucose level about 300 times per day (each colour represents a different day): As you can see in the preceding graph, every day starting at about 3am this person’s glucose levels started to go up. This individual, like so very many others living with diabetes who have high blood glucose levels first thing in the morning, blamed themselves and attributed their elevated morning blood glucose to having overeaten or snacked the night before. Not so! What they (and you) eat at bedtime (or suppertime) seldom is a significant factor in leading to high blood glucose levels the next morning; heck, the food you ate the night before is long since digested, absorbed into the body, and metabolized well before the following morning’s breakfast. This graph nicely illustrates that point. One colourful term for the liver’s tendency to release glucose into the blood overnight is a liver leak. How much sugar (glucose) gets released from the liver if you have the dawn phenomenon? How about this: Almost as much as is contained in TWO CANS OF COLA! If you have the dawn phenomenon this is something that is not simply to be accepted. Rather, your therapy should be adjusted to fight it so that your blood glucose levels are kept w Continue reading >>
Does Anyone Take Lantus In The Morning? | Diabetic Connect
Hi I was taking my Lantus only at night, but about a week ago right aboout the end of the 24 hr. Period my basal would be so weak that I would spike up to 50-70 numbers. For the last 2 days my D nurse started trying it out where I take 1/2 at 7:30 pm and again at 7:30 am, my numbers are still higher than I want them to be so am trying to slowly work into this. Doing it this way means you are overlapping your insulin which in my case we had decided I need something working for me constantly. Are you a T1? no.. i take mine at nights and if i forget to do so it reflects in my numbers.. they usually jump up Years ago, when I was put on Lantus it was in the morning, but I had problems with it. The dr changed it to just before bed time and it worked out fine, I was also on other insulin as well. I split my dose and take half when I wake up and half when it's bed time. No problem! Continue reading >>
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 >>
I Take Lantus 1 Time A Day At Night Take Novalog 2 Times Morning And Night?
Home Q & A Questions I take lantus 1 time a day at... I take lantus 1 time a day at night take novalog 2 times morning and night? In all likelihood no, most all diabetic's have higher blood sugar readings in the morning, this is caused by the action of your bodies hormones and you can monkey around with how you prepare for bed in the evening such as a snach or not, etc. What it is called is the Dawn Phenomenon, I also have it and I have a evening snack high in carbohydrate and I usally have a b.s. reading about 110 and If I don't have that snack my b.s. readings are much higher. Changing when you take your basil insulin most likely won't change anything except the time of day that you take it. If you have access to a diabetes educator you may want to pose the question of the Dawn Phenomenon to that person, I'm sure there are many ways to treat it. Continue reading >>
Lantus In The Morning Instead Of Evening
I recently read on here somewhere that Lantus is usually given at bedtime because it lasts 18-24 hours and that by the time it is dwindling the dinner injection is given kind of as the bridge between the first Lantus injection and the next one the following evening. Thus making a steady regimen. However I quite frequently fail to give myself injections at dinner. I am just careless sometimes. But my Lantus peaks around 3 or 4 every morning, and depending on the night before I may experience a mild/mildly severe low. Has it ever been suggested to take Lantus in the AM? My thought is this: If I took Lantus in the A.M. (Aprox 6:30 or so) my peak would be about 5 or 6 hours later. This would be my lunch time. I could use a sliding scale determined at lunch. If I forgot the dinner shot, the Lantus would still be working. And I could still test at bedtime and bolus if needed. I see it this way because at least then I would have some insulin in my system at dinner, rather than the tiny amount of Lantus left, there would be a bit more (since I would be taking it about 8 & 1/2 hours later). Anyone have any suggestions or comments tomy thoughts? Continue reading >>
Lantus In Morning Is It Right Can You Take It In Morning
Diabetes Forum The Global Diabetes Community Find support, ask questions and share your experiences. Join the community Lantus in morning is it right can you take it in morning Rang nurse today to let her know my toujeo pen keeps breaking . So she putting me back on lantus in morning wit my novorapid . I took lantus at night before bed but nurse said take it as I would take my toujeo insulin . My question is can you take lantus in morning wit novorapid nurse said yeah but I never taking lantus in morning . Is it ok or not let me know Head323 not sure about taking it in the morning like you since ive been on it which is years always took it before bed and Novo rapid in morning? I'm sure someone will advise if they take it in morning keep us informed Hi @head323 . You can take lantus in the morning with your novorapid. Thing to consider is lantus is active for around 20/21 hrs in most people. In theory you could have no active basal insulin on board at around 4 am , this is also the time of day when a lot of us suffer with the dawn phenomenon . Ultimately you could find yourself waking with sugars higher than expected. Have you considered splitting your lantus? Maybe worth asking as it works for a lot on lantus. Rang nurse today to let her know my toujeo pen keeps breaking . So she putting me back on lantus in morning wit my novorapid . I took lantus at night before bed but nurse said take it as I would take my toujeo insulin . My question is can you take lantus in morning wit novorapid nurse said yeah but I never taking lantus in morning . Is it ok or not let me know Your toujeo pen. Disposable or reusable with cartriges..? The reason I ask. Why not try a different device to administer it...? Continue reading >>
Getting The Right Dosage
Even for those on Lantus® for a while, it may take a little time to get to the right dose of insulin. Your doctor may change your Lantus® dose several times in the first few weeks. This is to be expected. For best results, keep taking your Lantus® as prescribed, and keep talking to your doctor. What if You Miss a Dose? Your doctor will guide you on when to take Lantus®. Ask him or her what to do if you forget to take your insulin, so you can be prepared in advance in case it ever happens. Here are a few ways to remember to take your Lantus® once-a-day: 3 Helpful Tips Make yourself a reminder If you take your Lantus® at night, it might also be a good idea to leave yourself a note on your nightstand as a way to remember. If you take it in the morning, put your supplies where you can't miss them—next to your toothbrush, for example. Keep out of reach of children. Add it to your other daily "to dos" Many people take Lantus® right after brushing their teeth in the evening or while making breakfast in the morning. Set an Alarm Some people set alarms on their wristwatches or mobile devices to remind them when to take their Lantus®. “We changed doses a couple of times when I started on Lantus®, until we found the right amount for me.” Continue reading >>
Once-daily Insulin Glargine Administration In The Morning Compared To Bedtime In Combination With Morning Glimepiride In Patients With Type 2 Diabetes: An Assessment Of Treatment Flexibility.
Abstract AIMS: To compare the incidence of nocturnal hypoglycemia and glycemic control following bedtime or morning insulin glargine (LANTUS; glargine) plus glimepiride. METHODS: In this 24-week, multinational, open, randomized study, 624 patients with type 2 diabetes poorly controlled on oral therapy received morning or bedtime glargine plus morning glimepiride (2, 3 or 4 mg) titrated to a target fasting blood glucose level < or = 5.5 mmol/l. RESULTS: The incidence of nocturnal hypoglycemia was equivalent between the two groups, with morning glargine non-inferior to bedtime (13.0 VS. 14.9 % of patients; between-treatment difference -1.9 %; one-sided 95 % confidence interval -100 %; 2.84 %). At endpoint, similar improvements in glycemic control were observed with morning compared to bedtime glargine: HbA1c: -1.65 +/- 1.21 VS. -1.57 +/- 1.16 %; p = 0.42; fasting blood glucose: -4.25 +/- 2.82 VS. -4.48 +/- 2.75 mmol/l; p = 0.08. The endpoint mean daily glargine dose was comparable (34.7 +/- 17.4 VS. 32.4 +/- 17.0 IU; p = 0.15), and there was no significant between-treatment difference in the change in body weight (2.1 VS. 1.8 kg; p = 0.39). CONCLUSIONS: Once-daily glargine can be administered in a flexible morning or bedtime regimen (plus morning glimepiride) to achieve good glycemic control without any difference in hypoglycemia. Continue reading >>
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