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Why Do We Give Lantus At Night?

Lantus

Lantus

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 (insulin Glargine)

Lantus (insulin Glargine)

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

Lantus (insulin Glargine) Side Effects

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

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 >>

Should Insulin Glargine Be Dosed Once Or Twice Daily?

Should Insulin Glargine Be Dosed Once Or Twice Daily?

Should Insulin Glargine Be Dosed Once or Twice Daily? Insulin glargine (Lantus, sanofi-aventis) claims to have a 24-hour duration of action. Is there any advantage to using it twice daily? If so, what patient population might benefit from twice-daily dosing? Response from Jenny A. Van Amburgh, PharmD, CDE Associate Clinical Professor, School of Pharmacy, Northeastern University, Boston, Massachusetts; Director of the Clinical Pharmacy Team and Residency Director, Harbor Health Services, Inc., Boston, Massachusetts Since its approval in April of 2000, insulin glargine has been used successfully in the treatment of sustained hyperglycemia in patients with type 1 or type 2 diabetes mellitus.[ 1 ] Long-acting insulin formulations such as glargine offer patients a steady, "peakless" 24-hour release of insulin for blood glucose control, in a convenient once-daily dosing schedule. Insulin glargine exerts its therapeutic effects by mimicking the basal secretion of pancreatic insulin to provide around-the-clock coverage for patients with elevated fasting plasma glucose levels. As with other diabetes treatments, the goal of insulin therapy is to prevent both microvascular (eg, retinopathy, neuropathy, nephropathy) and macrovascular (eg, stroke, myocardial infarction) outcomes. Although insulin glargine is US Food and Drug Administration-approved for once-daily dosing, the actual duration of action ranges from 10.8 to more than 24 hours in some patients.[ 1 , 2 ] This fairly wide range suggests that a second dose may be necessary to achieve optimal glycemic control, although this is considered off-label use.[ 3 , 4 ] To further investigate the variability in duration of action, an 8-week, 2-way crossover study was conducted in 20 patients with type 1 diabetes who used insulin asp Continue reading >>

Best Time To Inject Lantus...

Best Time To Inject Lantus...

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. Well, you know me, the consummate "tester". 9 months ago I started out on Lantus. The instructions that came on the Lantus said to inject X amount of units at bedtime. Now, I think we've discussed this before and came to the conclusion that those instructions, as to 'time of day', were created so that one has a good reference point-in-time for their injection. Some people have remarked that their Lantus doesn't last for 24 hours. I have no idea how someone comes to that conclusion. Awhile back, if some remember, I wondered how long I'd last without insulin. I stopped taking Lantus and maintained my same diet and testing times. It was 6 days before I saw a rise in my FBG. I guess my Lantus injections last me 144 hours if we're to use that as a benchmark. Anyway... In the question of 'how long does my basal insulin last' I pondered about what time I took my Lantus. Usually it's right after dinner as that's when I shut this postin' machine down and migrate to the TV. That's around 7 o'clock. Which means that the tail end of my Lantus has to deal with my dinner...the biggest meal of my day. So, what if there was a better time, for me, to re-up my Lantus. I understand that a basal insulin isn't designed to cover meals, that's what rapid-acting insulin is for. But I'm not a Type I, my pancreas seems to still be puttin' out like a cheap crack-whore...so I'm controlling that little spike with carbohydrate restrictions. Then again, I feel that I oughta' have the lion's share of Lantus available when I've got food inside me...not while I'm sleeping, doing nothing. So I've started a time-of-day test to Continue reading >>

Basal Insulins | Diabetesnet.com

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 >>

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.

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 >>

The Effects Of Transition From Bedtime To Morning Glargine Administration In Patients With Poorly Regulated Type 1 Diabetes Mellitus: Croatian Pilot Study

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 >>

Getting The Right Dosage

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 >>

Is There A Maximum Insulin Glargine (lantus) Dose?

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 >>

Ask D'mine: Missing In Action

Ask D'mine: Missing In Action

Need help navigating life with diabetes? Ask D'Mine! That would be our weekly advice column, hosted by veteran type 1, diabetes author and community educator Wil Dubois. This week he's offering some wisdom on what we people with diabetes (PWD) can do if and when we miss a dose of insulin... Yes, it happens. So, read on! {Got your own questions? Email us at [email protected]} Edwin, type 2 from Maryland, writes: I have been diabetic for approximately 12 years. I take Humalog shots before meals, and one shot of 28 units of Lantus at bedtime. My question is, what do I do if I miss a bedtime Lantus shot, and I realize this the next day? This is exactly what happened this morning. The previous night, I had stayed home watching movies and I had a few vodka martinis. I got sleepy, and just went to sleep. When I woke up, I realized I forgot my shot! [email protected] D'Mine answers: Gotta watch out for those vodka martinis! But these kind of things can happen to all of us, with or without the martinis, so don't feel badly. Actually, I'm amazed you remembered in the morning. Maybe your blood sugar reminded you? ;-) As to what to do about the missed shot, this is a trickier question than you might think. I'll give you my thoughts, but this probably falls into the "ask your doctor" category, which means that I need to remind everyone that my title of Doctor WilD is a purely honorary one, granted to me by an un-accredited mail-order "university" in the northeastern part of Liechtenstein. And on top of that, my honorary doctorate isn't a medical degree, but a PhD, and it isn't even in diabetes, it's in underwater basket weaving. So, the medical disclaimer dispensed with, let us proceed... Some missed meds should be taken as soon as you realize you missed them. With others, you need to Continue reading >>

Lantus Dosing

Lantus Dosing

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 >>

Lantus

Lantus

Published: January 28 I have had great results with this, since I was diagnosed 11 months ago I have been on numerous different medications. My A1C b4 beginning this was 10.4, but now my b/s stays in the low to mid 100's 2 hours after a meal with a lower carb meal plan. The only problem I've had is getting properly adjusted, I take 28 units a day and have dropped below 70 and became disoriented twice, but lower dosages than that don't seem to work near as well. I cannot wait until I get my next blood results in a couple months because I finally feel as though I've gained control of my blood sugar. I hope this helps some of you. Published: October 15 Lantus has kept my blood sugar under control. I'm in normal limits now. Its never let me down. Its sooo easy to use juck a click and your done! The small needle makes it totally painless. I've had no side effects. I reallly recomend lantus to everyone with diabetes who need insulin. Lantus has lasted for a full 24 hours for me. Its important to get your correct dose with lantus.once you have your correct dose it works perfectly! It dosent cause low blood sugar either like other insulin because it doesn't peak. I give it a all star rating! Lantus really works for me! Published: October 18 My blood sugar numbers were always high and I was struggling to control them then my doctor perscribed lantus solostar pen. Lantus keeps my blood sugar at normal levels now. I was actually amazed on how well lantus worked. Also, it is soo easy to use just change the needle tip with every usee.its ready to go.I recomend lantus to all diabetics. It has made a huge difference in my life. I use lantus solo star pen for my injections. It has been amazing at controling my high blood sugar! The pen is extremely easy to use and mostly pain free. Aft Continue reading >>

Pharmacokinetics And Pharmacodynamics Of Insulin Glargine Given In The Evening As Compared With In The Morning In Type 2 Diabetes

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 >>

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