Using Lantus® (Glargine)

Author: Judy Kohn, RN, BSN, CDE

Last Updated: Sunday, June 01, 2003

Q: "I am currently taking Ultralente (breakfast 10U, dinner 13U). If I switched to a once daily injection of Lantus®, how would my dosage change? What time do you take it? Do you need to adjust the mealtime doses of Humalog®?"

A: Before I respond to the question re: how would the dosage change if you switched to Lantus, I'll provide some information about this insulin.

What is Lantus?

Lantus is newer, long-acting insulin, from Sanofi Aventis and was designed as a once-a-day insulin to deliver smooth, "peakless" 24-hour basal coverage. Basal insulin is a term used to describe the slow, steady release of insulin needed to control blood glucose when no food is being digested (between meals and during the night).

One common problem with traditional intermediate or long acting insulins (NPH or Ultralente¹) is that their absorption rate, peak and overall action often varied up to 50% from day to day. Both of these insulins are cloudy in appearance, and the substances that give these insulins their long action contribute to their variability. That meant that some people might follow a rigid regimen, eating very consistent food, yet their blood glucose levels fluctuated widely. Usually, the only way to remedy this problem was to eliminate the cloudy insulin, and use only clear, rapid-acting or short-acting insulin-which required using an insulin pump.

Furthermore, neither NPH nor Ultralente lasted 24 hours. NPH duration can vary from 13-24 hours, with a peak between 3-9 hours, while Ultralente could last 23-36 hours, with a peak somewhere between 8 and 16 hours.

Characteristics of Lantus:

Lantus, which is clear insulin, absorbs very slowly into the system, lasting approximately 24 hours, and has little variability and no peak. So far, published studies have reported:

• People with type 1 diabetes using Lantus had lower fasting glucose levels, with fewer episodes of nighttime hypoglycemia.
• People with type 2 diabetes using oral agents during the day and Lantus at bed had improved blood glucose levels with less nighttime hypoglycemia.
• Studies on people with type 2 diabetes using Lantus at bed, and Regular insulin with meals, showed improved control, less hypoglycemia, and less weight gain.

In addition, many people with type 1 diabetes who did not want an insulin pump found that the only way they could achieve reasonable control was by using "insulin cocktails"-mixing Regular insulin with Humalog before each meal, and NPH alone at bed.

They tried this because they found that the Humalog action "ran out" after 4 hours, so the Regular would "cover" them till the next meal. But this required using 3 different insulins. There are now reports that some people achieve better control by using only a rapid-acting insulin before each meal, with Lantus at bed, as noted here:

A study reported in the May 2003 issue of Diabetes Care compared two regimens:

1. Humalog with meals and Lantus at bed;
2. Humalog combined with NPH before each meal, and NPH at bed.

The conclusions were that both regimens were effective and resulted in improved control, however the Lantus regimen had several advantages:

• The Lantus group had lower fasting, premeal, and postmeal blood glucose results compared with the NPH group.
• The Lantus group had a greater percentage of glucose values in the target range, primarily in the fasting state, before meals, and at night.
• The Lantus group had a greater reduction in A1C.
• The Lantus group had a lower frequency of hypoglycemia primarily at night.
• The Lantus group had less variability of blood glucose at night.
• The time of evening administration of Lantus (i.e. dinnertime versus bedtime) did not make a difference in terms of control. So whereas NPH should preferably be given at bedtime to reduce the frequency of nighttime hypoglycemia, Lantus can be injected either at dinnertime or bedtime without compromising control.

Important points about Lantus:

• Lantus is a prescription drug, and therefore first you need to discuss this insulin with your doctor, as well as to obtain dosage recommendations.
• It should not be diluted or mixed with any other insulin. You must use a separate syringe for injecting Lantus.
• Lantus is generally taken once daily, usually before bed. However, some people are able to take it once daily at dinnertime, in a separate syringe. In addition, some people take Lantus twice daily.
• Some people report a temporary pain at the injection site (2.7% Lantus versus 0.7% NPH). These reports have been mild, and there are no reports of anyone who discontinued use of this insulin due to pain.
• The manufacturer recommends that if changing from a twice-daily NPH or Ultralente schedule to once daily Lantus, to reduce the dose by 20%.
• No official recommendation was made regarding the Humalog.
• Reports from various endocrinologists and diabetes educators are that some people need more than a 20% reduction in the dose of Lantus, while others need less. The rapid-acting insulin dose generally stays the same initially, and is then adjusted by looking carefully at pre-meal and 2 hour post-meal glucose levels.

Lantus is another exciting tool to help you control your diabetes. As with any insulin recommendation, people are all different and individual needs may vary; anytime you change doses or insulin regimens, you should monitor your blood glucose frequently, keep a detailed record, and maintain contact with your physician.

¹ 2006 Update NOTE: Humulin® Lente and Ultralente insulins were both discontinued by Eli Lilly and Co. in 2005.

Related Questions

When to Take Lantus® (Glargine)
Q: "Is it better to take Lantus®, in the morning or in the evening?"

Insulin Cocktails
Q: "Would you explain the term "insulin cocktail" where regular and Humalog® are mixed to handle unusual BG patterns?"

DOC09412-Rev-A 01/07