Confusing posts about Lantus

[hodgsonsurvivor]

I've read many threads here about dosing, injections, insulins, etc. One thing that bothers me is the confusing information I get about Lantus. In several threads, I've read about splitting the doses and taking it several times throughout the day. How does this help? :confused: Lantus has no peak and lasts 24 hours. Why on earth would I want to split my 42u up into 2 separate injections? Also, everyone is different, so 42u may be alot for one person and not nearly enough for another, whereas it may be the perfect dose for me. I understand that there are guidelines, but that does not make the cut. Our care is not cookie-cutter and cannot be applied to the next person.

This is an excerpt from the Lantus website:

LANTUS® is the only 24-hour insulin approved exclusively for use once a day. LANTUS® is injected just once a day, at the same time each day.

Once-daily 24-hour LANTUS® is released at a relatively constant rate with no pronounced peak for 24 hours, so you don’t have to balance a peak by eating or snacking at a specific time.

[andypoo]

It is very confusing,and hard to explain why Lantus works the way it does,all I know is Im taking Lantus twice a day,in the morning and at bedrime. I also take novolog(rapid acting) as needed (on a sliding scale) I am rather insulin resistant and this has been recommended to me and it is working. I have had the big "D" for 40 years,so I have tried many different forms of insulin. It is through trial and error and trial and success when you're a diabetic. Whatever works for one doesn't work for another,you are right about that. If what you are taking works for you ,you can't ask for more than that.

[fgummett]

Of course you are right: there is no one-size-fits-all, cookie cutter solution for D :)

Some general comments:

I have heard of an up to 40% variability in absorption of injected (exogenous) insulin from one day to the next... in some people I understand that this effect can be minimised by breaking one large injection into several smaller at different sites.

As posted by BlueSky on another thread - http://www.diabetesforums.com/forum/type-1-diabetes/33959-serious-am-problems.html - there is chart showing the various curves associated with different insulins. Although Lantus tends to be flatter than most others, it does still have a curve and again this can vary person to person, day to day. Multiple doses through the day can again (in some people) minimise the effect of the curve - perhaps by providing some element of overlap. It can also provide greater flexibility; as suggested, to use different insulins at different times.

As for the amount required; to my thinking that comes down to factors such as body-size/weight, amount of carbs [and protein] eaten each day, level of physical and mental activity, degree of insulin resistance/sensitivity. As a gross generalisation I would expect a typical thin Type 1 to be using less insulin than a Type 2 like me... carrying over 100lbs extra and with considerable IR. :(

[xMenace]

It is a confusing thing. I'll try to answer it as un-jaded as I can; though I know I'll fail.

How do they know it lasts exactly 24 hours? As you say, everyone is different. Many find it does not last a full 24. They end up going high the last few hours. For them, splitting into two doses ensures a 24 hour coverage.

Some people do not get full coverage because of poor absorption. Maybe it's their fat, maybe it's scar tissue, or maybe they just forgot to shoot up that day. Two doses is a bit aof protection against these things.

Once-daily 24-hour LANTUS® is released at a relatively constant rate with no pronounced peak for 24 hours, so you don’t have to balance a peak by eating or snacking at a specific time. ... BUT, answer this: are everyone's needs peakless? Consider the Dawn Phenomenon (DP), the afternoon dip, the midnight dip, or the evening rise. These events experienced by at least many, if not most, demand specific treatment. A 24 hour peakless one is not sufficient nor appropriate coverage.

Besides that, Lantus isn't bad ;)

[fgummett]

... BUT, answer this: are everyone's needs peakless? Consider the Dawn Phenomenon (DP), the afternoon dip, the midnight dip, or the evening rise. These events experienced by at least many, if not most, demand specific treatment. A 24 hour peakless one is not sufficient nor appropriate coverage.pssst... wanna buy an insulin pump that allows multiple basal rates throughout the day, tailored to an individual's specific basal needs, and supporting a temporary override of that rate for exercise etc... ;)

[Real4]

confused: Lantus has no peak and lasts 24 hours.

This is an excerpt from the Lantus website:

LANTUS® is the only 24-hour insulin approved exclusively for use once a day. LANTUS® is injected just once a day, at the same time each day.

Once-daily 24-hour LANTUS® is released at a relatively constant rate with no pronounced peak for 24 hours, so you don’t have to balance a peak by eating or snacking at a specific time.

Read the website again, carefully, like you're reading an agreement from your wife's divorce attorney. Pay attention to the words "relatively" and "pronounced".

Lantus can be used as once a day, but most people get far better results by injecting twice a day. That smooths out the small peaks in its activity.

If you would look carefully at the graph of its activity that they publish, you'd see that the Lantus activity does not stop at exactly 24 hours - the graph stops.

[hodgsonsurvivor]

BUT, answer this: are everyone's needs peakless?

I can't begin to say what anyone's needs are, not even my own. I'm using Lantus now and adjusting my life for better control. If my targets aren't reached, then I'm sure my doctor will suggest I try something different (whether it's a complete medication switch or just an adjustment to how I take my current meds, or something else entirely...I don't know.). I haven't studied any of these terms and acronyms that I've seen around because I've never heard of them and don't know where to start to find out what these things mean. I just learned the term "bolus" last week! My whole life (diabetic life that is) I've referred to my insulin shots as "taking my insulin", "injections", "shots", or just plain "shooting up" lol. There was another term I had to look up at the same time, but I can't remember what it was now. I'm just trying to get to a point where I have some semblance of control (which is going much better now :D ) So, unfortunately, I can't consider dawn phenomenas, or anything else, in terms of what I need for insulin peaks. I like the idea that my insulin won't force me to eat when I'm not hungry, as suggested by the lack of a peak. I use Novolog to cover my food and to correct highs, which I think is a massive improvement from when I was using 70/30 and R! LOL

[fgummett]

I like the idea that my insulin won't force me to eat when I'm not hungry, as suggested by the lack of a peak. I use Novolog to cover my food and to correct highs, which I think is a massive improvement from when I was using 70/30 and R! LOLYou are doing just great and heading in the right direction (a pump is next... maybe ;) )... Knowledge is power, so please keep asking questions. I'm a firm believer that the only person who really understand my D is ME... it has been several years since my health care team had any say as to how much insulin I should use each day :)

[Lizzie G]

Hey Kristina

Havent read the whole post BUT...agree lantus is peakless, but bottom line, Im not!!! between 4 and 10 am i need approximately 4 times as much basal as between 4 and 7 pm, and then various other less extreme variations during the day; leave that up to lantus and it doesnt take great care of me. to me makes little difference whether i split or not but take a supplementary overnight insulin; not perfect, but way way better! PM me if you want more info or chat

Liz x

[jenb]

I use Levemir, not Lantus, but it too is marketed as having no peak. I guess it doesn't, but it does have markedly different duration of action depending on the size of one's dose.

I originally began with 2 shots at 12 hour intervals. For months I had relative highs about 8 or 9 hours after my basal injections and was totally frustrated! On careful study of the prescribing information I found that NovoNordisk's test data indicates that at small doses (.2u per kg of body weight) the duration of action is 8 to 16 hours, not the 20 to 24 most people think it has. Since I was taking less than their smallest study dose, I decided to split it into three injections at 8 hour intervals. Voila! More stable, lower BG and lower insulin (both basal and bolus) doses.

What a fun project...my life as a lab rat continues.

[TenderVittleS]

I take Lantus before bedtime. I tried splitting my dose once and it was a disaster. Sometimes trying to keep your BS perfect is not worth it.

[fgummett]

I take Lantus before bedtime. I tried splitting my dose once and it was a disaster. Sometimes trying to keep your BS perfect is not worth it.Can you please elaborate..?

[Subby]

I've read many threads here about dosing, injections, insulins, etc. One thing that bothers me is the confusing information I get about Lantus. In several threads, I've read about splitting the doses and taking it several times throughout the day. How does this help? :confused: Lantus has no peak and lasts 24 hours. Why on earth would I want to split my 42u up into 2 separate injections? Also, everyone is different, so 42u may be alot for one person and not nearly enough for another, whereas it may be the perfect dose for me. I understand that there are guidelines, but that does not make the cut. Our care is not cookie-cutter and cannot be applied to the next person.


It can be confuing. Let's break it down again.

Here are some things people find as they use Lantus in the "Real world". Like so many things in life and especially pharmacuticals, real world experience vs the "official line" (as you quoted) can vary wildly.

The practical action of Lantus can change from person to person. For some people it lasts only 16 hours. For others more than 24.

The best method of delivery can vary from person to person. Some find that once a day is fine. Others find that twice a day is better, usually because they are the people it doesn't last the whole 24 hours for. There is no mandatory need to try 2 times a day. It's all completely up to the diabetic to research and discuss this stuff and make their own decisions. Usually that is driven by the situation and need, for example finding that they lose basal coverage toward the end of the 24 hour period and wish to try a technique that may work better for them.

The dosage will most certainly be different from person to person. The majority of discussions here are sensible and will only suggest "relative" changes to dosages, such as "a bit up" or "a lot less". Any specific dosage suggestions are of course not useful or wise comments, but happily these so called recommendations are either few and far between, or quickly corrected by the vast majority here who know better.

It's strictly a case by case basis. For many the "default" usage of Lantus may well suit just fine. Suggestions or discussions held at the here are strictly at the will of the diabetic. If they wish to strictly follow directions by their doctor or the Lantus website, what is stopping them? No one forces anyone's arm here, in fact "talk to your doctor" or "what does your doctor say?" are very common statements in most threads. No one is suggesting it is "cool" to fiddle with your Lantus. It's just people trying to solve real issues with their insulin therapy.

So, I'm trying to work out why you are bothered. Is it that there is variation in the experience of people using Lantus, and a variety of techniques that may be tried to get around the issues? Or in a similar vein, are you just bothered at the range of information and discussion here, and do you suspect that people are over complicating things or making things hard for themselves, or trying to dictate to others?

Or, are you bothered that the official line suggests it should be uniform and simple, and yet from reading around here people don't have that simple experience?

So, when you complain of a "cookie cutter" mentality, are you talking about the "official guidelines" or the comments and suggestions around this place?

Sorry if I am being thick. But I honestly can't tell quite which you mean. Hoping to understand better. :)

[sweetlife]

Yes Lantus acts differently on each person.If someone plans for spiltting dose then,
How much one should take at bedtime?40-50-60%
and remaining after 12 hrs?
In my daughter's case she finds high BS before dinner so can I try giving her Lantus in morning rather than at bedtime?Just for a test to test 1 shot regime?

[Subby]

Hi sweetlife, usually people split straight down the middle 50 50 when they go split dose. This makes sense if consistency of basal effect is the intended result. I wouldn't worry about changing that ratio unless you see a good reason that suggests it, down the track.

So, lets say if she was taking 20 units at night, she would go to 10u at night and 10u 12 hours later in the morning.

Certainly you also could try just moving the one shot to the morning as well, to see if that fits her needs better.

These things are pretty much trial and error. Neither option should be dangerous in any way but as always, take extra tests and monitor things more closely when changing anything about an insulin regimen. You might like to discuss these changes with her doctor if you have any doubts or are not confident with what you are doing.

[sweetlife]

Hi Subby
I belong to a family where majority members are doctors so a plus point BUT inspite of that some things only come by own trials this is fact,my daughter's issue is like that.
I was told that one MUST take Lantus at bedtime but now from tomorrow I am thinking to give her Lantus in the morning at 10 a.m.,will post results for sure in next 3-4 days.

[Subby]

Well sweetlife, it might be worth mentioning that my own (quite conservative) endocrinologist suggested changing from night to morning, and split dosaging, to me, herself. I've heard of quite a few endos suggest these techniques. This in itself doesn't prove much, except it's worth saying just to indicate that these are not necessarily highly radical ideas that no doctor would touch, for example.

Good luck, I hope you find improvement one way or another.

[fgummett]

Good luck sweetlife - you clearly have the motivation to succeed for your Daughter's sake :)

As for a family of Doctors and the trial and error approach... well, I'll simply remind everyone that it is called "Medical Practice" ;)

[hodgsonsurvivor]

Hi Subby
I belong to a family where majority members are doctors so a plus point BUT inspite of that some things only come by own trials this is fact,my daughter's issue is like that.
I was told that one MUST take Lantus at bedtime but now from tomorrow I am thinking to give her Lantus in the morning at 10 a.m.,will post results for sure in next 3-4 days.

Hi, Sweetlife,

I think my doctor told me to take mine in the mornings(not really sure who suggested it now). Not sure why...maybe because I had trouble remembering to take it in the evenings. Like I said before, what thought I knew about Lantus meant it wouldn't really matter when you took it. :)

Someone else asked what bothered me...nothing that was said by anyone in particular or the info gathered on Lantus bothered me. In hopes of explaining myself, what I meant was that as I read the varying uses of Lantus in threads, it conflicted with what my doctors have said and my personal studies of the medicine and while I'm considering what others are doing (who are using the same meds I am) for my own care, I was confused and frustrated by my lack of understanding. So I decided to ask. My next post is going to be to ask for an explanation of all the acronyms and words that I don't recognize! :D

[Subby]

Someone else asked what bothered me...nothing that was said by anyone in particular or the info gathered on Lantus bothered me. In hopes of explaining myself, what I meant was that as I read the varying uses of Lantus in threads, it conflicted with what my doctors have said and my personal studies of the medicine and while I'm considering what others are doing (who are using the same meds I am) for my own care, I was confused and frustrated by my lack of understanding. So I decided to ask. My next post is going to be to ask for an explanation of all the acronyms and words that I don't recognize! :D

Thanks for the clarification, it's appreciated :) Many of us have similar frustrations in trying to reconcile information from different sources. It becomes very knotty when we want to trust our doctor to know all the right knowledge and make all the right decisions. There are great doctors out there, but they are just human too and sometimes won't know everything. There are also some not so great doctors as well. A sign of a good doctor is some open mindedness - after all, they need to be constantly learning about insulin therapy, to stay good endos!

For example if you said to your doctor "I've been talking to some long-term diabetics on the internet and it seems if they are truthful, that some of them don't get a full 24 hours out of Lantus, what do you think/can you look into this?" it would be hoped the doctor would investigate this or seriously consider the issues. If they disparage either the idea straight out or discourage your own personal efforts to be involved with your disease, you know you may be in the wrong hands. (Because as you are probably learning, knowledge is power in solving BG puzzles, and you probably need to be involved to a certain degree to get anywhere).

The key I think is to understand there are variations between people for most things and it seems somehow especially the case for all things involving insulin and blood glucose. If anyone, including a doctor, insists that any insulin works exactly the same in all diabetics they are either delusional or lazy (just don't want to face up to different cases). In the case of the notes from the Lantus website, well it's widely accepted that drug companies make generalised claims that are "best case scenarios" and will not apply to everyone.

As for trying to consolidate all the info about Lantus say on these forums, I suggest don't worry about that, just seek out answers to your particular problems if and when they arise.

[sweetlife]

Eureka!
Her predinner was 229(which is still high but will slowly try to find a solution with the help of our dear members to bring it down),a huge drop from her normal readings which vary between 300-350!I was out of station when she called me and gave this news,came back home with full music on in car...!Such news can change our approach to life,long live all members of this marvellous forum,be blessed.
Good luck, I hope you find improvement one way or another.

[BlueSky]

The Lantus publicity maintains that it is peakless and lasts 24 hours. Here is the graph they display all over the place.

http://dailymed.nlm.nih.gov/dailymed/image.cfm?id=3283&name=lantus%2Dimage02%2Ejpg&CFID=1166434&CFTOKEN=ae6313e1951a8be3-A79C920D-BC8D-F864-BC855F7687CFDC25&jsessionid=ca30f2a0406e741ac6d6

The Lantus action looks nice and flat (the solid line). And it magically stops in mid air at 24 hours :confused: . But I suspect this is just marketing hype. It certainly doesn't fit with my experience at all, and I know I am not the only one.

Here is the action profile of Lantus that was found by independent researchers (Glargine, whic is the bottom line).

http://i288.photobucket.com/albums/ll181/stratplan/basalinsulincomparison.jpg

At 24 hours, the level of action is less than half of the peak action at 11 hours. So which one do we believe? There is a big difference between the Aventis publicised flat action and the peaky action in the bottom graph. The independent research is certainy more credible as there is no vested interest. And I am inclined to believe what fits best with my experience. This is why I like the bottom graph. Lantus is a superior long-acting insulin, but the claims made by Aventis are overstated.

[Subby]

What is more, I found that Lantus would "bunch up" in my system when inactive (such as sleeping, watching TV), and then rush in at twice the strength when active (such as exercise, working). Much more so than a basal regimen on the pump, which suggests the issue was connected to the particulars of the insulin, rather than just the quirks of my body. Further complication and removal from this concept of a close-to-perfectly-flat releasing insulin.

Still, it was indeed a big step up in the action of previous long acting (NPH), for me.

[sweetlife]

Today her predinner BS was

114!

[nopump4me]

Watch out for Lantus!! It is said that it can cause depression. It did for me and I'm glad I'm off of it. Just letting you know. You can believe it or not believe it. Some people thinks it's bull but I experienced it. I'm fine now far as depression after using the pump with Novolog.

[hodgsonsurvivor]

Thanks...fortunately, I haven't experienced any ill effects from Lantus use. No depression, no bunching, no decrease in effectiveness after 12 hours, nothing.

[xMenace]

Thanks...fortunately, I haven't experienced any ill effects from Lantus use. No depression, no bunching, no decrease in effectiveness after 12 hours, nothing.

There's no one all inclusive treatment regimen -- YMMV.

It does work well for many if not most who use it. I can't deny that. For people with such effects, Levemir is an effective substitute.

For those who cannot manage their sugars well with either L, alternatives do exist. Even the harder-for-most-to-manage NPH and mixes can work for some.

[Cloudedbrains]

Lantus is supposedly a 24hr profile insulin BUT for some people it just doesnt last 24hrs and then a twice daily regime is recommended

Different peoples bodies will process drugs at different rates

So for some people twice daily is an option

Lantus wouldnt even last 8 to 10hrs for me, it was useless
But I tend to process any slow releasing drugs far too fast (including many drugs I am on for other conditions - blood tests proven this) but even 2x daily lantus did nothing for me but Levemir does but *Humulin-I* was my best long acting insulin but I just couldnt cope with the sheer size od injections I needed with it but it did work

[slgraham]

Hi there, I think that all insulin affects people a bit differently... the key is finding out how it affects you (and can work for you)! For me, Lantus does have a small peak at 2-4 hours after injection. At first I was taking it before bedtime and was waking up super low... so we switched to the morning injections. It took a fair bit of tweaking to get it right (I also reduced my short-acting at breakfast) but it was worth it and has worked well since then :)

[DanG]

For me, Lantus does have a small peak at 2-4 hours after injection. At first I was taking it before bedtime and was waking up super low... so we switched to the morning injections. It took a fair bit of tweaking to get it right (I also reduced my short-acting at breakfast) but it was worth it and has worked well since then :)

I have had the same experience.
I think universally prescribing lantus at bedtime is a wrong prescription. Lantus in the morning is soooo much better for me - thanks for saying the same is true for you. How many of us do lantus in the morning? I too find a peak about 2-4 hours after breakfast - yum - a little sugar in my coffee. not... "no sugar tonight in my coffee, no sugar tonight in my tea, la dada da dada dada, la dada da deedee" who was that, anyway? guess who?

[owlyn]

Lantus is supposedly a 24hr profile insulin BUT for some people it just doesnt last 24hrs and then a twice daily regime is recommended

Different peoples bodies will process drugs at different rates

So for some people twice daily is an option

Lantus wouldnt even last 8 to 10hrs for me, it was useless
But I tend to process any slow releasing drugs far too fast (including many drugs I am on for other conditions - blood tests proven this) but even 2x daily lantus did nothing for me but Levemir does but *Humulin-I* was my best long acting insulin but I just couldnt cope with the sheer size od injections I needed with it but it did work

After experimentation and advice here, I found that 24 U in the morning, and 8u at bedtime works perfectly for me. My fasting BGs have been great- finally. Looking forward to my next A1C.

[Cloudedbrains]

I am glad you are getting somewhere Owlyn :)