CureNow: BTS: Lantus

Free Web Hosting Provider - Web Hosting - E-commerce - High Speed Internet - Free Web Page

Glargine, commonly called Lantus, is the newest and the longest acting insulin on the market. Produced by Aventis, it is absorbed and then released into the body over a 24-hour period, allowing diabetics to avoid those pesky peaks that cause hypoglycemia and dangerous valleys leading to hyperglycemia. It provides basal insulin coverage to keep the blood sugars steady throughout the day, leaving insulin injections of lispro (humolog, aspar, or novolog) for the meals.

Lantus is for the young and the old, the Type 1 diabetic and the Type 2 diabetic.

"I think that candidates for [Lantus] are people who are having difficulty controlling their blood glucose levels adequately on more traditional approaches," said Dr. James R. Hansen, M.D., a pediatric endocrinologist at Emmanuel Children's Hospital in Portland, Ore. Peaks and valleys associate with NPH, Lente, and UltraLente can be difficult to predict, as the peaks vary according to exercise, the time the shot is given and various other reasons. With Lantus, there are no peaks or valleys, thus a smooth release of insulin throughout the day.

Since the amount of insulin released in the body does not dramatically change from hour to hour, unlike NPH and other long-term insulins, patients using Lantus are able to vary their eating patterns to fit their schedule. They only need to give their injection of lispro when they eat.

"The best part of Lantus is the ability to eat when and what my schedule allows, instead of when and what my schedule demands," said Jonathan Pace, a Type 1 diabetic of 23 years who has been using Lantus for eight months.

"Enjoy its flat line and not being quite so dependent on exact eating schedule," recommends, Linda Kelly, a Type 2 diabetic for four years and a Lantus user for over a year.

Many doctors find the great improvements in blood sugar to be a motivating factor for people to switch to Lantus.

Mary Throntviet, mother of Teale, 10, a Type 1 diabetic for four years, had her daughter start Lantus because of a recommendation by her doctor.

"Her [doctor] asked her to consider Lantus for more stable blood sugars," Mary said. It turned out to be the right decision. Teale started in December 2001, and according to Mary, "I like the independence that Teale feels, [and] now I really don't worry and her life is more flexible!"

What They Think
"Everyone I've spoken with
about their children going on
Lantus have had rave reviews. "
- Mary Throntveit

The word basal might sound familiar if you have read or heard about the insulin pump. The pump is a small device hooked intravenously into the body that constantly delivers insulin throughout the day. Pumpers "bolus" for their meals, a series of button pushes that delivers the amount of insulin calculated for the amount of carbohydrates eaten. [for more information on the pump, see October 2001 "To Pump or Not To Pump"]

For some people, Lantus is a better alternative to the pump. Lantus is cost effective, doesn't require a box to be attached twenty-four hours a day and there is less of a chance for there to be malfunctions.

"In certain people, they aren't quite ready to make the commitment necessary to use an insulin pump," Dr. Hansen said. "[But] there are some people who think 'gee, I'm not really ready for a pump, but I would like to have more control in my life and more flexibility.'"

Lantus allows for the same kind of flexibility seen in the pump, but without some of the troubles seen in the pump.

But Lantus also has its problems. Just like any other diabetes treatment, Lantus users can find faults with the insulin. The most common cause of problems is forgetting to take the insulin daily. If a diabetic forgets to take their shot before bedtime or in the morning, they will notice a dramatic rise in blood sugars since there is no insulin in the body. "The worst part of using Lantus is having to cope when forgetting to take it," Pace noted.

What They Think
"Once a day, [it] seemed
to smooth out highs and lows."
- Keith Sides

A common problem is having the insulin run out prematurely, especially in children. "Children typically absorb certain types of insulin faster than adults do," Dr. Hansen explained, "And as a result there are probably some kids with whom it's running out before 24 hours has elapsed."

Another possible problem is fluctuating blood sugars. Unlike the pump, there is no way to increase the amount of insulin being given during a certain time of day, such as the hormonal "dawn phenomenon".

"My insulin need turned out to not be constant, and Lantus would lower by blood glucose level excessively overnight," Pace said.

The research has been read, the pros and cons have been weighed and your doctor supports your decision to switch to Lantus. Now what?

"It wasn't hard to switch to Lantus, but was a lot of work," Pace noticed. The harder part was the simultaneous switch to Humalog and carbohydrate counting."

What They Think
"Once you adjust the dosing
correctly, life is infinitely easier."
- Jonathan Pace

The first thing your endocrinologist will do is determine how much Lantus you will need to cover the day. This is determined using the amount of NPH or other long-acting insulin. Ratios for mealtimes will then be determined by calculating how much insulin is be given for the amount of carbohydrates eaten.

" We [the doctors at Emmanuel Children's Hospital] figure out a starting dose, which is about 50 to 75 percent of the total daily insulin that has been taken," Dr. Hansen said. "As far as the meals go, we look at how much Humolog or Novolog is being injected at breakfast and dinner, how many carbohydrates are being consumed, [and then] we estimated what the ratio is of insulin to carbohydrates."

It isn't all hard work for nothing, though. After a couple of weeks, most diabetics settle into their new routine and the new and improved blood sugars start appearing.

"It has been an extremely easy transition," Throntveit said, "And [it] has proven to be the right choice."