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Question:

From Kent, Connecticut, USA:

I'm a 15 year old male who has had type 1 diabetes for about six months, and I'm now debating whether or not to switch to Lantus insulin. I know that this means more shots, but I have a lighter schedule. I would like to hear an opinion on the subject and some pros and cons I would get from switching.

Answer:

Hopefully this answer complements information you have received from asking your diabetes team:

Lantus (insulin glargine) is a synthetic derivative of regular insulin that has been designed to be long-lasting and "peak-less" meaning that it avoids times of higher levels in the bloodstream thereby trying to diminish episodes of unexpected hypoglycemia. In people who do not have diabetes, insulin is always around, but at low, relatively consistent basal levels (with some fluctuation with activities/exercise), but the levels increase after food intake. So, while Lantus provides a basal insulin, additional short-acting insulin (Novolog, Humalog, or Regular) would need to be taken based on meals and carbohydrate counting. This is nearly the same principle as insulin pump therapy, with a constant infusion of short-acting insulin, plus additional doses with meals.

Main advantages and Disadvantages

  1. Meal flexibility:
    • Advantage: Eat meals and snacks when you want rather than to a more fixed schedule. If you don't eat breakfast until late on a Saturday when you sleep in, the Lantus covers your "basal" insulin requirements. If you eat a late brunch, you take your short-acting insulin then.
    • Disadvantage: You must take a bolus of insulin with each meal and snack, every time you eat, based on your physician's recommendations. So you will need to take insulin at school, for example. That is why such a regimen is often called Multiple Daily Injections (MDI).
  2. More variety of foods:
    • Advantage: This is not a blanket "get-out-of-jail-free card" to allow you to eat anything and everything, but does allow more flexibility in types of meals.
    • Disadvantage: You still must take extra insulin when you bolus.
  3. Cost:
    • Advantage: The cost is the bottle of insulin, rather than the approximate $5000 for an insulin pump.
  4. More frequent testing:
    • I don't see this as an advantage or disadvantage as folks with diabetes need to test, but, in order to best estimate your short-acting insulin requirements, many diabetes teams recommend that glucose levels be checked before and about two hours after a meal.
  5. Carb Counting:
    • This also is not an advantage or disadvantage, but you need to be good at it for MDI or insulin pump therapy to work best. It is important for overall diabetes management almost regardless of your medical management, but it takes on more importance with MDI and pump treatment.
  6. Mixing:
    • Disadvantage: You cannot mix Lantus with any other insulin in the same syringe. Lantus is a stand alone shot, usually given at bedtime. So your bolus shots of short-acting insulin must be given separately. (I usually prescribe insulin pens.) Lantus does not yet come in a pen-delivered device [in the USA].
  7. Stinging:
    • Disadvantage: First few injections of Lantus often sting.
  8. Long-term studies:
    • Disadvantage: We don't have decades worth of experience to know any possible long-term problems. This is a new product. Sure it has been tested in animals and humans around the world, but we don't have the experience of time yet. It is FDA approved however. (Of course we don't have an abundance of data with insulin pumps and the newer short-acting insulins too. But some type of insulin pump therapy has been around since around 70s.

DS

DTQ-20011212175942
Original posting 16 Dec 2001
Posted to Insulin Analogs

  
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Last Updated: Tuesday April 06, 2010 15:09:30
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