Why does Lantus peak and dip?
| Author: Judy Kohn, RN, BSN, CDE |
| Last Updated: Friday, April 11, 2008 |
Q: “I have been a Type I diabetic for 43 years. I have been taking Lantus® at bedtime and Humalog® before meals. Lantus is not supposed to peak but I find it does 8 to 12 hours after I take it. I cannot always catch my hypoglycemic episodes as I lost that ability a few years ago. I also find that approximately 18 to 20 hours after my Lantus shot, before dinner, my blood sugar starts creeping up. I don't always eat 3 times a day, usually eating at 11a.m. and 6p.m. Why does my Lantus peak and dip and do I need to start mixing regular insulin and Humalog with my 11a.m. meal? Even if I don't eat anything but a 6p.m. meal, why would the Lantus not keep my glucose level more even during the day?”
A: You are describing a situation that is actually more common than you might think. Some people have found that Lantus does seem to have a bit of a peak and/or that it does not last the full 24 hours. Considering the length of time you have had diabetes, you can understand that your pancreas does not produce any insulin on its own (in contrast to a newly diagnosed person with type 1 who might still have a little bit of residual beta cell function).
Please remember as you read this answer that I can only explain how the different insulins work, and that you will need to discuss these various options with your healthcare team to see what is best for you.
The role of background (also called basal) insulin:
First, here is just a little review of what your basal insulin (the Lantus) is supposed to do.
- 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). It regulates the liver from releasing too much glucose between meals. In the person without diabetes, when there is enough glucose in the blood, insulin tells the liver to shut down its production of glucose. I like to say that the role of your basal insulin is to “keep a lid on the liver” and only let a little glucose out at a time.
How Lantus works:
Please be sure to read the related questions listed at the end of this answer for more details about Lantus.
- Lantus is long-acting insulin, from Sanofi Aventis and was designed as a once-a-day insulin to deliver smooth, "peakless" 24-hour basal coverage.
- It is described as being a clear insulin that absorbs very slowly into the system, lasting approximately 24 hours, and has little variability and no peak.
- However, as you will read in the related questions, each person with diabetes is an individual, and individual responses vary. Some people do find that it seems to have a peak, and also in some situations, this insulin does not last the full 24 hours.
Options to consider:
- 1st-- Talk to your diabetes team: Again remember that these are just things to consider, and all these options should be discussed and explored with your diabetes team.
- Consider two shots/day of Lantus: It is possible that you may do better splitting the dose of Lantus into two shots—one in the morning, and the other one either at dinner or at bedtime. This might solve the problem you have of your Lantus “running out” around 18-20 hours. Naturally you would still require the Humalog with each meal.
- Consider an insulin pump: Another way to get a steady supply of basal insulin is by using an insulin pump, as this is the optimal way for you to customize your basal needs—especially if you like to skip meals. There is more information about insulin pumps in the related questions below.
- Insulin cocktails may not work: Mixing Humalog and regular has been referred to as an “insulin cocktail” which you can read more about at the end of this answer. However, that concept is not as popular now that Lantus is available, plus there would be concern that if you went too long between meals, you may experience hypoglycemia due to the prolonged effect of regular insulin compared to Humalog.
- Consider your hypoglycemia unawareness: Please read the details about hypoglycemia unawareness below, to be sure you are doing everything you can to manage this condition. You may also want to consider a continuous glucose monitoring system to provide you with more frequent glucose results as well as alarms to alert you when your glucose is dropping.
Conclusion:
What you are experiencing is understandable, and there are various ways to resolve your situation. There is no one right way, and you should consider the pros and cons of each option. Then hopefully you and your diabetes team decide will be able to determine what the best solution is for you.
Related Questions
Using Lantus® (Glargine)
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®?"
Q: When to Take Lantus® (Glargine)
"Is it better to take Lantus®, in the morning or in the
evening?"
Q: Short-Acting Insulin vs. Rapid-Acting Insulin
“I was taking regular insulin before each meal and NPH at bed. My doctor
recently switched my NPH to Lantus®, and kept the regular insulin the same. I
met someone in a diabetes class who is on a similar routine but uses Humalog®
instead of the regular insulin before each meal, and her doctor said the
Humalog is better. What’s the difference between regular insulin and
Humalog?"
Q: Insulin Cocktails
"Would you explain the term "insulin cocktail" where regular and
Humalog® are mixed to handle unusual BG patterns?"
Q: Hypoglycemia Unawareness
"I never feel myself going low until I'm there so I need to remember to
take a snack before I exercise. Why don't I get a warning? I used to but don't
anymore and I'm insulin resistant too."
Related Links
Lantus
http://www.lantus.com/default.aspxg
www.continuousmonitor.com
www.continuousmonitor.com
Important Notice: The responses provided by the team of Diabetes Educators are based on their personal experiences and expertise as practicing diabetes healthcare professionals, and are not to be considered diabetes management advice from Abbott Laboratories. Remember that information provided by the team of Diabetes Educators is for general background purposes and is not intended as a substitute for medical diagnosis or treatment by a trained professional. You should always consult your physician about any healthcare questions you may have, especially before trying a new medication, diet, fitness program, or approach to healthcare issues.
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