Should Lantus Be Given at Night?

As a rule, time of administering insulin medications is important, but not in the case of Lantus. This is a very slow-acting insulin, and time doesn’t matter as much. Still, it’s true that Lantus was initially recommended for nighttime use. Well, the thing is that all the pre-approval clinical trials of this insulin glargine were carried out using bedtime dosing. The FDA approved it that way just for this reason. In fact, Lantus can be administered subcutaneously in the morning, around bedtime or any other time that’s convenient for patients with diabetes provided it’s the same hour every day.

How does it work?

Just like most diabetes medications, Lantus acts differently depending on the patient. Even though this insulin is supposed to provide a full 24 hours coverage to its users, Lantus usually doesn’t last as expected. Sometimes it wears off towards the end of 22 hours or even less. In such cases, it might make more sense to administer this insulin medication in the morning to make sure that when it finally wears off, it’s nighttime. Many patients, who found that Lantus wasn’t working for them the way it was supposed to work, switched to morning insulin injections and reported beneficial drug results. 

How to discover the time that works for you

Lantus is usually the most effective 5 hours after you inject it, fading gradually over the next 17-19 hours. Many patients notice that it doesn’t really work for the first 3 hours and the last 3 hours. However, these numbers are averages that might vary from person to person. Check yourself how Lantus works for you using your glucometer. To make sure you get reliable results:

  •  don’t eat carbohydrates for the day as they bring about blood sugar peaks
  • check your blood sugar every two hours
  • plot the results on the graph
  • discuss the “curve” you get with your doctor

If you do it right, you will be able to come up with the optimal time to administer Lantus according to your own situation.

For some patients with diabetes it might be more logical to administer Lantus in the morning simply because they are prone to forget using medications when they get too sleepy. Forgetting to administer Lantus can hardly be a good idea because of the danger of developing diabetic ketoacidosis. This is especially true if your blood sugar levels aren’t well controlled. 

Splitting the dose: does it make sense?

To average things out, many patients split their Lantus doses, administering them twice a day, 12 hours apart. Those who need more than 50 units daily might also find that splitting the dose is better for them. 

Some doctors agree that it might be beneficial, while others disapprove of this practice because there is a lack of clinical studies on splitting the dosage of insulin glargine.

Still, a number of reports have demonstrated that changing to a twice-daily regimen of insulin medication like Lantus might be more effective for certain patient groups. For example, one report described a patient suffering from type 1 diabetes whose nighttime glucose values saw a sharp increase when insulin glargine was used once a day before bedtime. Switching to morning use didn’t change anything. As soon as the patient started splitting the dose and administer it twice a day, the situation was significantly improved. 

Moreover, Albright and colleagues discovered that splitting the dose of glargine insulin was needed when patients with type 1 diabetes started to have symptoms of afternoon hyperglycemia and morning hypoglycemia. Such patients can expect a considerable improvement of their glucose values simply by administering insulin glargine every 12 hours instead of every 24 hours. Further studies are needed to help define other patient groups whose condition might be improved if they switch from once daily administration of insulin glargine to split dosing.

What is Lantus?

Lantus is a synthetic form of insulin that is used to help patients with type 1& type 2 diabetes control their blood glucose levels. A product of Sanofi, it contains insulin glargine, a long-acting type of insulin, and can be used even by children aged 6 years and over. This drug is designed for subcutaneous injections and comes in the form of a solution or as a prefilled SoloStar pen that contains 3ml of drug with 100 units per ml.

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