Back to Diabetes Basics Lantus (Insulin Glargine)

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Lantus Vial Lantus® (insulin glargine) is a very long acting insulin marketed by Aventis. Lantus is an insulin analog, meaning that its molecular structure has been changed slightly, and it is this change that gives it the long lasting effect. Other insulin analogs, such as Humalog, are engineered to provide a very rapid effect. Lantus is designed for once-a-day use and will provide a 24-hour basal dose of insulin. Lantus has been approved for use in children with diabetes as young as six.

Unlike other long acting insulins (NPH and UltraLente, for example), Lantus is clear. It's the first clear long-acting insulin; previous long acting insulins were "cloudy" (i.e., suspensions). (Levemir, another long acting insulin analog, is also clear.) With a very low pH of 4 (acidic), Lantus also differs from other insulins which are generally neutral (pH of 7). When Lantus is injected, the acidic solution is neutralized by the body, causing insulin glargine crystals to precipitate out. From those crystals, the insulin is slowly absorbed over 24 hours. Since Lantus lasts for 24 hours, it can be taken once a day.

Lantus, because it has essentially no peak, reduces the risk of nighttime hypoglycemia compared with NPH, according to a study published in Diabetes Care. Another study concluded that Lantus was a better basal insulin than NPH when used as part of a basal-bolus regimen for patients with Type 1 diabetes.

While Sanofi-Aventis says that Lantus should not be mixed with other insulins, two recent studies published indicate that mixing Lantus with a short-acting insulin analog and injecting immediately has no adverse effect on HbA1c. The two studies are:

However, in early 2010, a team from Yale found that mixing Humalog and Lantus "... markedly flattens the early pharmacodynamic peak of lispro and causes a shift to the right in the GIR curve changes that might lead to difficulties in controlling meal-related glucose excursions." See The early pharmacodynamic and pharmacokinetic effects of mixing lispro with glargine insulin: results of glucose clamp studies in youth with type 1 diabetes.

If you decide to mix Lantus, be sure to tell your diabetes team. Note that mixing is off-label use.

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