Is Lantus effective?

[montel]

I am retired from the US Air Force and have been using insulin now for many years. I am currently using both Novolog and Lantus. However I have been thinking for a long time that the Lantus is not very effective. Recently I have taken up volunteer work at the same military hospital that I receive treatment for my diabetes. I help dispense the medications in the pharmacy. When I dispense Lantus, without mentioning any of my doubts, I ask the persons how they believe the medication is working for them. Everyone I've asked believes it is working well. You might ask why is it that I've not presented my concern with the doctor assigned to me. Because it only prompts more test and visits. My last A1c was 6.4, and my doctor is satisfied . I want to keep it that way. I've checked up on Lantus at Wikipedia. They say is assists in good control over a 24hour period with no peaks in the effect. I would think that if I were to stop injecting it, and only used the Novolog, those blood test readings would show increases. Maybe they do a little - it's hard to tell. So much depends upon what/when I eat, etc. I also use the Novolog on a sliding scale based upon blood readings . All of which tends to cloud what the Lantus maybe doing. I am wondering if anyone at this site has any information on Lantus that would relate to my situation.

 

[Heathenlass]

Hello Montel, and welcome
Lantus differs from Novolog, in that it is a "background" insulin. That is - it mimics the continuous slow release of insulin from the pancreas found in a non diabetic. In theory, your blood glucose levels would remain steady if you chose not to eat anything at all . Novolog mimics the release of insulin from the pancreas when a person eats. So the Lantus helps keep BGL level , literally in the background.

Should you not take Lantus (or any other background, slow release insulin) the Novolog or other "short acting " insulin would not be able to keep your levels steady, and you would need to inject much more , plus experience an erratic pattern in your BGL's.

Currently your A1c is good, and it sounds like you have good control overall. Stop the background insulin, and this would change

Signy

 

[noblehead]

I find lantus works well and I'm on one injection a day, some find it doesn't last the full 24 hours and have to split-dose. There's a new basal insulin called Trisiba that lasts up to 42 hours and is said to have a flatter profile than other background insulin's such as lantus, not sure if it's available in the USA yet but it came on the market in the UK back in 2013.

 

[Jaylee]

Hi Montel,

You must know that old saying "if it ain't broke, don't fix it."

I use Lantus for the Basal/background. I also use Novorapid in the same way you would use your novolog to bolus for meals..
I did an experiment on a day off a year ago to see how I could roll along on just the Novorapid & it was not the best day of my life...
Infact I was glad to shoot up on the Lantus when the evening came & have a normal following day...
The Lantus does it's job..!

 

[AlexMBrennan]

Yes, you are correct in that the action of lantus/levemir/NPH can be replicated with quick acting insulin - that's what insulin pumps are doing.

In your particular case, if you stopped taking Lantus you'd expect your morning fasting sugars to rise a lot as there wouldn't be much insulin active from the Novolog you injected for the previous dinner.
If you wanted to look at it that way, you could say that lantus is merely a more convenient way of delivering insulin (you don't have to wake up every hour during the night to inject a small amount of novolog)

 

[Jaylee]

Yes, you are correct in that the action of lantus/levemir/NPH can be replicated with quick acting insulin - that's what insulin pumps are doing.

In your particular case, if you stopped taking Lantus you'd expect your morning fasting sugars to rise a lot as there wouldn't be much insulin active from the Novolog you injected for the previous dinner.
If you wanted to look at it that way, you could say that lantus is merely a more convenient way of delivering insulin (you don't have to wake up every hour during the night to inject a small amount of novolog)

...Or keep banging it in during the day either. Other than mealtimes..

 

[montel]

Thanks for all the replies. Pretty much as I expected. Heathenlass, your comment "In theory, your blood glucose levels would remain steady if you chose not to eat anything at all." Is not what I believed would be happening. My thinking has been that Lantus would act as Novolog but at a very slow rate. In which case would seen to continue to lower glucose. On rare occasion, I have found my morning reading high when at night it was good. I know that getting too low during the night causes liver-release which can cause too-high in the morning. But long ago I had ruled out that Lantus was that cause.

Incidentally, this reminds me of an advertisement email I received just a few days ago. A "doctor" was pitching a complete cure for diabetes. In his video, he was saying that pharmaceutical businesses and other physicians are in the business of treating diabetes - not curing it. He explains his discovery that the cause of diabetes is the liver. He says that there must have been times that I have noticed good blood readings at night without further eating, followed by high morning readings - is proof that the liver is the cause of diabetes. He wants to sell his diet that shuts down the glucose-release by the liver and stop all diabetes. I switched him off! While I share his statements about treatment instead of cure, and the liver can cause high glucose readings, it all doesn't add up. I think in fact, the liver is a safety that would be too dangerous to disable.

 

[Jaylee]

Montel,

There apparently is I believe a very slow plateau & tail off with Lantus.. As oppoassed to the quicker acting insulins used for meal bolus..
The "remove the symptom, but not a cure" therory on pharmaceutical companies is widly shared.. I for one on a cynical day would tend to agree..

Regarding the emailed video with "doctor liver switch".. Lol. You would be right in assuming "snake oil"..!
Liver & kidneys work well together filtering toxins out the body.. Alcoholism over a prolonged period of time would probably do the same job with shutting down the liver!

 

[montel]

Montel,
.. Alcoholism over a prolonged period of time would probably do the same job with shutting down the liver!

lol.. that's a good one. It would be good if there were a way to police this bogus selling. Last month I received another one about the Blumburg generator - a so called Nazi Germany invention for creating electrical power. This procedure was to have been destroyed by bombing and lost until recently. Now it's possible to build the devise out of commonly found parts for about US100.00. It will not only completely power everything in your home, but also put energy back into power company line so that you will receive a cash credit from the company. There was a demonstration of the device working and creating power to light electric lamps. "See how well it works!"...... utter BS! What's worse, Newmax was hosting it! I fired off an email to Newmax explaining why it should be dropped. They never answered and I don't think my words did any good because the item remained up for nearly a week.

 

[Heathenlass]

Heathenlass, your comment "In theory, your blood glucose levels would remain steady if you chose not to eat anything at all." Is not what I believed would be happening. My thinking has been that Lantus would act as Novolog but at a very slow rate. In which case would seen to continue to lower glucose.

That's why I said "in theory" Supposedly, the long acting Lantus would do the job of supplying glucose to the body just to keep it trundling on. It's been said already that Lantus is supposed to last for 24 hours, usually with one injection a day, and with a flat ish profile with a very small peak.

In practise , we are all different, and it doesn't work that way for everyone. As @noblehead has rightly said, for some people it doesn't last 24 hours, so for those who inject in the morning, it can stop working some time in the early hours. leading to higher readings in the morning than was recorded at night. This can, allegedly, also happen with split does of lantus, with it not lasting twelve hours following the split dose in the evening. This can also be because of the "dawn phenomenen" as well as a bit of both. It sounds like your experience is not because of the Lantus, but could be an occasional DP

When Lantus works well, it seems to do the job very well, but for some people it just doesn't. I'm one of those who it doesn't work for and struggled for years with crashing night hypos as low as 1.2 mml/l on as little as a split dose of 6 units, with massive highs too. A series of fasting testing revealed that in me, Lantus had many peaks and troughs, so was useless as a basal insulin. It was some small comfort to see the expressions of the HCP's, when I had been complaining for years, and been told I was "just" a poorly controlled diabetic Since going back to the older Insulatard that I used before Lantus, my control has been SO much better

It's not the first time my insulin has been changed to a more "modern" version that for some reason they seem to want everyone on, to my detriment. I agree with @Jaylee 100%, "If it ain't broke, don't fix it "

Signy

 

[Nyxks]

No idea what type you are hun, but as you know were all different when it comes to how insulin works or doesn't work for us.

I'm T1 and find that for myself if I'm taking my lantus at night before going to bed that my humalog bolus of insulin with meals tends to be much lower during the day, yet forget or can't take my lantus before bed (because i couldn't afford to buy it) and the morning and rest of the day I'm going from hypo to hyper without much rhyme or reason to it (there is but its how it feels).

Lantus works for some people and stays in the system between 18 to 24 hours on average (can be shorter or longer depending on your body) which is why most people take it once a day, but it can be split into twice a day for those that find it doesn't give them the full coverage (have to work it out with your doc though as to whats right). Also some people don't understand that if you can double up on the lantus if you are taking it learner then the 24 hour period (as in you take it at 11pm each night yet one night you take it at 9pm because you need to get up early - its still in your system and adding your regular dosage to it can mean you might go lower then normal as a result, this can also happen if your body actually hakes it last longer then the 24 hours that it should - or this is how it was explained to me by my endro when we where trying to find the right amount for me).

 

[montel]

It sounds like your experience is not because of the Lantus, but could be an occasional DP
Since going back to the older Insulatard that I used before Lantus, my control has been SO much better

Signy

Your experience with Lantus is a little disappointing, but I understand.
I'm not very literate when it comes to medical terminology - not sure what DP means. While doing a little reading at this site, I also don't understand the glucose readings that look like A1c's. It obviously a different metering system. I'm using a meter supplied by my hospital called Accu-Chek and the acceptable reading range is 80 to 140 (for diabetics). The meter is provided so that its stored readings can be off-loaded during doctor visits for progress evaluation.
I was switched from NPH to Lantus over 10 years ago. Is that what you've gone back to? I don't believe NPH is any longer an option for me, at least at my pharmacy job I haven't come across any.

 

[Nyxks]

not sure what DP means. While doing a little reading at this site, I also don't understand the glucose readings that look like A1c's. It obviously a different metering system. I'm using a meter supplied by my hospital called Accu-Chek and the acceptable reading range is 80 to 140 (for diabetics). The meter is provided so that its stored readings can be off-loaded during doctor visits for progress evaluation..

Montel, in the US you use a different unit of measurement for your glucose then the rest of the world does (here in Canda we use the same as the UK) to convert to international units you need divide your number by 18 to get our mmol number.

Example …. 90 / 18 = 5

more info at … http://www.diabetes.co.uk/blood-sugar-converter.html

and in most cases DP means Dawn Phenomenon

if you are looking for a more american based diabetic forum try the Forums at the American Diabetes Association site at http://community.diabetes.org

 

[Heathenlass]

What Nyxks said


Signy

 

[Heathenlass]

Your experience with Lantus is a little disappointing, but I understand.
I'm not very literate when it comes to medical terminology - not sure what DP means. While doing a little reading at this site, I also don't understand the glucose readings that look like A1c's. It obviously a different metering system. I'm using a meter supplied by my hospital called Accu-Chek and the acceptable reading range is 80 to 140 (for diabetics). The meter is provided so that its stored readings can be off-loaded during doctor visits for progress evaluation.
I was switched from NPH to Lantus over 10 years ago. Is that what you've gone back to? I don't believe NPH is any longer an option for me, at least at my pharmacy job I haven't come across any.

Sorry, I forgot to answer your question
No, Insulatard isn't NPH, it's Human insulin that works in a similar way to Lantus, (as a background insulin). Humulin S is my bolus . It's been around since (I think!) the 1980's and actually works well for me.


Signy

 

[Nyxks]

I'm using a meter supplied by my hospital called Accu-Chek and the acceptable reading range is 80 to 140 (for diabetics). .

Diabetic Target numbers in general are…
before meal 4 - 7 mmol/L (72 - 126)
after meals 5 - 10 mmol/L (90 to 180)
but like a lot of diabetic care these numbers do change depending on what your surgery/endrocronolgist feels works best for you, and for many the closer to normal range you can be before and after meals the better, but its understood that for some that won't happen.

 

[AlexMBrennan]

He wants to sell his diet that shuts down the glucose-release by the liver and stop all diabetes. I switched him off! While I share his statements about treatment instead of cure, and the liver can cause high glucose readings, it all doesn't add up. I think in fact, the liver is a safety that would be too dangerous to disable.

That's essentially what Metformin does.

 

[Jaylee]

lol.. that's a good one. It would be good if there were a way to police this bogus selling. Last month I received another one about the Blumburg generator - a so called Nazi Germany invention for creating electrical power. This procedure was to have been destroyed by bombing and lost until recently. Now it's possible to build the devise out of commonly found parts for about US100.00. It will not only completely power everything in your home, but also put energy back into power company line so that you will receive a cash credit from the company. There was a demonstration of the device working and creating power to light electric lamps. "See how well it works!"...... utter BS! What's worse, Newmax was hosting it! I fired off an email to Newmax explaining why it should be dropped. They never answered and I don't think my words did any good because the item remained up for nearly a week.

Yep, I'm a member on a Jap import car forum & there are plenty of snake oil devices crop up on there..
One is a magnetised tube put inline with the fuel filter? It's meant to improve fuel performance by changing polarity or demagnetising the petrol passing through the line.. Lol
Another device is plugged into the lighter socket & meant to enhance fuel performance via the vehicles electronics.. But is actually just a crude box powered by the 12v system that flashes a few LEDs...lol

@Heathenlass I remember using Insulatard in the late 80's.. Are you saying that stuff is still in use...?

 

[Heathenlass]

Yup!
Brought back by demand !
With me, it has ONE peak, and that I can deal with .

Signy

 

[Jaylee]

Yup!
Brought back by demand !
With me, it has ONE peak, and that I can deal with .

Signy

Refresh my memory.. Did it peak or "plateau" mid morning? (Regarding a before bed dose.)