Lantus: spotted a trend.

[Jaylee]

Hi,

As the title suggests. Lol I have noticed this for a very long time regardless of insulin sensitivity/activity levels in hot weather. I'm talking about almost a year..? I have checked & changed the delivery system. (Click star pen.) the insulin is always stored cool in the fridge. Even the currently used cartrige in the pen...
I take 20 units of Lantus at bed time. Around 23.00 though I can be up till 3am.
How can I explain this.? Basically my fasting basal BS levels are on an even keel.. But when I get to the point I have used half the cartridge, these background levels rise.. Then I find I am heavily relying on correcting using my bolus. (novorapid) to keep the levels stable.
When I start a new cartridge all is good again! Shame to waste half the amount in the cartriges...

Any similar experience or ideas from my brethren...? Even if you're on a different basal..

 

[ewelina]

Hi,

As the title suggests. Lol I have noticed this for a very long time regardless of insulin sensitivity/activity levels in hot weather. I'm talking about almost a year..? I have checked & changed the delivery system. (Click star pen.) the insulin is always stored cool in the fridge. Even the currently used cartrige in the pen...
I take 20 units of Lantus at bed time. Around 23.00 though I can be up till 3am.
How can I explain this.? Basically my fasting basal BS levels are on an even keel.. But when I get to the point I have used half the cartridge, these background levels rise.. Then I find I am heavily relying on correcting using my bolus. (novorapid) to keep the levels stable.
When I start a new cartridge all is good again! Shame to waste half the amount in the cartriges...

Any similar experience or ideas from my brethren...? Even if you're on a different basal..

Hmmm interesting. I used to take Lantus and didn't like it. maybe it was a reason

 

[ewelina]

Where do you keep the pen you use? Still in the fridge?
At some point I realised that I was leaving my insulin pens next to my laptop. They were getting quite warm from the heat coming from it. I think Lantus is quite sensitive to temperature changes

 

[Jaylee]

Hi @ewelina

All my insulin including the contents of Lantus pen used are kept consistently cool..

Fair comment on heat exchange though. I will admit to the novopen being at an "ambient temp" more often than not due to the nature of my life style.. Though I find novorapid a little more robust..

 

[Daibell]

Hi. I use Levemir and have never had problems with aging of cartridges. Have you tested your fridge temp? It needs to be below 8 deg C. I always store my Basal pen at ambient which in our house is fairly cool. Your units do appear to be slightly on the high side? Do you have any excess weight that can sometimes cause insulin needs to fluctuate?

 

[noblehead]

Hi @Jaylee

Can I ask, do you take the lantus pen out of the fridge and leave it to reach room temperature before injecting? I'm just thinking if you do the warming/cooling process may be having an effect on the insulin.

Try keeping the pen in a Frio Wallet instead and see if this makes any difference.

 

[ewelina]

Hi @Jaylee
Can I ask, do you take the lantus pen out of the fridge and leave it to reach room temperature before injecting? I'm just thinking if you do the warming/cooling process may be having an effect on the insulin.

Try keeping the pen in a Frio Wallet instead and see if this makes any difference.

Do you need to keep lantus cooled? I always kept the one I was using out of the fridge

 

[noblehead]

Do you need to keep lantus cooled? I always kept the one I was using out of the fridge

No it can be kept at room temperature for up to 4 weeks after removal from the fridge, just the same as other insulins.

 

[Jaylee]

Hi. I use Levemir and have never had problems with aging of cartridges. Have you tested your fridge temp? It needs to be below 8 deg C. I always store my Basal pen at ambient which in our house is fairly cool. Your units do appear to be slightly on the high side? Do you have any excess weight that can sometimes cause insulin needs to fluctuate?

The fridge temp has been checked.. I have a couple on teprature meters I use regarding auto engine coolant hose & block checks. One is the lazer type. (Lol I feel like I'm back on my car forum.) I've never had any "excess weight" without sounding like a "trumpet blower". By sheer luck, I have maintained the same weight since I was 18. Not so much as a middle Aged beer gut now. I'm an old school 1970s D & don't practice the non D diet & bolus for it method airring towards the LC.. I'm basically a short 47 year old male with a 30" waistline in reasonable perpotion to my frame.

I can mark a spot half way down the Lantus cartridge currently used & when the pen mechanism plunger/ram positions in that spot. Guarantee my fasting level will rise by about 4mmol the following days... Until I change the cartrige. The the patern starts again.

I apreciate your reply Diabell. I fancy I may need to research the profiles on other basals & armed with the graphs & information set up a review at the clinic & push for a change..

 

[Jaylee]

Hi @Jaylee

Can I ask, do you take the lantus pen out of the fridge and leave it to reach room temperature before injecting? I'm just thinking if you do the warming/cooling process may be having an effect on the insulin.

Try keeping the pen in a Frio Wallet instead and see if this makes any difference.

Lol I've been "manning up" & taking the "sting" straight from the fridge consistently for a number of months.. Same trend though.... I have seriously tried working this out on my own before posting my query...

 

[noblehead]

Lol I've been "manning up" & taking the "sting" straight from the fridge consistently for a number of months.. Same trend though.... I have seriously tried working this out on my own before posting my query...

It does sting when cold, your a brave man

I'm not sure of the answer then, do you get the same results when you keep the pen out of the fridge.

 

[Jaylee]

It does sting when cold, your a brave man

I'm not sure of the answer then, do you get the same results when you keep the pen out of the fridge.

That is what's so frustrating I noticed the trend with the basal pen more out of the fridge than not months ago..? Then actioned more diligence on the temp.. Including making sure the pen was giving the right dose. Then changing the pen. You name it?!

 

[RuthW]

Oh yeah. This is not wrong. I spotted this too, and when I googled it there was a report that the last 25% of the cartridge is less effective than the beginning of it. I didn't want to chuck out a quarter of every cartridge so I used to increase my daily dose towards the end of the cartridge and that did work. I also at that time had a friend who was a midwife working with pregnant diabetics and I told her about it. She looked dubious, then came back the next week and told me I was right. So, yes, you're right too.

Here's a link to the paper:

http://care.diabetesjournals.org/content/26/9/2665.full

And the manufacturers are full of it. I keep a thermometer in my fridge. It's always at the right temperature and I would take my pen out, do the shot and then put it back.

 

[donnellysdogs]

I used to be guaranteec to have my worst hypo every July /August... Guaranteed. Every year. Not needing help, but almost lost my driving licence one year..and this date has stuck in my brain. Guaranteed I could place hypos every year around that date.
Last year after being so aware of the summer months I managed without any hypos...just through heightened diligence to be honest

 

[zjed]

Thanks @Jaylee I've never noticed this but I will keep an eye on it. I'm half way through my current cartridge now, always left at room temp.

 

[Jaylee]

Oh yeah. This is not wrong. I spotted this too, and when I googled it there was a report that the last 25% of the cartridge is less effective than the beginning of it. I didn't want to chuck out a quarter of every cartridge so I used to increase my daily dose towards the end of the cartridge and that did work. I also at that time had a friend who was a midwife working with pregnant diabetics and I told her about it. She looked dubious, then came back the next week and told me I was right. So, yes, you're right too.

Here's a link to the paper:

http://care.diabetesjournals.org/content/26/9/2665.full

And the manufacturers are full of it. I keep a thermometer in my fridge. It's always at the right temperature and I would take my pen out, do the shot and then put it back.

Many thanks for this link Ruth. So I'm not going crackers...?! Lol. OK. Just to reiterate after noticing this trend for a couple of months tracking it down to the Lantus. I always keep what's in my basal pen cool.... (Though, this trend has been going on a lot longer & thanks to an app I use to log stuff for the past year or so has made it more apparent.)
One other thing I haven't thought about? Till just now.. (Due to my lifestyle.) I always replace the needle in readiness for my bedtime basal...
I'm wondering if the constant needle set up in the capped pen stored cold, could be a factor regarding the Lantus degradation I am experienceing over the course of vial use...?

 

[noblehead]

@Jaylee, see if you can change basal insulins, push your HCP's to prescribe Tresiba which seems to have a steady flat profile.

 

[Jaylee]

@Jaylee, see if you can change basal insulins, push your HCP's to prescribe Tresiba which seems to have a steady flat profile.

Hi,

Yep, looked the profile on Tresiba. Looking good for my lifestyle. Which in my case is a one off bedtime hit. (As opposed to a "split".) though I have to admit Lantus when it works, works well for me!
I'll look into my needle therory. (Constant vial membrane piercing causing air to degrade.) & if the show is the same.? Get my case together for a trial of Tresiba.. Yes I believe the cost of Tresiba is a little pricier? But weigh that against ditching half a vial's worth of Lantus for the sake of reasonable managment.... Even if stored to the manufacturers spec.... & of course long term prevention of complication onset..... I have been lucky so far... I don't wish to upset the apple cart.

 

[HaroldC]

I found that Lantus gradually stopped lasting it's advertised 24 hours over the years I used it. In the end I took it twice daily and tried 3x for a week or two. (Didn't work). I asked if I could go back onto Ultratard but got "disgusted looks" from my consultant. In the end the pump was the best fix.

 

[donnellysdogs]

Please note that Degludec, Tresiba in many CCG's is a double red medication.
It has to be requested on an individual basis by a consultant for the CCG to consider approval.