Overview
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:
- Mixing rapid-acting insulin analogues with insulin glargine in children with type 1 diabetes mellitus (J Pediatr. 2006 Apr;148(4):481-4.)
- Effects of Mixing Glargine and Short-Acting Insulin Analogs on Glucose Control (PDF)
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.
For More Information
- Polls about Lantus:
- Have you considered switching to Lantus (insulin glargine)? (Ocotber 2002)
- Have you considered switching to Lantus (insulin glargine)? (August 2001)
- What insulin regimen do you or your child use most often? (September 2006)
- Lantus Web Site
- Prescribing information from Aventis
- Lantus Fact Sheet
- Color slide showing Lantus activity level compared to NPH
- From Diabetelogia, the journal of the European Association for the Study of Diabetes: Lantus insulin: a possible link with cancer which requires further investigation. The science and a statement from Sanofi-Aventis are freely available at that link in PDF form. See also Sanofi-aventis stands behind the safety of Lantus® (PDF), Lantus®: message from Dr. Jean-Pierre Lehner, sanofi-aventis Chief Medical Officer (video and PDFs), European Medicines Agency update on safety of insulin glargine (PDF), European Public Assessment report on Lantus (PDF), Points to consider on the Non-clinical assessment of the carcinogenic potential of human insulin analogues (PDF) from 2001, Statement from the American Diabetes Association Related to Studies Published in 'Diabetelogia', Companies counter insulin safety concerns, and Early Communication About Safety of Lantus (insulin glargine) from the FDA.
- PubMed and other citations:
- Survey of glargine use in 115 pregnant women with Type 1 diabetes.
- Use of insulin glargine during pregnancy.
- Insulin glargine in the treatment of type 1 and type 2 diabetes.
- Insulin glargine improves glycemic control and health-related quality of life in type 1 diabetes
- Mixing rapid-acting insulin analogues with insulin glargine in children with type 1 diabetes mellitus
- Effects of Mixing Glargine and Short-Acting Insulin Analogs on Glucose Control (PDF)
- Twice-daily compared with once-daily insulin glargine in people with Type 1 diabetes using meal-time insulin aspart suggests that better results will be achieved by splitting the daily dose of Lantus
- Improved glycaemic control with insulin glargine plus insulin lispro: a multicentre, randomized, cross-over trial in people with Type 1 diabetes.
- Switch to multiple daily injections with insulin glargine and insulin lispro from continuous subcutaneous insulin infusion with insulin lispro: a randomized, open-label study using a continuous glucose monitoring system.
- Reduced hypoglycemic episodes and improved glycemic control in children with type 1 diabetes using insulin glargine and neutral protamine hagedorn insulin.
- Insulin glargine improves hemoglobin A1c in children and adolescents with poorly controlled type 1 diabetes.
- Insulin Glargine: An Updated Review of its Use in the Management of Diabetes Mellitus.
- Insulin glargine improves hemoglobin A1c in children and adolescents with poorly controlled type 1 diabetes.
- Insulin glargine: a systematic review of a long-acting insulin analogue.
- Randomized Cross-Over Trial of Insulin Glargine Plus Lispro or NPH Insulin Plus Regular Human Insulin in Adolescents With Type 1 Diabetes on Intensive Insulin Regimens
- Comparative trial between insulin glargine and NPH insulin in children and adolescents with type 1 diabetes mellitus
- A 16-week comparison of the novel insulin analog insulin glargine (HOE 901) and NPH human insulin used with insulin lispro in patients with type 1 diabetes
- Basal insulin glargine (HOE 901) versus NPH insulin in patients with type 1 diabetes on multiple daily insulin regimens
- Less nocturnal hypoglycemia and better post-dinner glucose control with bedtime insulin glargine compared with bedtime NPH insulin during insulin combination therapy in type 2 diabetes
- Pharmacokinetics of 125I-labeled insulin glargine (HOE 901) in healthy men: comparison with NPH insulin and the influence of different subcutaneous injection sites
- Time-action profile of the long-acting insulin analog insulin glargine (HOE901) in comparison with those of NPH insulin and placebo
- Less hypoglycemia with insulin glargine in intensive insulin therapy for type 1 diabetes. U.S. Study Group of Insulin Glargine in Type 1 Diabetes
- Long-acting insulin analogs
- No evidence for accumulation of insulin glargine (LANTUS(R)): a multiple injection study in patients with Type 1 diabetes.
- UK's National Institute for Clinical Excellence recommends that Lantus should be available as a treatment option for people with type 1 diabetes.
