Question from Germantown, Tennessee, USA:

I’m a 34 year old who has had type 1 diabetes for 22 years, and two months ago, I switched from twice-daily NPH/Regular insulin to an evening Lantus injection with Humalog boluses based on carbohydrate intake. Three times now I have forgotten to take my evening Lantus injection. I know I forgot it as soon as I wake up the next morning, but I can’t find any information on what to do next. I am the first patient my physician has switched to Lantus (at my request), but the Lantus prescribing information does not address this situation.

I have tried treating it two ways. I’ve skipped the missed dose and compensated with Humalog based on my blood sugar level at meals. I’ve also gone ahead and taken the injection (nine hours late) and made sure my blood sugar was somewhat elevated that night to cover the overlap in the injections.

Which do you feel is the better solution? What is the actual duration of Lantus? The literature says 24 hours, but the activity profile chart make it appear to last quite a bit longer than that (it’s still well elevated at 24 hours). If it’s effects are statistically significant out to 36-48 hours, I would think I should go ahead and take injections late? Does anyone know the true duration?