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August 3, 2005

Insulin Analogs

Question from Eureka, California, USA:

My five year old daughter was diagnosed with type 1 seven months ago. She uses seven units of Lantus and between two and five units of Humalog a day. In the last few months, her Lantus seems to lose effectiveness after 15 to 25 days. Her blood sugars will gradually increase to over 350 mg/dl [19.4 mmol/L]. I compensate with the Humalog, but when it wears off her blood sugars immediately increase. If I start a new vial of Lantus, her blood sugars return to a normal range. I store the opened vial of Lantus in a cabinet away from sunlight and there are no particles or cloudiness in the vial. Her endocrinologist called Sanofi Aventis and they said they have not heard of this problem. I was wondering if other patients have seen the same problems.

Answer:

There was a letter in Diabetes Care last year by Dr. Martin Grajower reporting that his patients had higher blood sugars the fourth week of using a Lantus bottle. I have not had this problem with my patients, but I encourage them to keep the bottle in the refrigerator and not store it at room temperature. I would suggest that you do this. if you feel a bottle is spoiled, I would start a new one and not continue covering with extra Humalog until the end of the month.

TGL
Additional comments from Jane Seley, diabetes nurse specialist:

Why don’t you switch to the Lantus pen? Each insulin cartridge holds 300 units instead of 1000 units so the insulin will be used up a lot sooner.

JS
Additional comments from Dr. David Schwartz:

This is not a problem that I have recognized, yet.

DS