December 9, 2003
Insulin, Insulin Analogs
Question from London, United Kingdom:
I am on Insulatard [NPH] and Actrapid [Regular] and have recently asked to be put on Lantus. I have now obtained the Lantus, and I am waiting to see my diabetes nurse about starting it. She is keen that I stay on Actrapid to cover the bolus, rather switch to a shorter lasting insulin. Given that Actrapid lasts 4-5 hours, do you think Humalog would be more appropriate?
I have recently had a couple of episodes of hypoglycemia unawareness and. although I test a lot, I don’t want to disrupt my working life too much whilst I change over. I don’t have 100% faith in my consultant’s opinion, as previously they put me on Humalog and Insulatard which led to rising sugars after a couple of hours after injecting Humalog as it didn’t last long enough. I requested to revert to Actrapid which did the trick, so I’d like to go to this with advice from here.
Answer:
The use of Lantus requires a short acting insulin to cover the meal time bolus. Either the use of NovoLog or Humalog would be appropriate but Actrapid, which in the US is regular could be acceptable. Remember that regular or Actrapid is of longer onset and duration and therefore could lead to higher glucoses immediately post prandially and lower 3-5 hours later. There have been reports that Humalog is shorter in duration than NovoLog, so you might want to check the use of NovoLog, if Humalog did not suit you. I would not just use Lantus by itself.
ABS
