August 20, 2001
Insulin Analogs, Insulin Pumps
Question from Bethel, Maine, USA:
I am starting insulin pump and have been using Lantus. What is your suggestion for stopping the Lantus prior to starting the actual insulin pump therapy?
Congratulations on being very concerned about getting the correct amount of insulin and not running into any problems. The package insert for Lantus (insulin glargine) says its duration is about 24 hours, but I ‘m not sure whether or not there might be some left over until the next Since I would err on the side of too little insulin and be sure the last injection of Lantus is about 30 hours from when you will actually start on the pump.
Usually, insulin pump initiation includes some time of general instructions, so it may be an hour or two into your scheduled pump start appointment before you actually start pumping. So, if you are scheduled for a pump start appointment at 3:00 pm on Friday, I would plan you would not be getting any pump-generated insulin in you until at least 4:00 pm, meaning your last injection of Lantus would be on Wednesday night. Of course, you would cover your meals and blood glucoses with Humalog as you usually do, but you may need more since there is no Lantus on board.
Having said all of this, you really need to contact your diabetes team for specifics regarding insulin dosages and timing.
Additional comments from Dr. Tessa Lebinger:
I have not switched anyone using Lantus to the pump, but I have switched people using Ultralente twice daily to the pump. I usually lower the Ultralente slowly over several days and start the basal level slowly and gradually increase. I usually estimate about 0.1 units/hour Humalog basal delivery for every 2 units of Ultralente I discontinue (1unit twice a day). I also like doing it this way as the patients have some injected insulin still in their body for several days to protect them against sudden onset of ketoacidosis if they make a mistake or have problems during the first few days of pump therapy.
Discuss this with your physician!
Additional comments from Dr. Jim Lane:
Another way to approach the problem would be to convert to NPH for a week before placing on the pump.