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April 28, 2003

Insulin Analogs

Question from :

When used in clinical trials and subsequently marketed, Lantus (insulin glargine) was given at night, perhaps to try to best provide a "continuous" basal dose of insulin during sleep. However, some individuals seem to be "fast metabolizers" of Lantus and also require a smaller dose during the day. It probably is not critical, but from my perspective, if given during the day,and the dose does not last the expected near-24 hour duration, then in the early morning hours, when glucoses tend to rise due to the dawn phenomenon, there will not be insulin to suppress a fasting high glucose. So it is okay in the morning, but it is not the preference of many.

Answer:

When used in clinical trials and subsequently marketed, Lantus (insulin glargine) was given at night, perhaps to try to best provide a “continuous” basal dose of insulin during sleep. However, some individuals seem to be “fast metabolizers” of Lantus and also require a smaller dose during the day. It probably is not critical, but from my perspective, if given during the day,and the dose does not last the expected near-24 hour duration, then in the early morning hours, when glucoses tend to rise due to the dawn phenomenon, there will not be insulin to suppress a fasting high glucose. So it is okay in the morning, but it is not the preference of many.

DS

[Editor’s comment: Lantus was approved in Europe for any-time-of-day administration in late 2002: “The EC granted that a flexible, any time of day administration of Lantus be added to the prescribing information. The long lasting basal insulin should be administered once daily at any time but at the same time each day” (Aventis press release, December 12, 2002).

WWQ]