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November 11, 2003

Insulin Analogs

Question from Billings, Montana, USA:

In your experience, would there be a benefit to giving Lantus in the morning, rather than bedtime if a six year old with type 1 diabetes is having low early morning blood sugars? If so how would the change be made so there is not an abrupt switch?

Answer:

In general, any significant insulin adjustment (starting a new insulin, changing the time of dosing such as you describe) should be made with the input of your child’s diabetes healthcare team and endocrinologist. Please talk with them.

Generally, I think making a change in Lantus dosing from bedtime to morning time is as easy as an abrupt switch, recognizing that, depending on when the last Lantus dose was given, you may have a day of relatively higher or lower readings.

While Lantus is now approved for use in the morning, I am not sold on that — especially for young children who may be “fast metabolizers” of Lantus. A morning dose may not last the full 24 hours, potentially leaving you some hours in the middle of the night when there is not enough insulin on board. I prefer Lantus at bedtime, most of the time.

DS