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March 24, 2004

Insulin Analogs

Question from Windsor, Ontario, Canada:

I have heard that Lantus insulin has been approved for use in Canada. Could you confirm if this is in fact the case? On that same note, I wanted a summary of what the benefits of a regimen of Lantus and Humalog would hold over a regimen of Ultralente and Humalog. I realize that, in many cases, Lantus only requires one shot for a 24-hour period, however, I also understand that Lantus cannot be mixed in a single syringe with other insulins. If this is the case, it is unlikely that using Lantus as my basal insulin will reduce my number of daily injections. I am also curious as to whether this product will be available in insulin pen format.


I think that the best plan would be to check with the pharmacist from whom you normally get diabetes supplies as to whether Lantus is actually available in Ontario. Being approved does not always mean being available or available without restrictions and it is in any case a prescription item. My own information on Lantus Insulin is that it can be ordered in Canada; but has to be shipped from the U.S. at a significant increase in cost. The main advantages of Lantus are that it gives very even basal insulin coverage and significantly reduces nocturnal hypoglycemia. When used with lispro immediately after meals, in doses that are adjusted for carbohydrates consumed, and appetite, it is essentially equivalent to using a pump. Normally, this regimen requires at least four injections a day, but this can be reduced to three by giving NPH with the breakfast Lispro and omitting the lunch time injection. Lantus (glargine) is available in pen form in Europe; but again you should check with your supplier about availability in Canada.