June 27, 2001
Question from Altona, New York, USA:
I would like to switch my son to Lantus (insulin glargine) because I think it would improve our afternoon snack/blood sugar issues, but I am concerned that the trade off might be out of range pre-breakfast blood sugars. It is unclear to me how this insulin, which essentially has no peak in activity, will be effective in controlling the rise in blood sugar that naturally occurs in most individuals in the early morning hours. Don’t you foresee higher waking blood sugar values as a down side to this insulin?
I believe that your concern that Lantus (insulin glargine) will lead to “out of range” pre-breakfast blood sugars is unfounded. There have been several studies that have shown that glargine significantly reduces nocturnal hypoglycemia which is one cause for raised before breakfast blood sugars. This insulin does have the disadvantage though that it has to be given as a separate injection; but in other respects it is comparable to, but rather less flexible than, the basal rate in an insulin pump. A regimen that depends on glargine plus adjustable Humalog or Novolog coverage of the glucose rise after each meal is increasingly an approach to intensive insulin therapy.