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June 23, 2003

Daily Care

Question from :

Brazil: My 24 year old brother, who has type 1 diabetes, is quite obsessed about having his glucose levels lower rather than slightly higher which results in hypoglycemia during sleep. Should he switch to Lantus is order to avoid these ups and downs? What is the tail effect of Regular insulin? Could this be related to my brother's hypoglycemic events?

Answer:

Hypoglycemia during sleep is not desirable. I believe it is a clinical priority to prevent these episodes at the time of day people are most vulnerable. However, I do not think that the only answer is to switch to Lantus.

First of all, it needs to be determined when he is having the lows and work backwards. Is he low before he goes to bed? Is he taking his NPH insulin at bedtime or at supper — Bedtime is safer because the insulin peaks before arising in the morning.

It is not enough to want the sugars low. You have to do the detective work to avoid hypoglycemia. Of course, Lantus is a perfectly fine insulin. However, change for change sake is not always the best policy.

As far as the tail effect of Regular insulin, this is a very important issue and could impact your brother. For instance, Regular insulin can last for up to eight hours. If taken at supper, this can extend into the early morning hours. This is a disadvantage when you are trying to avoid hypoglycemia. There are rapid-acting insulin analogs (Humalog or NovoLog) that can replace Regular insulin. These analogs can be given immediately before meals and last only four hours. These agents have been associated with fewer low sugar problems in the early morning hours in clinical trials.

JTL