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March 20, 2002

Insulin Analogs

Question from Point Pleasant, New Jersey, USA:

My 20 year old daughter, diagnosed with type 1 diabetes 11 years ago, has been on an insulin pump with Humalog for approximately four years but would like to try Lantus with Humalog boluses. She has not been using the pump to its full advantage and would like to take a break from wearing it. How are they calculating the Lantus dosage during transition? How long should pump delivery be halted before starting Lantus? What is the incidence of hypoglycemia with Lantus? She has history of nocturnal hypoglycemia with seizures prior to the insulin pump so we are concerned.


In my opinion, an insulin pump is a better way to deliver insulin than Lantus (insulin glargine), although Lantus can certainly be used as a basal insulin for many people with diabetes.

Your daughter should discuss this in some detail with her diabetes team so that they can give her some initial guesstimates of how to transition to the Lantus. It usually takes about a week or so to make the necessary adjustments, but all this is very individualized and based upon frequent blood glucose readings, carbohydrate counting, etc. They can then assess the risks of hypoglycemia based upon her current control and expected changes with the Lantus.

Not everyone using Lantus gets a full 24 hour coverage so that she may need Lantus in two doses instead of just at late night dose. We often use a small dose of NPH either at lunch or suppertime to catch the last few hours of the 24 hour cycle. Humalog would then be used as bolus doses whenever food is eaten for meals or snacks.


[Editor’s comment: Since Lantus takes a while to get started, don’t be surprised if your daughter’s diabetes team might advise starting Lantus before discontinuing the pump.