March 22, 2007
Insulin Analogs
Question from India:
I am still bit unclear on the use of Lantus (insulin glargine). Since it does not work well following meals, can it be considered as lesser available insulin than other long acting at any instance? Its steady and peakless effect and lesser solubility after injection also indicates such lesser availability. As such, does one need more units of Lantus than any other long acting insulin? Does endogenous insulin in normal health have its “peak time effects after meal” somewhat like long acting insulins? Further, in view of its low pH=4, can’t it specifically damage tissues at injected sites more than other insulins?
Answer:
It works well as a basal insulin. It is not designed to work effectively as a bolus insulin. I think you have to keep in mind that insulin, as it is normally secreted, is secreted in different patterns; there is a basal level of insulin secretion over the night and between meals and there is a bolus insulin pattern surrounding meals. Lantus is very good as a basal insulin. When you use it as a single insulin, you are asking it to do too much if you want it to work as a basal insulin and a bolus insulin.
JTL
