Question from Dexter, Michigan, USA:

I have noticed several e-mail questions related to severe lows after taking a shot of Lantus at night. This has happened to me twice. Each time I was six hours past my last Humalog shot at dinner and my blood sugar was in the 220 mg/dl [12.2 mmol/L] range. Within one hour, my blood sugar dropped to 36 mg/dl [2.0 mmol/L] the first time; 29 mg/dl [1.6 mmol/L] the second time. Normally, I have no problems with Lantus. I usually take about 14 units. None of my doctors/health care team had heard of this problem. I contacted Aventis twice. The second time I spoke with a pharmacist who gave me a possible explanation. Because the insulin is in a suspension which allows it to be released over 24 hours, it is important that the site not be exposed to extreme heat, such as heating pads, long hot showers or baths. It is also important that one does not rub or massage the site. Both of these actions might possibly result in the Lantus being released erratically, theoretically resulting in extreme lows. I reviewed my shot technique with a nurse and am careful about the heat and massage. I’ve had diabetes 35 years without complications, but these extreme lows created a lot of fear and uncertainty at the time. Have you any other explanations?