Why is lantus given at night

His starting dose of Lantus would be about one-third of 34 units, which is about 11 units of Lantus. The drug is given as an injection just under your skin a subcutaneous injection. You can inject Lantus in the skin of your upper arms, belly at least 2 inches away from your belly button , or thighs. The usual starting dose of Lantus for people with type 2 diabetes is 0.

The usual starting dose of Lantus for children with type 1 diabetes is calculated in the same way as for adults. The dosage of Lantus for these children is about one-third of their total daily insulin dose. It ranges from 0. For example, a lb child weighs about 27 kg. If her doctor prescribes 0. If you miss a dose, take it as soon as you remember. This could increase your risk for serious side effects, such as hypoglycemia low blood sugar levels. You might. Lantus is typically used for long-term treatment of diabetes.

Lantus can interact with several other medications. It can also interact with certain supplements as well as certain foods. Different interactions can cause different effects.

For instance, some interactions can interfere with how well a drug works. Other interactions can increase side effects or make them more severe. Below are lists of medications that can interact with Lantus. Before taking Lantus, talk with your doctor and pharmacist. Tell them about all prescription, over-the-counter, and other drugs you take. Also tell them about any vitamins, herbs, and supplements you use.

Sharing this information can help you avoid potential interactions. If you have questions about drug interactions that may affect you, ask your doctor or pharmacist. Taking Lantus with other diabetes medications can increase your risk for hypoglycemia low blood sugar level. If you take Lantus with other diabetes drugs, your doctor may need to adjust your dosage of one or all of them to reduce your risk for low blood sugar.

They may also want you to monitor your blood sugar levels more often. Examples of other diabetes medications that can increase your risk for low blood sugar if taken with Lantus include:. Taking Lantus with thiazolidinediones can cause heart failure , or worsen heart failure if you already have it.

If you take a thiazolidinedione, be sure to discuss it with your doctor before you start treatment with Lantus. If you take one of these drugs with Lantus, your doctor will likely monitor you for signs of heart failure. Taking Lantus with certain blood pressure medications can increase your risk for hypoglycemia low blood sugar level. If you take Lantus with one of these drugs, your doctor may need to adjust the dosage of either Lantus or the blood pressure medication. Examples of blood pressure medications that can increase your risk for low blood sugar if taken with Lantus include:.

Taking Lantus with other types of blood pressure medications can hide the symptoms of low blood sugar when they occur. This can put you at risk for severe hypoglycemia very low blood sugar level with little warning.

If you take Lantus with any of these drugs, your doctor may want you to check your blood sugar levels more often. Taking Lantus with certain antipsychotics can decrease how well Lantus works.

This can lead to high blood sugar levels and an increased risk of complications from diabetes. They may also recommend that you check your blood sugar levels more often. Taking Lantus with corticosteroids can decrease how well Lantus works.

This could increase your blood sugar levels, leading to a higher risk of serious complications, such as heart disease. They will also advise you to check your blood sugar levels more often. However, drinking too much alcohol while taking Lantus can increase your risk for hypoglycemia low blood sugar levels.

This is because both alcohol and Lantus can lower blood sugar levels on their own. Lantus is classified as a long-acting insulin. It lowers blood sugar levels in people with type 1 or type 2 diabetes. Lantus is made to work like natural insulin in your body. Insulin is a hormone that does the following:.

So you take medication, such as Lantus, to replace the insulin. Your pancreas may also stop making insulin, which would need to be replaced with medication. Lantus starts lowering blood sugar levels within a few hours. Long-acting insulins take longer than short-acting insulins to start working. But they last longer in your body. After you inject Lantus, the drug forms clusters beneath your skin. As these clusters break down, insulin is slowly released into your bloodstream throughout the hour period.

The solution in the vial is injected using a syringe and needle. Your doctor will discuss whether the vial or SoloStar pen is right for you. Whether you use a syringe or the Solostar pen, never reuse a needle or share a needle with another person. This helps prevent the spread of germs. Below is information on how to use the vial and syringe, and SoloStar pen. Lantus is given as an injection just under your skin a subcutaneous injection , once a day.

When you first get your Lantus prescription, your healthcare provider will explain how to inject the medication yourself. You can take Lantus at any time, but it should be at the same time each day. Ask your doctor what time is best for you. Many people take their Lantus dose at bedtime.

However, according to the American Diabetes Association , insulin therapy such as Lantus is the first-choice option for diabetes treatment during pregnancy. Insulin therapy is also recommended for women who developed diabetes while pregnant called gestational diabetes. If you need treatment to help control your blood sugar levels during pregnancy, talk with your doctor. This can help keep your blood sugar levels in a safe range for you and your baby.

However, you may need a different dose of Lantus for a time after you give birth. This is due to changes in your body and changes in your sleep and mealtime schedules. You may need a rapid-acting insulin , short-acting insulin, or intermediate-acting insulin to fine-tune your blood sugar level control.

Many people who use a long-acting insulin such as Lantus will also need rapid-acting or short-acting insulin to control blood sugar levels after meals.

This could change how well the insulins work. If you have any questions about when or how to take each type of insulin, talk with your doctor or pharmacist. In clinical studies , blood sugar levels were reduced to a similar degree whether people took Lantus in the morning or evening. Your doctor will monitor how your blood sugar levels change throughout the day. It can. Hypoglycemia low blood sugar levels is one of the most common side effects of insulin products, including Lantus. Also, making any changes to your insulin treatment plan could increase your risk for both hypoglycemia and hyperglycemia high blood sugar levels.

Severe hypoglycemia very low blood sugar level can be life-threatening if not treated right away. Talk with your doctor or pharmacist about creating a plan to prevent and manage low blood sugar levels. DKA is a serious complication of diabetes. It occurs when your blood sugar levels are very high but your insulin levels are low.

Instead, your body starts breaking down fat into ketones a certain type of protein for energy. High levels of ketones make your blood more acidic, which can harm many organs in your body.

DKA treatment takes place in a hospital setting. Treatment involves using insulin to bring sugar into your cells. Faster-acting insulins such as insulin aspart Fiasp, Novolog , insulin glulisine Apidra , or insulin lispro Admelog, Humalog are typically used as part of DKA treatment.

Before taking Lantus, talk with your doctor about your health history. Lantus may not be right for you if you have certain medical conditions.

These include:. When you get Lantus from the pharmacy, the pharmacist will add an expiration date to the label on the bottle. This date is typically one year from the date they dispensed the medication. The expiration date helps guarantee the effectiveness of the medication during this time. If you have unused medication that has gone past the expiration date, talk to your pharmacist about whether you might still be able to use it.

How long a medication remains good can depend on many factors, including how and where you store the medication. You should store unopened Lantus vials in your refrigerator until the expiration date listed on the package. Once you open a Lantus vial, you can store it at room temperature or in the refrigerator for 28 days.

You can store unopened Lantus SoloStar pens in the refrigerator until the expiration date listed on the package. You can also store them for 28 days at room temperature. You should store unopened Lantus SoloStar pens in the refrigerator until the expiration date listed on the package.

You should never freeze Lantus vials and SoloStar pens. Also, keep them out of direct heat and light. Put it in a hard container, such as a sharps disposal container. You can get an FDA-approved sharps container at your pharmacy, through medical supply companies, or online.

Examples of containers that you can use include metal coffee cans and used laundry detergent bottles. Put a label on the container to warn people that there are needles inside. Be sure to keep a lid on the container at all times and store it away from children and pets. This helps prevent others, including children and pets, from taking the drug by accident. It also helps keep the drug from harming the environment.

The FDA website provides several useful tips on medication disposal. Therefore, bedtime injections of insulin glargine and NPH insulin were compared overnight and in the morning. On separate days at bedtime h , patients received a sc injection of insulin glargine, NPH insulin, or saline in a randomized, double-blind fashion.

Results: Similar doses of both insulins had different metabolic profiles. By contrast, in the morning, insulin glargine was more effective, increasing Rd by 5. Clinical trials have repeatedly demonstrated that type 2 diabetes T2DM patients treated with insulin glargine show significant improvements in glycemic control, which are at least equivalent 1 — 8 or superior 9 , 10 to improvements associated with neutral protamine Hagedorn NPH insulin. Furthermore, most studies have shown that patients treated with glargine are at a lower risk for hypoglycemia, and in particular, nocturnal hypoglycemia 1 — 4 , 6 , 7 , 9 , 10 , compared with NPH insulin-treated patients.

Such differences may be related to the absorption and dispersion profile of the two insulins. Insulin action defined as the maximum glucose infusion rate GIR max was reached about 4 h later with glargine compared with NPH insulin in healthy subjects 11 , In patients with type 1 diabetes T1DM , there was also a trend for a later maximum effect, but with large variations 13 , In T2DM, the physiological effects of sc administered long-acting insulin is subject to greater variability owing to insulin resistance and poor absorption Studies indicate that insulin glargine has a flatter postinjection profile compared with intermediate or NPH insulin, however, data are inconclusive owing to the lack of placebo groups controlling for variability 16 , If given at bedtime, the peak insulin activity would be reached at approximately h with NPH insulin, resulting in a high risk of nocturnal hypoglycemia.

Therefore, it is important to determine whether there are differences between insulin glargine and NPH insulin overnight after bedtime administration. The majority of studies have indirectly examined the effect of insulin on glucose disappearance, characterized by changes in glucose infusion rates GIRs to maintain blood glucose BG concentration at physiological concentrations 11 — However, these studies tend to overlook changes in the rate of glucose appearance Ra , disappearance Rd , and endogenous glucose production EGP , which is normally suppressed by insulin, but enhanced in the fasting state.

Two reports in healthy male subjects have directly addressed the impact of insulin glargine on EGP and glucose balance 18 , These two studies showed that iv insulin glargine and regular human insulin have equipotent effects on glucose balance and suppressing EGP.

They conclude that the specific effects of insulin glargine on glucose turnover are completely dependent on its absorption kinetics. Therefore, it remains to be investigated whether or not EGP changes at all after a single sc injection of insulin glargine. With any insulin therapy, a clinically important issue is the prevention of hypoglycemia during the night. However, there are no studies available on the overnight action profile of NPH insulin or insulin glargine.

Therefore, the aim of this study was to investigate the nocturnal metabolic effects in terms of glucose turnover after the administration of glargine or NPH insulin in patients with T2DM. This was a randomized, placebo-controlled, double-blind, three-way cross-over study to investigate the metabolic effects of glargine compared with NPH insulin in patients with T2DM.

The Ethics Committee of the University Hospital at Giessen approved the protocol, and the study was conducted according to the Declaration of Helsinki and the principles of Good Clinical Practice.

All patients provided written informed consent before study entry. Exclusion criteria included smoking, concomitant illnesses, taking concomitant medication other than that for treatment of diabetes, or hypersensitivity to any of the study medications or excipients. At the first visit, patients were screened for eligibility, and baseline characteristics were recorded. Informed consent was obtained. Nurses or physicians provided assistance to the patients to help them optimize their glycemic control.

In four patients the dosage of OADs or insulin was changed. For visits 3—5, euglycemic-hyperinsulinemic clamps were performed according to their predefined randomization procedure. The patients and investigators were kept blind to the study medication, which was prepared and injected by a person who was not involved in the study design or analysis. OADs were discontinued 1 d before the clamp. Patients were admitted to hospital at h, where they stayed for about 24 h.

They remained fasted until completion of the clamp. They were allowed access to water throughout the study. At h, the euglycemic clamp was initiated with a primed infusion of insulin 0.

Time course of the euglycemic-hyperinsulinemic clamp. Insulin infusion 0. At h 0 min , either placebo saline; 0. BG was measured at 5- to min intervals until h min the following morning. Blood samples were collected every 5—15 min for measurement of glucose and insulin using established methods. Plasma glucose was immediately measured using a Beckman Coulter glucose analyzer Beckman Coulter, Inc. Serum insulin was determined by a chemiluminescent assay with intraassay and interassay CVs less than 5.

Plasma enrichment with [6,6] 2 H 2 glucose was measured by gas-chromatography mass spectroscopy as previously described At h a single dose of 0. The same region was used for all three visits to avoid changes in absorption and distribution of insulin 23 , 24 and minimize within-subject variability, even though rates of absorption are similar in the arm, leg, and abdomen On the next day and at the end of the clamp, the patients were allowed to recover under observation before they left the hospital.

A 2-wk washout period was mandatory before the patients were readmitted for the next stage of the cross-over study. Correction for the placebo effect was performed by subtracting the measured parameter GIR, T, or AUC under the placebo condition at each time point from the parameter measured under the experimental conditions NPH insulin or glargine at the same time point.

Areas under the GIR profiles were calculated by the trapezoidal rule. The best-fit values of the constants of the polynomial function were proved to approximate a normal distribution.

We used nonsteady-state equations for stable isotopes, i. Glucose Ra and Rd were calculated using the equations described by Finegood et al. We have previously determined EGP in healthy subjects to be ANOVA for repeated measurements was used to determine differences among the three treatment groups, with treatment entered as a fixed variable.

Calculations and statistical analyses, including tests for normal distribution of data sets, were performed using Prism GraphPad Software Inc. Normal range C peptide was 0. Glargine was a mean daily dose of 0.

Overall, patients had acceptable control of their diabetes [HbA 1c , 6. Euglycemia was maintained throughout all clamps. Plasma glucose levels were stable between and h, with mean concentrations of 6. The mean of the individual CVs for glucose during the clamp studies was 4. One hundred twenty minutes before the sc injection of study medication according to the randomization schedule, glucose infusion was commenced to maintain steady BG concentrations Fig. Subcutaneous injection of saline 0.

GIR max was reached min later with glargine min compared with NPH insulin min or saline min. Adjusting for the effect of saline injection T max was still significantly later with glargine vs. NPH insulin vs. Insulin profiles differed considerably as expected Fig. As expected, C-peptide concentrations Fig. Insulin A , glucagon B , and C-peptide C concentrations during the 12 h euglycemic-hyperinsulinemic clamps.

For description see the legend for Fig. The total amount of glucose infused to maintain euglycemia was nearly identical for NPH insulin and insulin glargine, demonstrating the equipotency of the insulin doses Table 2. There was no difference in the time to starting glucose infusion, and GIRs max were different only after adjustment for iv insulin.

The statistical analysis of the mean rate of glucose Rd of the insulin preparations is demonstrated in Table 3. In particular, time courses made differences evident Fig. At night, glucose Rd was more efficiently influenced by NPH insulin [— h, 60— min glargine NPH insulin During the morning hours, the situation was completely vice versa.

Insulin glargine increased Rd significantly compared with NPH insulin — h, — min insulin glargine For details, see the legend for Fig. NPH insulin. Night — h or 60— min.

Morning — h or — min. By contrast, glargine injection resulted in lower glucose production in the morning compared with NPH insulin 8.

Lantus is a long-acting insulin that works for 24 hours and should be taken regularly at the same time each day. If you miss taking your dose at the regular scheduled time, your blood sugar levels may become high hyperglycaemia. The usual starting dose of Lantus for people with type 2 diabetes is 0.

There are about 2. The maximum starting dose of Lantus is 10 units a day. Lantus is typically taken once a day, not twice a day. You should not use Lantus if you are having an episode of hypoglycemia low blood sugar , or if you are in a state of diabetic ketoacidosis call your doctor for treatment. Never share a Lantus injection pen or cartridge with another person.

Remember to rotate injection sites. The abdomen is the preferred injection site for the AutoShield Duo. This location facilitates proper injection technique—such as keeping the pen at the proper 90 degree angle. When taken once daily, it is usually best to take the injection in the morning on a consistent hour cycle. Research has shown that the morning injection has the least potential to cause an undesired blood sugar rise when the insulin is tapering off at around hours. Long-acting: It begins working around four hours after injection and it has the ability to work for up to 24 hours.

These insulins do not peak but are steady throughout the day. Examples of long-acting insulin including glargine Lantus and detemir Levemir. NPH insulin is most often injected at bedtime to limit the risk of nocturnal hypoglycemia due to its peak of action 4—6 h postinjection 1—3.

Aside from this technical maximum, there is no mention of a maximum dose in the package insert. If you have taken too much Lantus, call your local Poison Control Center or seek emergency medical attention right away. Overdose can occur if you use too much Lantus or if you use the right amount of Lantus but eat less than usual or exercise more than usual.

Lantus overdose can cause hypoglycemia low blood sugar. Uses: To improve glycemic control in patients with diabetes mellitus; U insulin is for use in patients requiring more than units of insulin per day. One unit of insulin should cause your blood sugar level to drop 30 to 50 mg per dL, but you may need more insulin to get the same effect. The first method is visual inspection.