Studies regarding Lantus

The situation: V had his 6 month check-up 2 weeks ago (we are in France). His A1C was 7.1 - not wonderful, but not horrible, but the result of highs and lows. The doc took one look at his records, saw that he took Lantus twice a day and refused to discuss anything else.

She said: Lantus is NEVER taken more than once a day. It is only for the nighttime and has no use for the daytime so there is no reason to take it in the morning, ever. She then told him to start at 10 units and increase by 2 untis until he had a morning reading of 100. Then to continue with that amount and he would be ‘fixed’.

He did exactly that and spent 2 weeks going from 80 to 200 to 80 to 250 with the added bonus of two 4am lows - one of 47 and one of 39.

After 2 weeks, we laid everything out and he determined to go back to twice a day.

The request: It’s obvious, and not out of character for a French doc, that she has only read the Lantus brochure or whatever, and accepts it has absolute truth (I don’t know about the ‘only for nightime’ bit)
Can anyone point me in the right direction to find either medical studies or opinions by doctors or reports be doctors that will lend any support to the benefits of taking Lantus twice a day?

He has another visit scheduled for April so she can make certain he is following her rules. As he is not, he can either lie (never a good idea) or offer some support (other than an improved A1C) for his decision.

Any help is appreciated… Thanks

I can’t believe his Dr. is still telling him after all these years, that only one dose of Lantus a day is sufficient. Most Lantus users(not all) would disagree. I take 2 doses a day, as do most, because it works Well for me as part of my regimen. My A1c has been 6.3 and 6.4 for the past 2.5 years.

Is she aware that Lantus does not work for all for the full 24 hours a day as originally thought? We are the guinea pigs. We know. There is something else going on that she is not aware of.

She said that Lantus works for 24 hours but it doesn’t matter because it’s only needed at night. It was frustrating because she grabbed on to that and wouldn’t listen to his questions. That’s why I’m trying to find some ‘medical’ documentation. I am going to tell her about this site, as well. I find it so frustrating that she seemed unwilling to learn - and she’s just a baby doc!

Considering we(Diabetics) are ALL different and consume foods and exercise differently, this is only one variable that I found on one search from a reputable site where the split was used. There are many other sites. Your Hubby’s Dr. should be aware of this simple change. Many Diabetics are.

I’ve taken Lantus in the morning since my dx. 1 1/2 years. Try looking on the Lantus website, all kinds of info for Dr.s

Thank you both - the article is a good example. I’ll check the Lanuts site - I didn’t bother because I assumed they would just spout the party line… Shame on me for making that assumption,

When I was taking Lantus I was splitting it between before bed and wakeup, so I don’t know why the French Doc told you that other that she was misinformed.

“Lantus is only for the night”??? She so obviously is ill informed. Lantus provides 24 hour background insulin (or is supposed to) that mimics what a normal pancreas does on its own. She obviously doesn’t even know the function of the pancreas!! I appreciate your quandry but when I get into a situation where I am doing things for the doctor instead of the reverse, I know I am seeing the wrong doctor. I think it’s a great idea to bring her research, but frankly this type of doctor would probably scoff at it and forget their response to anything “from the internet”. I have used the technique of e-mailing research info if there is e-mail contact with the doctor, because they can then read it on their own without having to show their ignorance to their patient. I’m sorry I have no respect for doctors like that. If you can’t get another doctor and are forced to deal with her, to me the best proof that your idea works should be in your husband’s lowering A1C and his daily numbers that show the split dose works better. For me I was getting regular highs before I took my one Lantus dose at bedtime. Now that I am splitting it I no longer see those highs.

Absurd to say Lantus is only for night use. She must have come up with that on her own. I argued with one endo about two basal doses (something I learned here) because Lantus did not last even close to 24 hours & taking larger doses sent me low due to Lantus peaks. (He also denied that Lantus could peak.) He shook his head & insisted two doses were unnecessary. I did it anyway with better results. I switched to Levemir. I take split doses of Levemir also. My current endo is supportive because my logs are evidence this works. Perhaps V’s logs can also prove this.

Not that a patient can usually win by putting a doctor on the defensive, but it would be interesting for her to show V. scientific evidence, not pharm brochures, that Lantus cannot be taken in two doses & only at night.

His doctor should know that the larger the insulin dose, the more unpredictably it will behave. Most doctors also raise dose by one unit at a time to prevent lows, not two. Small increments are safer & more accurate.

I’ve not had success convincing doctors. I’ve been pooh-poohed when I’ve brought up anything that refutes their views.

Doctors in the US also get their info mostly from pharm literature & pharm reps. Empirical evidence from patients doesn’t carry much weight.

Actually the only time I had good results giving info to a doctor was the endo I saw in Guatemala. Despite its being a third world country and behind in technology, doctors there don’t seem to have the god complex of U.S. docs. She looked at my list of five reasons I thought I was LADA not type 2 and put a check next to each one. She looked at my copy of Using Insulin and asked if it was available in Spanish so she could give it to her other patients. She even asked for the url for Tudiabetes when I said there was a Spanish group. She said “I wish all my patients were as educated (about their condition) as you.”

First a note to all readers here. The diary of V can be seen in our Glucosurfer project. Katie is willing to share the diary with us so we can see what is going on (just click on the following link):…

Now to Katies question:

The body needs glucose around the clock. To process glucose the body needs insulin. Thus he needs an insulin that will cover the basic needs for 24 hours. As you can see the argument of your doctor that the insulin is only needed for the nighttime is boldly wrong. I am sorry to say that she has disqualified herself with this argument. I would recommend to look for a specialized doctor like a diabetologist.

Please think about the following carefully:

Your husband has used two shots of Lantus per day for a while. This treatment was better than the current treatment with one huge shot of Lantus. But better does not mean very well. It only means that he had fewer lows. But even on the two shot regime the results were not as good as I have expected them to be. This is why I have got the impression that Lantus is not the best suited long-acting insulin for your husband. Look at the blood glucose spike after 19:00 o’clock. This even happened on two shots of Lantus:

In my opinion your husband should ask your doctor to be allowed to test another long-acting insulin called Levemir. I recommend this insulin to everyone when the results with Lantus are not that good or the risk of lows is unusually high. For this insulin I boldly recommend to inject it twice a day (every 12 hours). It is a good test and you will only need one vial of Levemir to make this test. It has the potential to improve the glucose control and to reduce the risk of lows. Even if your doctor is not a fan of shooting it twice the switch to Levemir alone can reduce the risk of having lows.

You should not wait until April to make this suggestion to your doctor. This is just too long in my opinion.

Next time just lie… add the two doses together and say you give it at night :stuck_out_tongue:

Seriously though, that’s just stupid… there are PLENTY of us out there who found that Lantus just does not last a full 24 hours.

The biggest enemy of a healthy T1D is a medical professional who is living in the dark ages.

The “Live Like a Pancreas; A Practical Guide to Managing Diabetes with Insulin”

Even the manufacture notes that Lantus may not last 24 hours in some people.

You could also draw the naive MD a picture of the insulin activity of Lantus over 24 hours and it is pretty obvious that the activity is not flat and the is low activity for 4-6 hours after the injection. If the insulin is not lasting a full 24 hours, the ups and downs may be more pronounced.

Here is an article published on what you are looking for that appeared in Diabetes Care (ADA)

"Twenty-Four Hour Action of Insulin Glargine (Lantus) May Be too Sho…

It depends on the individual. I was on one dose of Lantus while I was working out three times a day (3 hours worth of exercise a day), but after a while, I began having high blood sugar levels in the morning. So the doc prescribed an additional, smaller dose of Lantus in the evening. That seemed to do the trick for a while, but eventually I needed a pump and only use Lantus as a backup. Lantus works for 24 hours in some people and shows peaks and valleys in effectiveness in others. If it isn’t lasting 24 hours, then he needs a second dose. I took my larger dose in the morning and a second dose before bed, rather than taking the whole thing at night (had some terrible night hypos as a result - the daytime dosage was much safer for me). I’m not a doctor, so I can’t really tell you what to do, but I’d put in a call to the Barbera Davis Center and ask them about how they prescribe Lantus in both the Children’s Clinic and the Young Adult Clinic. They might be able to help, though you may have to make the call at an odd hour for you, as they’re operating at Mountain Standard Time, U.S.

My endo switched my Lantus to morning and it’s been better. No more morning lows. But even she says Lantus wears off around 20 hours. I haven’t had a split dose, but lately my AM BGs have been 110-125. I see her again in March.

Thanks for all the suggestions - and commiserating… His doc is part of the Endo department at the big teaching hospital in Bordeaux. He liked the first one, (and he likes the department head) but apparently she was gone in January and he was reassigned.

He is, slowly, switching back to twice a day and we’re gathering data for the April visit. If that one is as bad as the first we’ll try to be reassigned again. He has to have another surgery in the summer at the same hospital - muscle repair from the pancreas removal. After that he’ll have a bit more freedom to find another doc. One would expect a teaching hospital to be more up to speed with all the research, but I get the impression that Type 1 and particularly Type 1 without a pancreas are a bit of a rarity.

Also, they were surprised when he requested to go on the basel - bolus regime, rather than the 3 shots a day they started him on. They kept worrying - this doc, too, about him having to take so many injections… I think the French have a very low pain threshhold and they can’t understand why he would willing do this.

I also think that the typical French person would not bother learning anything on their own and would have accepted the ‘eat 35 carbs at every meal and inject this much insulin’ that they started him on.

We learn…

Thanks… I really appreciate the support.

You’d think V’s doctors would be even more encouraging of basal/bolus treatment because he has no pancreas to produce even the tiniest bit of insulin. V is a rarity.

French doctors appear to be more sensitive to injections. Perhaps they should take one to see it doesn’t hurt at all:) I can’t even feel injections with narrow, short needles. My doc told me pens were painless, but I had awful bruising & prefer syringes. Finger sticking is more annoying than shots.

Believe the typical person anywhere would rather be told what to do than learn on their own. It’s a lot of work & a lot to learn.

Hi Kathyann,
I have still been trying to figure out my Lantus schedule. I took it all in the morning the other day (instead of bedtime), and my am BG was 144 at BT; when I got up I was 233. It did not last 24 hours for me. Am trying to try a split dose now.