Lantus BID

[SteveDE]

Just wondering what your feelings or thoughts are on lantus BID for someone with type 2 diabetes. How does this help compared to lantus nightly? I see this as an unnecessary stick for patients, chance for more error, and even a chance for increased low blood sugar.

What do you think, it seems to be great once daily, titrate up the dose 1 unit nightly until the target AM glucose is obtained, if needed add meal time insulin, but I don't see a benefit to BID lantus dosing, seems like this is something I am seeing more and more and often times these people are uncontrolled and either simply need a dose adjustment or they need meal time insulin.

[scottaprn]

In theory a dose of lantus last for 24 hours. In actuality the range is from 10.8 hours to 24 hours. Some patients (estimate 15-30 percent) need bid dosing.

http://www.medscape.com/viewarticle/583396

has a nice explanation

[firstinfamily, RN]

I did see this in the sub-acute unit I worked. The patients who had this ordered were usually also on meal time insulin because their blood sugars were so elevated. The main problem we had was that the pt was not receiving HS snacks to prevent their blood sugar from being too low in the early am. It depends on what the goals are for the specific patient and some patients have insulin resistent diabetes, so they need a second dose. Close monitoring is needed to maintain good blood sugar results. We still did finger sticks about 4 times a day. We also had a policy that if their blood sugar was less than 100 prior to the Lantus administration it would be held.

[SteveDE]

Thanks for the information!

[mammac5]

Pts should not NEED a snack. If snacks are routinely needed, the insulin dose is too high.

[BostonFNP, APRN]

It is not unusual for prescriber to dose Lantus or Levemir twice daily based on patient response.

Sent from my iPhone.

[TheCommuter, BSN, RN]

Some of my former patients have been so insulin-resistant that they needed two high doses of Lantus or Levemir Q12 hours to achieve sufficient blood glucose control. This is in addition to sliding scale Novolog.

The highest dose I've seen is 95 units BID.

[mmc51264, BSN, MSN, RN]

When you have pts with that high a dose, how do you administer? Recommendations are no more than 30 units per site. We just had this discussion during our skills day.

[SteveDE]

I've never heard the 30 units per site? I would be interested to see where that comes from or if its one of those "urban legends". Many people routinely injection 30 plus units of long acting and meal time units a few times a day, I highly doubt they are going to break those 4-5 daily injections into 8-10 daily injections. I wonder if there is a recommendation for only 30 units per site, if this may be a pediatric recommendation?

[BostonFNP, APRN]

The clinical trial for Lantus used up to 120u in a single site, so that 30u number is not true. The pen itself will only administer 80u max per activation so doses larger in that need two activations, though the pen can remain inserted.

Sent from my iPhone.

[Spidey's mom, ADN, BSN, RN]

My husband gets 50 units of Lantus BID.

And then Humulog depending on BG.

Thanks for that link.

[ocean.baby]

Lantus BID can help those with difficult to control blood sugars due to the peak time of Lantus.

As a diabetic who has used Lantus for years (current dose 60 units qd), I am adamantly against HS dosing. My blood sugar has gone into the 40's on several occasions within an hour of taking my Lantus. It scares me to think of what might have happened if I had been sleeping.

The explanation I got was that my pancreas could 'kick in' at same time I took my Lantus, thus the low bloid sugars.