Lantus BID

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

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.

Thanks for the information!

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

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.

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?

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.

I did levemir BID while pregnant for tighter control. I saw significant improvement on the BID dosing. My CDE explained that not every person gets a full 24 out of either Lantus or Levemir. The link is very helpful, thank you.