Many patients and some healthcare workers are puzzled by basal insulins, and as a result, do not understand how the body responds to them. Basal insulin meets the basal metabolic needs of the body during times when the person is not eating. The purpose of this article is to discuss the significance of Lantus as a slow-acting insulin.
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The cells of the human body require a continual stream of energy at all times in the form of glucose, and insulin is the the vehicle that allows this glucose to enter the cells. The pancreas of a healthy non-diabetic person has two mechanisms of insulin secretion: basal insulin production and bolus insulin (a.k.a. prandial insulin) production.
Basal insulin is constantly produced by the pancreas in small amounts and is in the bloodstream at all times, whereas bolus insulin is secreted in bursts to address the postprandial spikes in blood glucose levels that are caused by eating. In other words, the insulin that a healthy person's pancreas makes has two separate functions: basal, which is for all-day baseline action, and bolus, which is for sudden mealtime action.
For effective blood glucose control, the diabetic patient might be prescribed a basal insulin (such as Lantus) and a bolus insulin such as Humalog or regular insulin. This regimen is designed to mimic the secretory response of the healthy non-diabetic pancreas.
According to Newton (2007), basal-bolus insulin is one of the most advanced approaches to diabetes care, offering a way to closely simulate natural insulin delivery. Basal insulin controls blood glucose levels in response to the constant low-level supply of glucose made by the liver, whereas bolus insulin responds to rises in blood sugar due to food intake.
Lantus is a slow-acting basal insulin. Many patients and some healthcare workers do not realize that Lantus is a basal insulin and conclude that if they administer it to replace the insulin that the pancreas no longer secretes, that it is enough to result in normal blood glucose levels. However, Lantus is absorbed slowly over an extended period of time and does not address the mealtime spikes.
In addition, some nurses will hold Lantus if a patient's most recent blood glucometer reading is in the 90s or low 100s with the mistaken belief that this type of insulin will lead to dangerous lows. However, nursing staff is mystified when the same patient's blood glucometer readings are extremely elevated on the next day. Holding Lantus is comparable to depriving the body of its supply of basal insulin.
Never mix Lantus with any other insulin because this action deactivates it. Lantus is for subcutaneous injection only and generally does not have a peak. According to Thompson (2008), the safest time of day to administer Lantus and Levemir is before bedtime. However, many patients experience successful outcomes when they take their basal insulin once daily in the morning. In addition, some physicians advise patients to divide their daily dose into two injections that are spaced 12 hours apart.
Since diabetes mellitus is so prevalent in healthcare settings, it is imperative that nurses and other healthcare workers are knowledgeable about the action of Lantus and other basal insulins. Knowledge is power, and together we can bestow our expertise upon our patients and their families to assist in warding off devastating complications.
