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View Full Version : Combining Lantus with Humolog or Novolog in one injection



coni
11-11-2007, 02:04 PM
Does anyone combine Lantus and Humolog or Novolog in one shot to reduce the number of overall daily injections? I have heard it's possible. (This makes it sound like our kids are one big science experiment.:eek:) If you combine the insulins, which one are you supposed to draw up first? Don't you have to make sure you don't get any of the Humolog or Novolog mixed into the Lantus?

sammysmom
11-11-2007, 02:16 PM
You are going to get different opinions on this and you may get some really die hard opinions also. We mixed lantus/log for 4 years and NEVER had a problem with doing so. Some are going to say "the instructions say not to" but we all know that not approved does not mean anything sometimes. There are several studies saying that it is alright to do so, although at this moment I can not link them to you. Always inject right away. Like I said, we did it for 4 year and never had a problem.

shannon

Bsbllmom
11-11-2007, 03:09 PM
Our endo said it was ok and to draw up the humalog first.

KTurner52
11-11-2007, 08:43 PM
We did it for several months without any problems. The Humalog needs to be drawn up first.

Big Hair Momma
11-11-2007, 10:44 PM
We are pumping now, but combined insulins from the beginning, per instructions from the endo. The Humalog should be drawn first. The explanation we were given is that if you get the Humalog into the Lantus, it's not going to effect the quickness of action. However, if the reverse happens the Humalog will not work like it should.

Good luck.

sanfam93
11-11-2007, 11:57 PM
We are drawing Lantus with other insulins, make sure you talk to your endo first before you do it. Draw the Lantus second,

Air in lantus
air in humlin
draw humlin
draw lantus

thats how we do it. but talk with Enod first.

Nelson
11-12-2007, 12:59 AM
We played around with mixing Lantus and humolog for a little while without any adverse affects. The theoretical problem, as I recall, is that the Lantus is disolved in a acidic buffer solution, and part of how Lantus works is that when it hits the normal pH of the body, it precipitates out of solution and thus is slow to be absorbed by the body. On the other hand, Novolog and Humolog are both neutral pH solutions, so when you draw the Lantus into the syringe, it gets all cloudy as it is precipitating in the syringe instead of inside the body. Obviously, since mixing Lantus has been widely successful, the outer-body precipitation doesn't lead to any real change in action for most patients (it apparently does cause problems for some). I have heard of the precipitated Lantus clogging ultrafine needles if it is not injected fairly quickly after being mixed.

All in all, I support developing better glycemic control through experimenting on our children if we do it with responsible care and careful follow-up.

Schpoodle's Dad
11-12-2007, 06:24 PM
Interesting. I'm surprised to see the number of people here that mix Lantus.

We were told to NEVER mix Lantus with any other insulin and to even use a different injection site from where the last Humalog was injected. The explanation was that mixing Lantus can cause it to behave differently than how it was intended.

From the Sanofi-Aventis website : "When LANTUS and regular human insulin were mixed immediately before injection in dogs, a delayed onset of action and time to maximum effect for regular human insulin was observed. "

http://products.sanofi-aventis.us/lantus/lantus.html

We will continue to use multiple injections for Lantus and Humalog. I'd recommend talking to your ENDO on this one.

coni
11-12-2007, 10:24 PM
Interesting. I'm surprised to see the number of people here that mix Lantus.

We were told to NEVER mix Lantus with any other insulin and to even use a different injection site from where the last Humalog was injected. The explanation was that mixing Lantus can cause it to behave differently than how it was intended.

From the Sanofi-Aventis website : "When LANTUS and regular human insulin were mixed immediately before injection in dogs, a delayed onset of action and time to maximum effect for regular human insulin was observed. "

http://products.sanofi-aventis.us/lantus/lantus.html

We will continue to use multiple injections for Lantus and Humalog. I'd recommend talking to your ENDO on this one.


Thanks. I will talk to the endo before mixing - no worries. What works with our endo is to propose something with back up information. I read about the possibility of mixing insulins in the Pink Panther book and heard a speaker mention it at the CWD FFL conference. I just wondered if anyone was doing it with good results, and it appears that the answer is yes.

Ellen
11-13-2007, 07:13 AM
There's one full text article at this link:

http://care.diabetesjournals.org/cgi/content/full/27/11/2739
Effects of Mixing Glargine and Short-Acting Insulin Analogs on Glucose Control

Walid Kaplan, MD, Luisa M. Rodriguez, MD, O’Brian



-------------------------------------------------

and here's an abstract of another article

J Pediatr. (javascript:AL_get(this, 'jour', 'J Pediatr.');) 2006 Apr;148(4):481-4.http://www.ncbi.nlm.nih.gov/corehtml/query/egifs/http:--linkinghub.elsevier.com-ihub-images-PubMedLink.gif (http://www.ncbi.nlm.nih.gov/entrez/utils/fref.fcgi?PrId=3048&itool=AbstractPlus-def&uid=16647408&db=pubmed&url=http://linkinghub.elsevier.com/retrieve/pii/S0022-3476(05)01134-0)
Mixing rapid-acting insulin analogues with insulin glargine in children with type 1 diabetes mellitus.

Fiallo-Scharer R (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Fiallo-Scharer%20R%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus), Horner B (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Horner%20B%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus), McFann K (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22McFann%20K%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus), Walravens P (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Walravens%20P%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus), Chase HP (http://www.ncbi.nlm.nih.gov/sites/entrez?Db=pubmed&Cmd=Search&Term=%22Chase%20HP%22%5BAuthor%5D&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsP anel.Pubmed_RVAbstractPlus).
Barbara Davis Center for Childhood Diabetes, University of Colorado Health Sciences Center, Denver, Colorado, USA. rosanna.fiallo-scharer@uchsc.edu
OBJECTIVE: To determine whether mixing insulin glargine (IG) with a rapid-acting insulin (RAI) analogue in the same syringe had any deleterious effects on glycemic control in children with type 1 diabetes mellitus. STUDY DESIGN: Data from 55 children mixing the IG with a RAI analogue was collected for 6 months before and 6 months after the insulin mixing began. Data from a control group of 55 children not mixing the insulins was collected at similar intervals. Parameters evaluated included hemoglobin A1c (HbA1c) values, number of non-severe and severe hypoglycemic events, number of diabetic ketoacidosis (DKA) events, and blood glucose distribution patterns. RESULTS: After 6 months of study, HbA1c values were equivalent for the control and test groups (8.54+/-1.14 vs 8.61+/-1.14, respectively; P=1.0000). Percentages of blood glucose values in, above, and below the target range did not vary significantly in the groups. There were no significant differences in the groups in the occurrence of non-severe or severe hypoglycemic events or of DKA events. CONCLUSION: There were no significant differences in glycemic control between children who mixed IG in the same syringe with a RAI analogue compared with children who took separate injections.
PMID: 16647408 [PubMed - indexed for MEDLINE]

hartpukas
11-13-2007, 08:00 AM
We mix humalog w/ NPH (I know, I know can you believe I said "NPH"? - mind you we have our beautiful pink animas pump waiting to start in December...) and we then do the Lantus by itself. With that being said, a good friend of ours mixed all three insulins and had good results. I would discuss it with your endo and see what works best for you all.

I tried mixing all three insulins for a week long trial and was not happy with how long it seemed to take for her numbers in a good range. Best of luck.

Jeff
11-13-2007, 08:39 AM
The study referenced by Ellen shows that you can mix Lantus with a rapid acting analog, inject immediately, and it has no impact on HbA1c. This is off label but the science supports it.