- advertisement -

Lantus peak

Discussion in 'Parents of Children with Type 1' started by wilf, Apr 22, 2011.

?

Have you observed a Lantus peak in your child?

  1. Yes, within 0-3 hours of injection.

    3 vote(s)
    6.7%
  2. Yes, within 3-6 hours of injection.

    21 vote(s)
    46.7%
  3. Yes, within 6-9 hours of injection.

    2 vote(s)
    4.4%
  4. Yes, but I've not pinpointed the time

    6 vote(s)
    13.3%
  5. I don't think so, but I haven't checked.

    1 vote(s)
    2.2%
  6. No, I've checked and there is no peak.

    12 vote(s)
    26.7%
Multiple votes are allowed.
  1. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    Now that DD is a teen and sleeping in, we have been able to really see how the Lantus shot she gets in the morning affects her blood sugars. On days she is sleeping in, I will briefly wake her to give her shot and then she sleeps on for a few more hours.

    For instance she rose from 200 at bedtime to 225 at 9 am, when I gave her the Lantus (we clearly needed to up her Lantus dose). So at 9 am I roused her briefly and gave her the day's Lantus - 16 units. At waking at 10:30 am she had fallen to 165, a drop of 60 points in an hour and a half due only to the onset of the Lantus peak.
     
  2. sarahspins

    sarahspins Approved members

    Joined:
    May 5, 2009
    Messages:
    2,205
    I never noticed one when I was on it, however it doesn't last a full 24 hours to me...I wonder if what you are seeing is more of a drop-off of effectiveness followed by the basal coverage "kicking in" again...not so much of a peak as much as that it's doing it's job again.
     
  3. Amy C.

    Amy C. Approved members

    Joined:
    Oct 22, 2005
    Messages:
    5,560
    This shouldn't be news to Lantus users. I noticed that the Lantus what I called valleys and plateaus of effectiveness. A peak suggests a quick up and down -- like the quick acting insulins -- which is not what happened.

    The ramp-up to the plateau was about 4 hours. The plateau ride was about 14 hours, then a drop back to the valley. This chart on the Lantus prescribing information shows a little what I am talking about: 12.2 Pharmacodynamics. My son had more of a drop at the 22 hour period than the chart shows.

    This time in the valley was when the sugars were higher than other times -- right before and after the Lantus shot. We managed by giving more insulin with Humalog for dinner and then the Lantus shot after dinner.

    For my son, giving two shots of Lantus helped reduce the depth of the valley
     
  4. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    I have seen this chart, but it doesn't really describe what I've always seen in DD's blood sugars. In DD Lantus has a clear peak in the first 4 or so hours after injection (with it acting more strongly and with blood sugars dropping in that time), after which blood sugars are steady while the Lantus plateaus..

    My sense is that the peak is caused by the overlap between the fading effects of the Lantus shot from the previous day and the building effects of the new Lantus shot. The "plateau" marks the point where the previous day's injection is no longer active, and the new injection is up to full strength.
     
  5. kidsmakes7

    kidsmakes7 Approved members

    Joined:
    Apr 12, 2011
    Messages:
    70
    Our son has a very pronounced peak between hours 5-8, and only seems effective for 18-19 hours. Splitting his daily dosage has really been effective in minimizing the peaks and given him more flexible dosage times on weekends and holidays.
     
  6. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    Here's an even more dramatic example from a few weeks ago.

    DD was a bit high at 210 when I measured at 6:30. Rather than correct, I gave 17 Lantus right then and she had dropped to 75 by the time she got up at 10:30 am.

    Note: this result is skewed a little because she had gotten the previous day's Lantus a couple of hours later, o the overlap period was a bit longer and stronger.
     
  7. hrtmom3

    hrtmom3 Approved members

    Joined:
    Jun 30, 2007
    Messages:
    1,128
    I voted between 3-6. As Amy said, we didn't have a peak, it just hit its plateau
    at the 5 hour mark. It also didn't last 24 hours for Tim. It started to loose effect around the 18th hour and was completely worn off around the 22nd hour.
     
  8. monkeyschool

    monkeyschool Approved members

    Joined:
    Mar 2, 2011
    Messages:
    526
    This is the same I am seeing in my DD...we do night shot for Lantus right now, a couple of hours before the shot (on the days we are not doing activities) the numbers go higher....4-6 hours after Lantus we get a sharp drop (it's almost like there is no kick-in to that point, except that we don't have climbing numbers, just steady ones...once the drop happens over that 4-6 hour period we remain at that lower numbers and more steady until early afternoon where there seems to be a lesser peak and the numbers drop again, but not as sharp as 'peak'....after that we are steady until the 20-21 hour climb.

    ETA ... technically here we see two peaks, a big one 4-6 hours and a lesser ~14 hrs later.
     
  9. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    I should note that I don't have a problem with the Lantus peak - it comes in handy to bring down overnight highs and/or help cover breakfast. But you want to be aware of the potential for it to be there if you're using Lantus, given that many endos deny it exists..
     
  10. FloridaMom

    FloridaMom Approved members

    Joined:
    Sep 26, 2010
    Messages:
    398
    I replied that we did have a Lantus peak somewhere between 6-9 hours. We always had problems in the middle of the night, so we ended up switching to morning.
     
  11. emm142

    emm142 Approved members

    Joined:
    Sep 7, 2008
    Messages:
    6,883
    Do you know for sure that this is a peak, rather than just a time when your daughter needs a lower amount of basal?

    I used to run low around midday, and I could have attributed that to a lantus peak, but now I'm on the pump it has become clear that I just need less basal at that time, whereas lantus was providing something flat-ish.
     
  12. Deal

    Deal Approved members

    Joined:
    Nov 2, 2009
    Messages:
    557
    For us it is 3-5 hours but comes on sooner and stronger if the Lantus is a bit old.
     
  13. MamaC

    MamaC Approved members

    Joined:
    Dec 9, 2006
    Messages:
    5,292
    Split dose here, roughly 1/3 AM and 2/3 PM. We see the "peak" at 4 - 5 hours, and we see a secondary peak on the AM dose at 10 hours. We don't seem to have that secondary peak with the PM dose.

    The primary peak is generally strong enough that we have to be mindful of a double peak if the novolog is timed badly...usually a weekend morning phenomenon - lantus goes in, he goes back to sleep for a few hours, gets up/eats/shoots novolog then boom! Hello double peak!

    ETA: Two years after this original post, we are at 50% AM and 50% PM, and the peak is common at 4.5 - 5.5 hours. Info offered to show that you needn't be locked into a certain proportion if you split the dose.
     
    Last edited: Jun 21, 2013
  14. Heather(CA)

    Heather(CA) Approved members

    Joined:
    Jun 18, 2007
    Messages:
    10,153
    It should be noted that there could be other variables in play here...For example, WHERE on the body was the Lantus given? If it was the belly or arm, you may see a sort of peak because of where it was given. If it had been given in a slow absorption area maybe there would not have been a peak. Also, was it given with a meal? If so, many variables could be happening there... Exercise can look like a peak too.

    I'm sure Lantus does have a peak for some, to know for sure it wold take time and eliminating as many variables as possible over several days. kwim?
     
  15. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    It's true, kind of. :)

    We only started seeing a pronounced Lantus peak when DD started getting her Lantus in the bootie. Before when she got it in her thigh, it would not quite last 24 hours. We didn't see so much of a peak then, more a period just around the time of the shot when blood sugars would go up.

    But now that she's getting the bootie shots, my sense is that each Lantus shot is lasting more than 24 hours and in the overlap period from the time of the injection of the new shot to when the old one fades out we have 2 injections at work..
     
  16. C6H12O6

    C6H12O6 Approved members

    Joined:
    Sep 16, 2008
    Messages:
    1,451
    I think this makes a lot of sense Emma.

    It is well established that variable basal rates are a valuable tool in diabetes management.

    Sorry if this offends anybody but I can't find any scholarly articles that indicate Lantus has a peak.(if there are any please post the info).

    Yet there are many that emphatically conclude that it is peak less.

    You're almost talking about an adverse event when you say it peaks contrary to how it is marketed. If you seriously believe that to be the case report it to the FDA or Health Canada and they can seriously look at the issue.

    Maybe it will turn out that you are 100 percent right and it can be proven there is a peak.
     
  17. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    I'm seeing 80% of responders to this poll indicate that Lantus has a peak - so emphatic conclusions and scholarly articles notwithstanding, I'm going to go with what I've seen and what others have seen. Namely that Lantus has a peak, and at the time of the peak blood sugars will tend to drop.

    It is not as pronounced as say an NPH peak, but it is there in many people and if you are using Lantus you need to be aware that this is possible.

    This was actually the reason for my starting this thread -there's lots of newer people on here who are using Lantus. If they're being emphatically told that Lantus has no peak then they're being misled.
     
  18. C6H12O6

    C6H12O6 Approved members

    Joined:
    Sep 16, 2008
    Messages:
    1,451
    Then you should seriously report it as an adverse reaction. If it does not work the way it is supposed to than that's classified as an adverse reaction

    http://www.hc-sc.gc.ca/dhp-mps/medeff/report-declaration/index-eng.php

    Before your DD had diabetes (Between 2003 and 2005 I believe) Aventis didn't even want to bother to sell Lantus in Canada. It was approved by Health Canada for like 2 years before they even agreed to sell it here.

    Apparently they think it's an insult that they are only allowed to sell it for 60$ per 1000 units here, and that was the lowest they were willing to set the price at before they would even bother
     
    Last edited: Apr 24, 2011
  19. kidsmakes7

    kidsmakes7 Approved members

    Joined:
    Apr 12, 2011
    Messages:
    70
    We have tried PM only doses, AM only doses, split dosages (in varying percentages), and have positively identified a 5-8 hour spike using lantus. We've also tried moving his injection times with consistent results. At hour 5-5.5, he's heading down (regardless of the hour of the day, or activity level), and by hour 7.5-8 he'll start rising with no COB during that 3 hour window.

    I wouldn't classify our sons response to Lantus as a reportable "adverse reaction" though. With any drug, individual responses will vary from the clinical "average". We come in all shapes and sizes :) It's inevitable that diverse individuals will react differently than the canned "24 hour", "no spike" sales pitch Lantus offers, and may produce adverse side effects in some that others may never experience.

    How many Dr's could successfully fill a patient with confidence by stating, "with Lantus, your basal insulin requirements will be met for 18-28 hours, and may produce significant lows during a 3-10 hour window." KWIM?

    From what I've read from Wilf's posts, which I fully support, his intent seems to be to forewarn more recently dx'd individuals that, whichever insulin you may use, YDMV. Even though you may hear arguments from your doctor, your nutritionist, or the big pharm companies, don't take what your told as gospel. After all, maintaining bg values in a particular individual is more of an art than hardcore science.

    Now that I've opened my mouth (figuratively) I would even take it one step further. Your support team can set you on the path, but will never fully appreciated or understand the intricacies of you or your child's T1. That responsibility falls on you/us, and most of the time we have to just McGyver our way to the best possible regiment.

    <steps off his soap box>

    P.S. Now that I actually registered I sure do talk a lot. LOL
     
  20. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    Well put. You have certainly captured the spirit I have intended for this thread. :)

    I actually like that Lantus has a peak, as we can work with it and use it. I'm not sure DD's NPH regimen would work as well if we didn't have the Lantus peak helping to cover lunch every day.. :cwds:
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice