- 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. C6H12O6

    C6H12O6 Approved members

    Joined:
    Sep 16, 2008
    Messages:
    1,451
    I think you guys may be on to something, but I think it might be a good idea to report it as adverse event.

    If a drug does not do what it claims to do, and no one tries to document this in an official way I see that as kind of a slippery slope.

    If a company marketed an antibiotic as being highly effective at treating say Group A Strep, and in reality in a significant number of cases, it was not effective no one would say that was okay.

    I don't really understand why Aventis can swear up and down that lantus has not peak, and someone can feel so strongly that that this claim is BS and just shrug it off.

    Doesn't that just say that you can market a drug and claim it does something it does not in fact do, and we should just accept it.

    Based on what you are saying lantus is no better than ultralente. And ultralente cost a fraction of what lantus did and didn't burn.
     
  2. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    I can't really relate to your analogy, because unlike your antibiotic that isn't effective there's no indication that Lantus is not effective. In our experience it has been the most effective basal insulin we tried.

    I'm not into reporting an adverse event when I have not had any problems. Any time we try a new insulin we check out how it works in DD, by testing more often and carefully considering what is happening.

    My understanding is that when Lantus was being licensed, like many other drugs it was tested on healthy (aside from their diabetes) male volunteers.

    They were receiving dosages far higher than what our children would get (30 units and up), and for them the Lantus lasted more than 24 hours with little or no peak.

    In smaller children the Lantus often lasts less than 24 hours (esp. if not given in the bootie), and the peaks are more noticeable.

    Now it could be kind of interesting to chat with someone from the company about what we're seeing, though I'm sure they're aware of this.
     
    Last edited: Apr 24, 2011
  3. Heather(CA)

    Heather(CA) Approved members

    Joined:
    Jun 18, 2007
    Messages:
    10,153
    For Seth, Lantus had no peak. None.
     
  4. monkeyschool

    monkeyschool Approved members

    Joined:
    Mar 2, 2011
    Messages:
    526
    Here we were rotating between rear and arms and were seeing higher numbers in the rear, lower numbers on the arms....but the drop at 4-6 hours was consistent regardless of site. There are days we exercise and days were we had a whole week off for spring break, the drop was always there regardless of our activity or site.

    I am not sure I would call what we see a peak, but rather Lantus' start time. Kind of like a ramp up until it gets to a steady state. We see the numbers creep up a little in the evening, so I think it may not be lasting 24 hours, and on top of that the lantus does not start right at the time of injection, it takes a little longer....so there's sort of a gap in coverage of sorts. I would say peak, if it was followed by a drop, but it isn't here. Once we drop we stay at that level.
     
  5. monkeyschool

    monkeyschool Approved members

    Joined:
    Mar 2, 2011
    Messages:
    526
    I agree with this....we even asked our nurse if there was a peak/drop, because we were clearly seeing it. We were told there wasn't, that we didn't need do to three checks at night (bed, 3am, and 5 or 6am), because Lantus would just hold her steady. We submitted log after log showing otherwise, and at our appointment were still told Lantus holds steady, maybe it was the exercise...there was no way to know.

    If we were told from the beginning a simple comment as you noted we wouldn't have to be investigating all this on our own.

    The problem I have is that they 'deny' it is there despite us seeing it.
     
  6. monkeyschool

    monkeyschool Approved members

    Joined:
    Mar 2, 2011
    Messages:
    526
    I am curious is the peak vs. non-peak or the duration of the Lantus is related to %body fat rather than age? Is it possible that the kids that are seeing the peak have little body fat? My dd has very very little body fat (we can't even use tummy as a site bec you can't pinch anything).
     
  7. C6H12O6

    C6H12O6 Approved members

    Joined:
    Sep 16, 2008
    Messages:
    1,451


    It is not that the hypothetical antibiotic does not work, it just does not work on pathogen x (I used group A Strep as an example), but the manufacturer claims it is effective in treating infections caused by pathogen x. The drug happens to have great efficacy for a host of other pathogens.

    Antibiotics cover bacterial pathogens according to their characteristics. Ex Vancomycin is generally effective against MRSA and C Diff (and a host of other gram positive cocci and bacilli) but it isn't accepted or marketed as being effective in treating Campylobacter jejuni or Shigella species or any gram negative bacilli
    Kind of like lantus, it possesses a host of qualities but you do not believe it to be peak less.

    There is a lot of transparency when it comes to emerging antibiotic resistance, and it is known that drugs that use to treat certain conditions are no longer the best choices because health care providers report on the behalf of their patients. I imagine some patients report independently as well.

    Sorry for the convoluted analogy I am just trying to say I think if it really does peak (in certain individuals ) it should be documented.

    You would have loved Ultralente Wilf:), and geographically it was used a lot in Hamilton. (Not big in other areas.) You could even mix it with other insulins.
     
  8. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    In my opinion, this was the most intelligent post in the thread, and was almost entirely overlooked. In order to determine whether Lantus has a peak or not, you'd have to know your child's basal need pattern very well. Jack's basal needs at 10:00 p.m. are double that of his basal needs at 3:00 a.m. (And vary up and down throughout the day.) I could draw some mightily incorrect conclusions about Lantus peaking in him if I didn't know that.

    When we were on Lantus we didn't see a peak, but I had no real clue how his basal needs varied throughout the day, so that anecdote is really rather worthless. If his general basal pattern was the same then as it was now, a Lantus "peak" at 5 hours post shot would have been completely obscured by the fact that his basal needs are highest at that point in the night.

    Correlation does not imply causation. And there is a normal human tendancy to see what others see. Finally, I doubt that 80% (or even 50%) of MDIers here could sketch out a rough graph of their child's basal need pattern. That's why I tend to value "scholarly articles" over anectodal evidence. I'm not discounting the possibility that there is a Lantus peak for some, but I'm skeptical that there is a true peak for over 80% of users.
     
    Last edited: Apr 25, 2011
  9. Tigerlilly's mom

    Tigerlilly's mom Approved members

    Joined:
    Dec 3, 2007
    Messages:
    3,492
    oh my!! This thread has my overtired brain spinning!;)

    From reading this thread, this is what I have come to the conclusion of for MY child with diabetes. He MAY have a peak from his lantus around four hours after injection OR maybe his lantus is JUST beginning to work at that four hour time and that's what is making me think he has a peak.:confused:

    I DO know that this lantus peak is NOT due to needing less basal at that time, because this "peak" time is actually when he has the greatest basal needs. He is hitting that fun puberty time - so his basal needs continue to rise during the night time hours:eek:.


    My guess is that this "lantus peak" issue is a YDMV thing! Everyone responds to various insulins in different ways. Wouldn't it be nice if all our kids had "cookie cutter diabetes" and we could all follow the same exact regime with the same results:D
     
  10. Tigerlilly's mom

    Tigerlilly's mom Approved members

    Joined:
    Dec 3, 2007
    Messages:
    3,492
    I am not arguing your skepticism of the 80% of users peaking..but wanted to point out that others may have responded to the poll that aren't MDIers.


    Tyler uses Lantus but also pumps and receives approximately 70% of his basal from his pump. This has increased 20% over the past few months due to puberty. I definately am finding the advantages of using the pump for at least partial basal during this crazy time, while still giving him the flexibility to remove his pump for sports if he wishes.
     
  11. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    This is true, and I'm one of those non-MDIers who responded. ;) But I'm sure there are others like me who know now what my son's basal pattern is, but had no idea on MDI. I can't really extrapolate from what I know now to then either, as he was mostly honeymooning on MDI. It may be similarily difficult for others to extrapolate, as my understanding is that "typical" basal patterns change from childhood to puberty and then again at adulthood.

    I'm also not entirely sure that "yes, but I've not pinpointed the time" should be counted as a "yes," but more of an "I dunno, but most people see a peak, so I guess I do too." ;)
     
    Last edited: Apr 25, 2011
  12. Tigerlilly's mom

    Tigerlilly's mom Approved members

    Joined:
    Dec 3, 2007
    Messages:
    3,492
    True true:cwds:
     
  13. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    For someone who's not currently using Lantus (and was using it mainly during the honeymoon) you're sure opinionated.. ;)

    Of course you're entitled to your opinion, but I'll continue to go by what I've seen based on diligent personal observation. Note that I'd be concluding that Lantus has a peak in my daughter even if no one else was seeing anything in their children, because I've got numerous observations at varying times of the day supporting my personal conclusion.

    Anyhow, why don't you share some links to the "scholarly articles" you're relying on for your opinions, given that you discount the personal observations of those who have responded to the poll?
     
  14. hawkeyegirl

    hawkeyegirl Approved members

    Joined:
    Nov 15, 2007
    Messages:
    13,157
    Well, my "scholarly articles" was in response to you using that phrase. Which scholarly articles were you referring to?

    I actually wonder if it's possible to know what your (general your) child's true basal needs are on Lantus. You've got an insulin that may or may not peak and may last more or less than 24 hours. Then you've got potential absorption issues and an insulin that appears to lose its effectiveness more easily than other insulins. How do you know what is the result of the insulin working and what is the result of variable basal needs? (Frankly, it wouldn't surprise me if you can tell the difference, but I doubt most people can.)

    Using the 'Logs as a basal, delivery is so constant that the peaks are not an issue for basal purposes.
     
  15. C6H12O6

    C6H12O6 Approved members

    Joined:
    Sep 16, 2008
    Messages:
    1,451
    Since you asked, these are all peer reviewed journal articles that express that Lantus is peakless. (Only one's in French) :)



    Agin, A., & Sapin, R. (2010). Analogues et dosages d?insuline : Le cas g?n?ral et le cas particulier de la glargine. M?decine Nucl?aire, 34(10), 571-582. doi:10.1016/j.mednuc.2010.07.014


    Bolli, G. B., Songini, M., Trovati, M., Del Prato, S., Ghirlanda, G., Cordera, R., . . . Noacco, C. (2009). Lower fasting blood glucose, glucose variability and nocturnal hypoglycaemia with glargine vs NPH basal insulin in subjects with type 1 diabetes. Nutrition, Metabolism and Cardiovascular Diseases, 19(8), 571-579. doi:10.1016/j.numecd.2008.05.003


    Bolli, G. B., & Owens, D. R. (2000). Insulin glargine. The Lancet, 356(9228), 443-445. doi:10.1016/S0140-6736(00)02546-0



    Campbell, R. K., White, J. R., Levien, T., & Baker, D. (2001). Insulin glargine. Clinical Therapeutics, 23(12), 1938-1957. doi:10.1016/S0149-2918(01)80148-X


    Chase, H. P., Dixon, B., Pearson, J., Fiallo-Scharer, R., Walravens, P., Klingensmith, G., . . . Garg, S. K. (2003). Reduced hypoglycemic episodes and improved glycemic control in children with type 1 diabetes using insulin glargine and neutral protamine hagedorn insulin. The Journal of Pediatrics, 143(6), 737-740. doi:10.1067/S0022-3476(03)00415-3


    Colino, E., L?pez-Capap?, M., Golmayo, L., ?lvarez, M. A., Alonso, M., & Barrio, R. (2005). Therapy with insulin glargine (lantus?) in toddlers, children and adolescents with type 1 diabetes. Diabetes Research and Clinical Practice, 70(1), 1-7. doi:10.1016/j.diabres.2005.02.004


    Furman, B. L. (2007). Glargine insulin. In S.J. Enna, & David B. Bylund (Eds.), xPharm: The comprehensive pharmacology reference (pp. 1-2). New York: Elsevier. doi:10.1016/B978-008055232-3.61824-0


    Garg, S. K., Gottlieb, P. A., Hisatomi, M. E., D?Souza, A., Walker, A. J., Izuora, K. E., & Chase, H. P. (2004). Improved glycemic control without an increase in severe hypoglycemic episodes in intensively treated patients with type 1 diabetes receiving morning, evening, or split dose insulin glargine. Diabetes Research and Clinical Practice, 66(1), 49-56. doi:10.1016/j.diabres.2004.02.008

    Hahr, A. J., & Molitch, M. E. (2010). Optimizing insulin therapy in patients with type 1 and type 2 diabetes mellitus: Optimal dosing and timing in the outpatient setting. Disease-a-Month, 56(3), 148-162. doi:10.1016/j.disamonth.2009.12.009

    Heller, S., Koenen, C., & Bode, B. (2009). Comparison of insulin detemir and insulin glargine in a basal?bolus regimen, with insulin aspart as the mealtime insulin, in patients with type 1 diabetes: A 52-week, multinational, randomized, open-label, parallel-group, treat-to-target noninferiority trial. Clinical Therapeutics, 31(10), 2086-2097. doi:10.1016/j.clinthera.2009.10.006
     
  16. C6H12O6

    C6H12O6 Approved members

    Joined:
    Sep 16, 2008
    Messages:
    1,451

    and a few more :):)



    Imbergamo, M. P., Amato, M. C., Sciortino, G., Gambina, M., Accidenti, M., Criscimanna, A., . . . Galluzzo, A. (2008). Use of glargine in pregnant women with type 1 diabetes mellitus: A case-control study. Clinical Therapeutics, 30(8), 1476-1484. doi:10.1016/j.clinthera.2008.08.013

    Karag?zel, G., Satılmış, A., Ak?urin, S., & Bircan, İ. (2006). Comparison of breakfast and bedtime administration of insulin glargine in children and adolescents with type 1 diabetes. Diabetes Research and Clinical Practice, 74(1), 15-20. doi:10.1016/j.diabres.2006.03.007

    Krans, H. M. J. (2004). Insulin, glucagon, and hypoglycemic drugs. In J.K. Aronson, MA, MBChB,FRCP (Ed.), Side effects of drugs annual (pp. 446-464) Elsevier. doi:10.1016/S0378-6080(04)80049-7

    Lu, M., & Inboriboon, P. C.Lantus insulin overdose: A case report. The Journal of Emergency Medicine, In Press, Corrected Proof doi:10.1016/j.jemermed.2010.04.007

    Meneghini, L., Liebl, A., & Abrahamson, M. J. (2010). Insulin detemir: A historical perspective on a modern basal insulin analogue. Primary Care Diabetes, 4(Supplement 1), S31-S42. doi:10.1016/S1751-9918(10)60007-1

    Miller, D. R., Gardner, J. A., Hendricks, A. M., Zhang, Q., & Fincke, B. G. (2007). Health care resource utilization and expenditures associated with the use of insulin glargine. Clinical Therapeutics, 29(3), 478-487. doi:10.1016/S0149-2918(07)80086-5

    Rolla, A. (2008). Pharmacokinetic and pharmacodynamic advantages of insulin analogues and premixed insulin analogues over human insulins: Impact on efficacy and safety. The American Journal of Medicine, 121(6, Supplement 1), S9-S19. doi:10.1016/j.amjmed.2008.03.022

    Rosenstock, J., Banarer, S., & Owens, D. (2006). Insulin strategies in type 1 and type 2 diabetes mellitus. In Vivian A. Fonseca, & MD (Eds.), Clinical diabetes (pp. 371-394). Philadelphia: W.B. Saunders. doi:10.1016/B978-1-4160-0273-4.50034-5

    Wang, F., Carabino, J. M., & Vergara, C. M. (2003). Insulin glargine: A systematic review of a long-acting insulin analogue. Clinical Therapeutics, 25(6), 1541-1577. doi:10.1016/S0149-2918(03)80156-X

    Wang, X. L., Lu, J. M., Pan, C. Y., Mu, Y. M., Dou, J. T., Ba, J. M., & Wang, X. (2007). Evaluation of the superiority of insulin glargine as basal insulin replacement by continuous glucose monitoring system. Diabetes Research and Clinical Practice, 76(1), 30-36. doi:10.1016/j.diabres.2006.08.005
     
  17. hrtmom3

    hrtmom3 Approved members

    Joined:
    Jun 30, 2007
    Messages:
    1,128
    We tried giving lantus in the morning, tried early evening, later evening, , tried split dose...all with the same results. At the 5 hour mark it showed a definite peak/plateau no matter when it was given.
     
  18. Lee

    Lee Approved members

    Joined:
    Oct 5, 2006
    Messages:
    9,633
    I voted no peak. I used to think we saw a peak, but once we started using a variable basal pattern, I realized that the peak was just a long slow drop in her basal needs in the night.
     
  19. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    I can not access the articles without paying through the nose - do you have access to the full articles?

    By the way, love your handle.. :)
     
  20. SarahKelly

    SarahKelly Approved members

    Joined:
    Nov 14, 2009
    Messages:
    1,147
    Wilf-I voted between 3-6hrs, my husband swears by it for himself and he's been using lantus for a long time now and consistently sees a peak around the 4 hour mark for himself. He has changed his intake so that he receives more in the AM and less in the PM which helps to keep him from dropping while sleeping, but he for sure sees a peak.
     

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