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Will Lantus Give Me the Same Flexibility the Pump Does?
Q: I have had type 1 diabetes for 20 years. I tried the insulin pump and didn't like it. So now I don't have any flexibility with my food or lifestyle if I want to keep my blood glucose under control.
Will Lantus (insulin glargine) give me flexibility the same way a pump does? For instance, can I take it once a day and then inject rapid insulin when I eat, etc.?
Tel Aviv, Israel
A: With Lantus as your basal insulin, you can live a very flexible lifestyle. The dose would be exactly what the basal requirements were with your pump, and you would take the same pre-meal boluses that you do now. If you switch to Lantus (insulin glargine), I recommend getting a good insulin pen with short ultrafine needles for the bolus rapid-acting insulin injections.
The downside, compared to the pump, is that you will be taking several injections per day and will be unable to have alternate basal rates throughout the day.
The upside is that you don't have to worry about pump occlusions, running empty or having the infusion line come out. When these things happen, the blood glucose rises very quickly because there is no long-acting basal insulin on board when using the pump.
Steven Edelman, MD
Associate Professor of Medicine
Division of Diabetes and Metabolism
University of California, San Diego, School of Medicine
Editor's note: For more information about various insulins and insulin pens, available in handy chart form, see these two articles in Diabetes Health: "Everything You Wanted to Know About Insulin" (March 2002, page 46), and "Your Own Injection: An Overview of Insulin Pens" (April 2002, page 48).
How Can I Better Control My Fasting BGs?
Q: People with diabetes, it would seem, have much more control over after-meal spikes by controlling the amount of food they eat, getting more exercise or adjusting meds/insulin.
However, what about the high morning readings?
Try as I may, mornings end up high (175-215 mg/dl).
What do you recommend?
A: The fasting, or morning, blood-glucose concentration may be a victim of several things:
In addition, if you have a middle-of-the-night low, the low blood glucose elicits a counter-regulatory response of anti-insulin hormones that produce glucose from the storage of glucose precursors in the liver. The net result is a high blood glucose about three hours after the low. Thus, a low at 3 to 4 a.m. can result in a high blood glucose upon awakening.
Lois Jovanovic, MD
Director and Chief Scientific Officer
Sansum Medical Research Institute
Santa Barbara, California
Diabetes Health is the essential resource for people living with diabetes- both newly diagnosed and experienced as well as the professionals who care for them. We provide balanced expert news and information on living healthfully with diabetes. Each issue includes cutting-edge editorial coverage of new products, research, treatment options, and meaningful lifestyle issues.