July 16, 2013

Mixing Lantus and Rapid Acting Insulin

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mixedHave you ever wondered what would happen if you mixed a long-acting analogue like Lantus and a rapid-acting analogue? Well, the researchers had this thought and published their findings in Diabetes Spectrum.

Rapid-acting insulin begins working fast, within minutes of injecting, and lasts for a few hours. Lantus, or glargine, is a once-daily injection that can last between 18 to 26 hours.

Nowadays, long-acting analogues (basal) and rapid-acting analogues (bolus) are not given together. It was done back in the days of NPH, Lente, and Ultralente with the short-acting insulin being Regular.

Can mixing these new basal analogues, like Lantus and Levemir,  with rapid-acting analogues, like NovoLog, Apidra, or Humalog, have a detrimental effect on glucose control?

Upon conceiving the idea for this comparison, 4 studies existed to provide data for this evaluation. All of these studies were conducted in pediatric patients with T1D.

Two of the clinical outcomes studies did not report significant differences in A1C levels or pre-meal, post-meal, or nighttime blood glucose levels from mixing glargine and rapid-acting insulin.

One of the clinical outcome studies reported improved blood glucose control with rapid-acting analogue mixed with Lantus, compared to rapid-acting analogue mixed with NPH insulin. There were no significant differences in hypoglycemia in any of the clinical outcome trials at any time measured. People who used Ultralente said it gave them supreme control. Maybe Lantus is the modern-day Ultralente?

Based on preliminary review, no significant changes in clinical outcomes were observed when mixing Lantus with rapid-acting insulin. If you’re wondering what criteria constitutes clinical outcomes, they are: lood glucose levels, A1C levels, and hypoglycemia.

Off the record, I know a handful of people who take an injection of a long-acting analogue and supplement it with an insulin pump, for bolus insulin at meals. Their diabetes control is unaffected. Granted, it’s not being delivered in the same injection, but it’s still ending-up in the same place without decay.

However, if you’d like to MacGyver your insulin dose, delivery method(s), or mixing technique – speak to your doc and see what he or she says.

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