Frequently Asked Questions About
Prefilled, disposable pens like the
Lantus® SoloSTAR®is prefilled with Lantus®—the only 24-hour insulin approved exclusively for use once a day1 Lantus® SoloSTAR®is the only insulin pen in which the dose can be set from 1-80 units in 1-unit steps, dialed both up and down
- Once opened,
Lantus® SoloSTAR®can be used for up to 28 days and should not be refrigerated1
- A vial of
Lantus®contains 10 mL, while the same prescription for the Lantus® SoloSTAR®pen has 5 pens with 3 mL each. A patient can get 50% more Lantus®units for the same copay as the Lantus®vial on most insurance plansa
aBased on TRx data from IMS Health, NPAâ„¢ monthly database, time period from May 2003 to October 2013.
- Prefilled with the #1 prescribed insulina
- Easy to teach, with only 6 straightforward steps21,22
- Easy to use—dial lets patients select the appropriate
Lantus®dose from 1 to 80 units, 1 unit at a time21,22
- Easy to inject—dose cannot be dialed past the number of units left in the pen22,23
- It is important to keep the injection button pressed all the way in and to slowly count to 10 before withdrawing needle from skin. After a full injection, the number in the dose window will return to zero. These steps help ensure that a full dose has been delivered
- Insulin dose dialed is the dose delivered24
- Dose dial returns to zero once dose has been delivered
- Portable25—once opened, the
Lantus® SoloSTAR®pen can be used for up to 28 days and should not be refrigerated. Instruct patients to keep the opened Lantus® SoloSTAR®pen at room temperature (below 86°F). Lantus® SoloSTAR®pens must be discarded 28 days after being opened1
Vials must also be discarded 28 days after being opened. Once the vial is opened, you can keep it in the refrigerator or at room temperature but away from direct heat and light.
- To see how your patients' managed care plans cover
Lantus®, use our formulary tool.
Lantus® SoloSTAR®pen users pay no more than $25 per prescription, for up to 3 prescriptions, with the Lantus®Savings Card.* Download the Lantus®Savings Card.
*Benefit may vary depending upon out-of-pocket costs. Card carries a maximum benefit of $100 per prescription for up to 3 prescriptions (maximum of $300) for the duration of this program.
When injected into the neutral pH environment of the subcutaneous tissue, the acidic
solution microprecipitates, slowly releasing insulin. This accounts for the lack
of a pronounced peak and longer duration of action, which allows
Do not dilute or mix
If your patients' A1C goals are not being reached by a basal insulin that has been properly titrated to appropriate FPG target,
consider timely intensification of insulin therapy to a basal-prandial regimen.3 If
your patients are on a basal-prandial regimen, know that
Hypoglycemia is the most common adverse reaction of insulin, including
When starting a type 2 diabetes patient on
- When initiating
Lantus®in insulin-naïve patients, add 10 units or 0.2 units/kg to OADs
- When switching patients from once-daily NPH to
Lantus®, substitute 1 unit for 1 unit
- Twice-daily NPH users who switch should initiate their
Lantus®dose at 80% of their total daily NPH dose
- When switching a premix insulin patient to
Lantus®, begin their dose at 80% of the intermediate-acting portion of their premixed insulin
The recommended starting dose of
The starting dose should be individualized based on the type of diabetes and
whether the patient is insulin naïve. Administer
Structure titration to help patients reach target fasting blood glucose levels.
Adapted from Gerstein.4
FPG=fasting plasma glucose.
Two suggested titration options6-8,a
The dose of
aOther titration options are available.
- 10 mL vial (1000 Units/10 mL)
- 3 mL
Lantus® SoloSTAR®prefilled disposable insulin pen (300 Units/3 mL)
Patients should be instructed on proper injection technique and to closely
follow the instructions in the instruction leaflet that accompanies the
A recombinant human insulin analog,
The time course of action of insulin, including
Long-acting basal insulins like
As this chart demonstrates, to closely mimic normal physiologic insulin secretion, a constant supply of basal insulin (glargine) and a mealtime dosing of prandial insulin is essential.10
- Is relatively continuous over 24 hours
- Suppresses blood glucose production between meals and overnight
- Should contribute approximately 50% of daily insulin needs
- Has no pronounced peak1
Hypoglycemia is the most common adverse reaction of insulin therapy,
- Allergic reactions
- Severe, life-threatening, generalized allergy, including anaphylaxis, can occur
- Rash, lipodystrophy, pruritus
- Weight gain
- In order to limit the risk of hypoglycemia, it's important for healthcare professionals to ensure that patients are taking their insulin as directed. Patients should be made aware of the activities that might alter blood glucose such as exercise, which stimulates glucose removal from the blood.14
These are some of the side effects for insulins such as
Patient adherence is an important part of insulin therapy. Several psychological barriers to the initiation of insulin therapy have been identified: injection anxiety, fear of hypoglycemia, or personal failure.12,13,20
- A Certified Diabetes Educator* or CDE*, can help support you and your patients when you transition them to insulin therapy. Patients can sign up for a FREE
online education session with a CDE live on webcam to answer questions. Patients
will learn the basics of diabetes self-management to support informed decision-making,
as well as step-by-step injection instructions for starting on
Lantus® SoloSTAR®or vial and syringe.
- Another way to help patients initiate insulin is to address the method of insulin administration. Explain all options available for insulin delivery, including easy-to-use pens.19
Patients should be informed that changes to insulin regimens must be made cautiously and only under medical supervision. It is important to inform patients about the potential side effects of insulin therapy, including hypoglycemia, lipodystrophy (and the need to rotate injection sites within the same body region), weight gain, and allergic reactions.
It is critical to instruct patients on self-management procedures, including glucose monitoring, proper injection technique, and management of hypoglycemia and hyperglycemia. Patients must be instructed on handling of special situations such as intercurrent conditions (illness, stress, or emotional disturbances), an inadequate or skipped insulin dose, inadvertent administration of an increased insulin dose, inadequate food intake, and skipped meals.
Patients with type 2 diabetes suffer from insulin deficiency long before their diagnosis.11
Adapted from Holman.11
By the time most patients are diagnosed with type 2 diabetes, their pancreatic beta-cell function may have deteriorated up to 50%.11 In one study, it was shown that from the time of diagnosis to the start of insulin therapy, the average patient spent nearly 5 years with an A1C >8% and about 10 years with A1C >7%.a,11
aBased on retrospective observational data from 7208 episodes of treatment initiation and secondary failure.
aGlucose utilization rate in mg/kg/min, determined as the amount of glucose infused to maintain
constant plasma glucose levels (hourly mean values); indicative of insulin activity.
A double-blind, randomized, crossover, euglycemic clamp study involving 20 patients with type 1 diabetes.
From Lepore15 and
Lantus®should be taken once a day at the same time each day
- The time course of action of insulins, including
Lantus®, may vary between individuals and within the same individual
Glucose infusion rate (mg/kg/min).
Adapted from Porcellati.16
Glucose infusion rate (mg/kg/min).
Adapted from Plank.17
Indications and Usage for
Lantus® (insulin glargine [rDNA origin] injection)
Important Limitations of Use:
Indications and Usage for Apidra® (insulin glulisine [rDNA origin] injection)
Apidra® is a rapid-acting insulin analog indicated to improve glycemic control in adults with type 2 diabetes or adults and children (4 years and older) with type 1 diabetes.
When used as a mealtime insulin, the dose of Apidra® should be given within 15 minutes before or within 20 minutes after starting a meal. Apidra® given by subcutaneous injection should normally be used in regimens that include a longer-acting insulin.
Important Safety Information for
Lantus® (insulin glargine [rDNA origin] injection) & Apidra® (insulin glulisine [rDNA origin] injection)
Apidra® is contraindicated during episodes of hypoglycemia and in patients hypersensitive to Apidra® or any of its excipients.
Warnings and Precautions
Closely monitor blood glucose in all patients treated with insulin. Modify insulin regimens cautiously and only under medical supervision. Changes in insulin strength, manufacturer, type, or method of administration may result in the need for a change in insulin dose or an adjustment in concomitant oral antidiabetic treatment. As with all insulin preparations, the time course of action may vary by individual or at different times in the same individual and is dependent on many conditions, including the site of injection, local blood supply, or local temperature.
Hypoglycemia is the most common adverse reaction of insulin therapy, including
Severe life-threatening, generalized allergy, including anaphylaxis, can occur. Discontinue
A reduction in the
Fluid retention, which may lead to or exacerbate heart failure, can occur with concomitant use of thiazolidinediones (TZDs) with insulin. These patients should be observed for signs and symptoms of heart failure. If heart failure occurs, dosage reduction or discontinuation of TZD must be considered.
Certain drugs may affect glucose metabolism, requiring insulin dose adjustment and close monitoring of blood glucose. The signs of hypoglycemia may be reduced in patients taking anti-adrenergic drugs (e.g., beta-blockers, clonidine, guanethidine, and reserpine).
Adverse reactions commonly associated with
In clinical studies in adult patients there was a higher incidence of treatment-emergent injection-site pain (2.7%
Important Safety Information for
Lantus®Prescribing Information. October 2013.
- Meece J. Am J Health-Syst Pharm. 2008;65:1076-1082.
- Raccah D, Bretzel RG, Owens D, Riddle M. Diabetes Metab Res Rev. 2007;23(4):257-264.
- Gerstein HC, Yale J-F, Harris SB, et al. Diabetic Med. 2006;23(7): 736-742.
- Riddle MC, Rosenstock J, Gerich J, on behalf of the Insulin Glargine 4002 Study Investigators. Diabetes Care. 2003;26:3080-3086.
- Davies M, Storms F, Shutler S, et al. AT
Lantus®Study Group. Diabetes Care. 2005;28(6):1282-1288.
- Yki-Järvinen H, Ziemen M, Dressler A; HOE 901/3002 Study Group. Diabetes Care. 2000;23(8):1130-1136.
- Nathan DM, Buse JB, Davidson MB, et al. Diabetes Care. 2009; 32(1):193-203.
- McKeage K, Goa KL. Drugs. 2001;61(11):1599-1624.
- Leahy JL. In: Leahy JL, Cefalu WT, eds. Insulin Therapy. New York, NY: Marcel Dekker Inc; 2002: 87-112.
- Holman RR. Diabetes Res Clin Pract. 1998;40(suppl):S21-S25.
- Polonsky WH, Fisher L, Guzman S, et al. Diabetes Care. 2005;28(10):2543-2545.
- Hirsch IB, Bergenstal RM, Perkin CG, et al. Clin Diabetes. 2005; 23(2):78-86.
- American Diabetes Association. Diabetes Care. 2009;32(suppl 1):S13-S61.
- Lepore M, Pampanelli S, Fanelli C, et al. Diabetes. 2000; 49(12):2142-2148.
- Porcellati F, Rossetti P, Busciantella NR, et al. Diabetes Care. 2007;30(10):2447-2452.
- Plank J, Bodenlenz M, Sinner F, et al. Diabetes Care. 2005;28(5):1107-1112.
- Levemir Prescribing Information. July 2009.
- Korytkowski M, Bell D, Jacobsen C, Suwannasari R, for the FlexPen® Study Team. Clin Ther. 2003;25(11):2836-2848.
- Funnell M. Clin Diab. 2007;25(1):36-38.
- Hancu N, Czupryniak L, Genestin E, Sourij H. J Diabetes Sci Techol, 2011; 5(5):1224-1234
- Data on file, Sanofi U.S. LLC.
- Clarke A, Spollett G. Expert Opin Drug Deliv. 2007;4(2):165-174.
- Krzywon M, Abdel-Tawab M, van der Burg T, Fuhr U, Schubert-Zsilavecz M. Curr Med Res Opin. 2010;26(4):901-905.
- Haak T, Edelman S. Walter C, et al. Clin Ther. 2007;29(4):650-660.