When it comes to taking insulin, what are
the benefits of the LANTUS® SoloSTAR® pen?
How can I switch my inpatients from IV-RHI
to LANTUS®?
Does the LANTUS® SoloSTAR® pen have
good insurance coverage?
How can I reduce the risk of hypoglycemia
when managing patients?
How do the pharmacodynamic profiles of LANTUS®
and NPH compare?
How does basal-bolus insulin therapy
compare with sliding-scale insulin delivery in hospitalized patients with diabetes?
When it comes to taking insulin, what are the benefits of the LANTUS® SoloSTAR®
pen?
One of the reasons certain patients are hesitant about starting insulin therapy
is that insulin therapy regimens can be confusing.74
In a survey of 456 patients using an insulin pen, 77% reported finding it easier
to comply with their insulin regimen.74
The LANTUS® SoloSTAR® pen is designed for ease of use and has optimized
dose and injection features. It’s easy to teach, as it can be used in 5 straightforward
steps. The LANTUS® SoloSTAR® pen is also easy to use, allowing doses between
1 and 80 units with just one injection.
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How can I switch my inpatients from IV-RHI to SC LANTUS®?
LANTUS® should be administered once a day at the same time each day. The dose of
LANTUS® should be individualized based on clinical response. Blood glucose monitoring
is essential to all patients receiving insulin therapy.
If an inpatient on an IV drip of regular human insulin (RHI) is being switched to
LANTUS®, begin the patient on LANTUS® 2 hours before stopping the RHI drip.
For patients receiving a very-low-calorie intake, there are two options for initial
dosage: the first is to estimate the 24-hour insulin use based on the IV drip rate
during the last 6 or 8 hours, then multiply that number by 80%. The second option
is to multiply the mean overnight drip rate (units per hour) by 20 hours. Adjust
as needed.
For patients with normal oral intake, or who are receiving an IV of dextrose or
enteral feedings, the LANTUS® dose should match the patient’s 24-hour combined
basal and nutritional requirements.
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Does the LANTUS® SoloSTAR® pen have good insurance coverage?
The LANTUS® SoloSTAR® pen is available for the same copay as the LANTUS®
vial for most managed care plans. This may translate to patients receiving 50% more
LANTUS® units per prescription for the same copay as the vial. One prescription
for the LANTUS® SoloSTAR® pen provides a box with 5 pens, each one containing
300 units of LANTUS® insulin for a total of 1500 units. One prescription for
a vial of LANTUS® insulin is only 1000 units. For the same copay, many of your
patients could save on the cost of LANTUS® insulin with the LANTUS® SoloSTAR®
pen.
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How can I reduce the risk of hypoglycemia when managing patients?15
In order to limit the risk of hypoglycemia, it’s important for physicians to ensure
that patients are taking their insulin as prescribed. Make patients aware of the
common causes of hypoglycemia, such as too much insulin, too little food or missed
meals, and too much exercise or activity. Early warning signs of hypoglycemia may
be different, less noticeable or not noticeable at all in some people. That is why
it is important for patients to check their blood sugar. Patients should be informed
that the ability to concentrate and react may be impaired as a result of hypoglycemia.
This may present a risk in situations where these abilities are especially important,
such as driving or operating other machinery.
A Low Rate of Severe Hypoglycemia in Patients Taking Once-Daily LANTUS®36
a Hypoglycemic events were classified as
severe if patients required assistance and either promptly responded
to therapy with oral carbohydrate, intravenous glucose, or parenteral glucagon,
or had a documented capillary glucose ≤36 mg/dL. Data were based on numbers of patients
experiencing specified adverse events. From Gerstein and data on file.36
b(P=NS)
If you are managing inpatients, hypoglycemia is a common obstacle to improving diabetes
care. Detailed planning is required when discharging inpatients with diabetes to
ensure the patient is educated about the risks of hypo- and hyperglycemia:
Reemphasize to the patient his or her diabetes diagnosis. Give clear recommendations
for short- and long-term glycemic management. Finally, connect the patient with
a Certified Diabetes Educator, or CDE, and schedule a follow-up visit to educate
the patient about diabetes management.
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How do the pharmacodynamic profiles of basal insulins compare?
LANTUS® is the only 24-hour insulin approved exclusively for use once a day,
and has been shown to exhibit a longer duration at a dose of 0.3 Units/kg over a
24-hour period.19
a Glucose 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.
Adapted from Lepore.19
The graph shows results from a study in patients with type 1 diabetes. The median
time between injection and the end of the pharmacological effect was 14.5 hours
for neutral protamine Hagedorn, or NPH, insulin and 24 hours for LANTUS®. Comparing
the profile of NPH to LANTUS® after subcutaneous injection in type 1 patients,
LANTUS® shows no peak over 24 hours.19
The longer duration of action of LANTUS® is directly related to its slower rate
of absorption and supports once daily subcutaneous administration. LANTUS® should
be administered at the same time each day. The time course of insulins, including
LANTUS®, may vary between individuals and within the same individual.
This is the action profile of LANTUS® compared to detemir in patients with type
1 diabetes.
d Glucose infusion rate (mg/kg/min).
Adapted from Porcellati.30
Twenty-four subjects with type 1 diabetes naïve to glargine and detemir were studied
twice in a randomized, double-blind crossover study. Plasma glucose was clamped
at 100 mg/dL for 24 hours after subcutaneous injection of 0.35 Units/kg of either
glargine or detemir. At 0.35 Units/kg, this study showed that LANTUS® had no pronounced
peak and lasted a full 24 hours, and the mean action profile of detemir tapered
off around hour 16.30
In this single-center, double-blind study, 12 subjects with type 1 diabetes were
randomized to a specific treatment sequence encompassing 5 dose levels of insulin
detemir. The subjects were kept isoglycemic, defined as 130 mg/dL, and C-peptide–negative,
defined as levels less then 0.03 nmol/L.31
d Glucose infusion rate (mg/kg/min).
Adapted from Plank.31
When we look at detemir, we see the duration of action is dose-dependent.30,31
Detemir can be administered once or twice daily. The mean duration of action of
detemir ranged from 5.7 hours at the lowest dose to 23.2 hours at the highest dose
(sampling period of 24 hours).
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How does basal-bolus insulin therapy compare with sliding-scale insulin delivery
in hospitalized patients with diabetes?
Sliding-scale insulin monotherapy may lead to wide fluctuations in blood glucose
levels.55
A review of 52 studies published over a 37 year period suggests that sliding scale
insulin alone is suboptimal. Sliding-scale insulin monotherapy, or SSI, has many
limitations.55
Many regimens include the practice of insulin initiation when glucose levels exceed
200 mg/dL.59
With SSI, dosing is reactive, based on inadequacy of previous doses, rather than
proactive.55
Treatment with a basal-bolus insulin regimen achieved better glycemic control than
SSI delivery in noncritically ill hospitalized patients and nonsurgical patients
with type 2 diabetes.59
With the blood glucose target of <140 mg/dL, 66% in the basal-bolus group reached
the target, while only 38% in the SSI group met this goal. There were no differences
between the groups in the rate of hypoglycemia.59
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Useful tools for your LANTUS®
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