* Recommended Dosage: Individually determined dose administered subcutaneously once daily at bedtime.
* Special Considerations: As with all insulins, hypoglycemia is the most common adverse effect, but the risk is lower than with NPH insulin. Should never be diluted or mixed with other insulins.
* Comment: Once injected, Lantus is slowly released from the subcutaneous tissue over 24 hours in a reproducible and predictable absorption pattern, with no peaks and a flat glycemic curve, said Dr. Robert Ratner, medical director of Med-Star Clinical Research Center, Washington. This reproducibility is "the major advantage" of Lantus over human ultralente, the absorption pattern of which, "clearly has a peak, and causes erratic hypoglycemia," he explained.
Lantus can be used in patients who are candidates for an overnight dose of NPH or ultralente, in combination with regular insulin or the more rapidly acting Humalog (lispro insulin) before meals in type 1 diabetics, and with short-acting insulin or oral agents in type 2 diabetics, he advised. Dr. Ratner, the principal investigator in studies of Lantus in type 1 diabetics, has received research funds from Aventis, Lantus won't be available until later this year.