Potential Lantus Gap (English)

Preliminary note: The following comments are not ment as an medical advisory. Every human needs other solutions for his health care. Therefore the diabetologist or nutritionist is the contact person for individual recommendations. My comments are meant to provoke thoughts about your treatment.

The drug called Lantus is a modern and very effective basal insulin. Its effect on the blood glucose is very steady and it needs only one injection per day. Therefore the late risers will appreciate this characteristic.

Unfortunately there are humans where the duration of the insulin effect is lower than 24 hours. This means that there is a potential gap in the supply with basal insulin. This gap happens around the typical injection time of Lantus.

The following image will show the potential impact of this gap. The black line in the middle separates two days. The Lantus will be injected around 22:00 o'clock. The insulin will need several hours to regain its effectiveness. Thus the gap is just after midnight. This causes an increase of the level of blood glucose between 22:00 and 1:30 o'clock. From 1:30 o'clock the effect of the Lantus will kick in that has been applied at 22:00 o'clock. But the Lantus can only stabilize the higher blood glucose level and it will not descrease it. The patient will experience a high blood glucose in the morning.




One problem is that the patient is sleeping when the gap is happening. Thus he can not react properly to the rise. Therefore it is recommendable to reschedule the injection of Lantus from 22:00 to 18:00 o'clock. This can be done in multiple steps:

Day 1: 21:00 o'clock
Day 2: 20:00 o'clock
Day 3: 19:00 o'clock
Day 4: 18:00 o'clock

After this shift the situation would be comparable to the next image. Now the gap happens around 18:00 o'clock. So the patient can treat the glucose increase with an injection of rapid insulin at 22:00 o'clock. This will allow him to reach a normal blood glucose in the morning. At the same time this hardens the assumption that the high glucose levels in the morning where caused by the nightly Lantus gap.




Now the patient can try to compensate the Lantus gap with an increase of the bread unit factor from 18:00 to 21:00 o'clock. This increase could be done as follows:

18:00 o'clock from 3 to 5
19:00 o'clock from 3 to 5
20:00 o'clock from 2 to 4
21:00 o'clock from 2 to 3.5

The higher level of rapid insulin should compensate the increase of glucose that is caused by the gap. In an ideal situation - like the following image - a normal glucose level can be reached at 22:00 o'clock:




Warning: this kind of changes to your treatment make it necessary to intensify your testing. To reduce the likelyhood of a hypoglycemia you should test your blood glucose level every 30 minutes from 18:00 o'clock!

Please contact your Diabetologist if you have the strong suspicion that you are experiencing this kind of Lantus gap and you are not willing to try the steps above. In any case I would like to encourage you to find a solution.

Another way to treat the gap is by applying Lantus two times a day with half of the dose. Please balance the pros and cons of these strategies and select the solution that will solve your problem in cooperation with your Diabetologist.