Twice-daily Lantus Effective For Reducing Blood Sugars in Type 1 Diabetes

Blood glucose concentration in type 1 diabetes rises in the late afternoon in association with falling plasma insulin levels can be prevented with twice daily injection over once daily injection of Lantus. To compare blood glucose control when using insulin glargine twice daily at breakfast- and dinner-times with insulin glargine once daily at dinner time, in unselected people with Type 1 diabetes using insulin aspart at meal-times. In this 8-week, two-way, cross-over study, 20 people with Type 1 diabetes were randomized to insulin glargine injection once daily at dinner-time or twice daily at breakfast- and dinner-times, both plus meal-time insulin aspart.

Each 4-week treatment period concluded with a 24-h inpatient metabolic profile. Insulin doses, HbA(1c), fructosamine concentration and pre-breakfast self-monitored blood glucose (SMBG) concentration did not differ between treatment periods. SMBG concentrations after breakfast, after lunch and before dinner were lower with twice-daily compared with once-daily dinner-time glargine [167mg/dL (9.3mmol/l) vs. 121mg/dL (6.7mmol/l) ; 187mg/dL (10mm/l) vs. 126mg/dL (7.0mmol/l); 173mg/dL (9.6mmol/l) vs. 119mg/dL (6.6mmol/l) ]. Mean 24-h SMBG concentration was lower with twice-daily glargine (128mg/dl (7.1mmol/l) vs. 158mg/dL. (8.8mmol/l). Within-day variability of SMBG concentration was lower with twice-daily glargine (sd 3.2 +/- 0.2 vs. 4.0 +/- 0.3 mmol/l, P = 0.044). Plasma free insulin concentration was higher in the afternoon with twice-daily glargine (21.9 +/- 1.4 vs. 16.1 +/- 1.3 mU/l, P = 0.009), but lower overnight (12.1 +/- 1.7 vs. 17.8 +/- 1.7 mU/l, P = 0.030), compared with once-daily injection. Plasma glucose concentration overnight was higher with twice-daily compared with once-daily glargine (mean 9.0 +/- 0.4 vs. 6.6 +/- 0.4 mmol/l, P = 0.001).

Blood glucose concentration rises in the late afternoon in association with falling plasma insulin levels towards the end of the 24-h period after insulin glargine injection in some people with Type 1 diabetes using once-daily glargine at dinner-time plus a rapid-acting insulin analogue at meal-times. This is prevented by twice-daily injection of insulin glargine.
Diabet Med. 2006 Aug;23(8):879-86.

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