From the Guidelines
Lantus and Aspart can be used together as part of a basal-bolus insulin regimen for diabetes management, with Lantus serving as the long-acting basal insulin and Aspart as the rapid-acting insulin to control post-meal blood sugar spikes. This approach is supported by recent guidelines, such as those outlined in the 2023 standards of care in diabetes 1. When initiating combination injectable therapy, it is essential to maintain metformin therapy, while sulfonylureas and DPP-4 inhibitors are typically weaned or discontinued.
Key considerations for using Lantus and Aspart together include:
- Administering them as separate injections to preserve their individual action profiles
- Starting with a single prandial dose of Aspart with the largest meal of the day and advancing to multiple prandial doses if necessary
- Adjusting doses based on blood glucose levels, carbohydrate intake, and pre-meal blood glucose levels
- Monitoring blood glucose regularly to avoid hypoglycemia and ensure proper dosing
As outlined in the 2023 standards of care in diabetes, intensification of insulin treatment can be done by adding doses of prandial insulin, such as Aspart, to basal insulin, like Lantus 1. This approach allows for greater flexibility in managing blood glucose levels, especially in individuals with irregular eating schedules. However, it is crucial to weigh the benefits against potential drawbacks, such as increased complexity of the regimen and higher costs associated with insulin analogs.
In terms of specific dosing, a common regimen might include Lantus once daily at a dose determined by a healthcare provider, plus Aspart before meals based on carbohydrate intake and pre-meal blood glucose levels. Dose adjustments should only be made under medical supervision, considering factors like weight, activity level, illness, and stress. By combining Lantus and Aspart, individuals with diabetes can achieve more effective blood glucose control, mimicking natural insulin patterns more closely than either insulin alone.
From the Research
Lantus and Aspart Together
- The combination of Lantus (insulin glargine) and Aspart (insulin aspart) is a form of basal-bolus therapy, which is commonly used in the management of diabetes mellitus 2.
- Studies have shown that this combination provides similar or better glycemic control and leads to less nocturnal hypoglycemia compared to other insulin regimens 2, 3.
- The efficacy and safety of Lantus and Aspart have been demonstrated in various patient populations, including those with type 1 and type 2 diabetes, as well as in pediatric and adult patients 2, 4, 5.
Glycemic Control
- Lantus and Aspart have been shown to provide effective glycemic control, with improvements in HbA1c levels and postprandial glucose control 2, 4, 5.
- The combination of Lantus and Aspart has been compared to other insulin regimens, including biphasic insulin aspart and human NPH insulin, and has been found to be non-inferior in terms of glycemic control 4, 6.
Hypoglycemia Risk
- The risk of hypoglycemia is an important consideration when using insulin therapy, and Lantus and Aspart have been shown to have a lower risk of hypoglycemia compared to other insulin regimens 3, 5.
- The combination of Lantus and Aspart has been found to reduce the risk of nocturnal hypoglycemia and severe hypoglycemia compared to other insulin regimens 2, 3.