Is it safe to add Lantus (insulin glargine) to a GLP-1 (glucagon-like peptide-1) agonist?

From the Guidelines

Yes, it is generally safe to add Lantus to a GLP-1 agonist medication for diabetes management, as this combination therapy is commonly used when a GLP-1 agonist alone doesn't provide adequate blood glucose control. This combination is supported by recent guidelines, such as those outlined in the 2017 American Diabetes Association standards of medical care in diabetes 1. Lantus is a long-acting basal insulin that works by providing a steady background level of insulin throughout the day, while GLP-1 agonists (such as Ozempic, Trulicity, or Victoza) work by stimulating insulin release in response to meals, slowing gastric emptying, and reducing glucagon production.

When starting Lantus with a GLP-1 agonist, a typical initial dose is 10 units once daily, usually at bedtime, with dose adjustments based on fasting blood glucose readings. The main risk of this combination is hypoglycemia (low blood sugar), though it's less common than when combining insulin with other diabetes medications, as noted in the Israel National Diabetes Council's recommendations 1. You should monitor your blood glucose levels more frequently when starting this combination and be aware of hypoglycemia symptoms like shakiness, sweating, confusion, and dizziness. Weight gain is possible with insulin, though the GLP-1 agonist may help counteract this effect.

Some key points to consider when adding Lantus to a GLP-1 agonist include:

• Monitoring for hypoglycemia and adjusting the dose as needed
• Being aware of the potential for weight gain and taking steps to mitigate it
• Regularly reviewing and adjusting the treatment plan with your healthcare provider to ensure optimal blood glucose control
• Considering the patient's individual characteristics, such as age, renal function, and presence of previous cardiovascular disease, when determining the best course of treatment, as suggested by the Israel National Diabetes Council's recommendations 1.

Always consult with your healthcare provider before making any changes to your diabetes medication regimen.

From the Research

Safety of Adding Lantus to GLP-1 Agonist

• The safety of adding Lantus (insulin glargine) to a GLP-1 agonist for the treatment of type 2 diabetes has been evaluated in several studies 2, 3, 4, 5.
• A study published in 2016 found that adding a GLP-1 receptor agonist to a basal insulin regimen, including Lantus, resulted in significant improvements in HbA1c and weight loss, with a reduction in insulin doses 4.
• Another study published in 2010 compared the efficacy and safety of GLP-1 receptor agonists with insulin glargine in patients with type 2 diabetes and found that GLP-1 receptor agonists were associated with significant weight loss and reduced gastrointestinal adverse effects, but had a higher incidence of nausea and vomiting 5.
• The use of GLP-1 agonists in combination with insulin therapy has also been evaluated in patients with type 1 diabetes, with some studies suggesting benefits including reductions in hemoglobin A1c, decreased insulin doses, and favorable effects on weight 6.

Potential Benefits and Risks

• The potential benefits of adding Lantus to a GLP-1 agonist include improved glycemic control, weight loss, and reduced insulin doses 4, 5.
• However, the combination of Lantus and a GLP-1 agonist may also be associated with an increased risk of gastrointestinal adverse effects, such as nausea and vomiting 5.
• Additionally, the use of multiple therapies for diabetes treatment may increase the risk of hypoglycemia, although some studies have found limited evidence of this risk 6.

Clinical Considerations

• The decision to add Lantus to a GLP-1 agonist should be made on a case-by-case basis, taking into account the individual patient's needs and medical history 2, 3.
• Healthcare providers should carefully monitor patients for potential adverse effects and adjust treatment regimens as needed to minimize risks and optimize benefits 4, 5.