From the Guidelines
When switching from NPH 70/30 to Lantus, it is crucial to consider an individualized approach based on current glycemic control, as suggested by the 2023 standards of care in diabetes 1. To initiate the switch, calculating the total daily dose of NPH 70/30 is essential. However, the exact method of conversion to Lantus is not directly outlined in the provided evidence. Given the information available, a practical approach might involve:
- Assessing the patient's current insulin regimen and glycemic control
- Considering the switch from bedtime NPH to a twice-daily NPH regimen if applicable, as per the standards of care in diabetes-2023 1
- Ultimately, transitioning to Lantus (insulin glargine) with a dose reduction to account for its pharmacokinetic profile, which provides a more consistent 24-hour coverage
- Adding a rapid-acting insulin before meals to replace the fast-acting component of the NPH 70/30 mix
- Monitoring blood sugar levels frequently during the transition period to adjust the insulin doses as needed
- Supervising the switch under the guidance of a healthcare provider to tailor the regimen to the patient's specific needs Key considerations include:
- The importance of individualizing the conversion based on the patient's current glycemic control and insulin regimen
- The potential benefits of Lantus in providing more consistent basal coverage and reducing the risk of nighttime hypoglycemia
- The need for close monitoring and adjustments during the transition period to ensure optimal glucose control and minimize adverse effects.
From the FDA Drug Label
When switching from: • Once-daily NPH insulin to once-daily Insulin Glargine-yfgn, the recommended starting Insulin Glargine-yfgn dosage is the same as the dosage of NPH that is being discontinued. • Twice-daily NPH insulin to once-daily insulin Glargine-yfgn, the recommended starting insulin Glargine-yfgn dosage is 80% of the total NPH dosage that is being discontinued.
To switch from NPH 70/30 to Lantus, the recommended starting dosage of Lantus is the same as the dosage of NPH that is being discontinued if the NPH is taken once daily. However, since NPH 70/30 is typically taken twice daily, the recommended starting Lantus dosage would be 80% of the total NPH dosage that is being discontinued 2.
From the Research
Switching from NPH 70/30 to Lantus
To switch from NPH 70/30 to Lantus, consider the following points:
- Lantus (insulin glargine) is a long-acting insulin analog, whereas NPH 70/30 is an intermediate-acting insulin 3, 4.
- Studies have shown that insulin glargine provides better glycemic control than NPH insulin, with similar or reduced risk of hypoglycemia 3, 4, 5.
- When switching from NPH 70/30 to Lantus, the dosage may need to be adjusted to achieve optimal glycemic control 3, 5.
- It is essential to monitor blood glucose levels and adjust the dosage as needed to minimize the risk of hypoglycemia 6.
Key Considerations
- The risk of severe hypoglycemia is lower with long-acting insulin analogs like Lantus compared to NPH insulin, especially in older patients 6.
- Insulin glargine has been shown to have a lower risk of nocturnal hypoglycemia compared to NPH insulin 5.
- The dosage of Lantus may need to be adjusted based on individual patient factors, such as age, weight, and concomitant medications 3, 5.
Clinical Evidence
- A study published in 2007 found that insulin glargine improved glycemic control and reduced the risk of hypoglycemia compared to NPH insulin in patients with type 2 diabetes 3.
- A review of clinical studies published in 2007 found that insulin glargine had similar efficacy to NPH insulin, with a lower risk of nocturnal hypoglycemia 5.
- A retrospective cohort study published in 2021 found that initiation of long-acting insulin analogs, including Lantus, was associated with a lower risk of hypoglycemia compared to NPH insulin in older patients with type 2 diabetes 6.