From the Guidelines
No, Lantus (insulin glargine) should not be given with insulin 70/30. Insulin 70/30 is a premixed insulin that already contains both intermediate-acting (NPH) and short-acting (regular) insulin components, designed to cover both basal and mealtime insulin needs [ 1 ]. Adding Lantus, which is a long-acting basal insulin, would create significant overlap in the basal coverage, potentially causing dangerous hypoglycemia.
Key Considerations
- Insulin 70/30 provides approximately 70% NPH insulin (intermediate-acting) for basal coverage and 30% regular insulin for mealtime coverage.
- This premixed formulation is typically administered twice daily, before breakfast and dinner.
- If blood glucose control is inadequate with insulin 70/30 alone, the healthcare provider might consider adjusting the 70/30 dose or switching to a different insulin regimen altogether, such as a basal-bolus approach using Lantus plus rapid-acting insulin separately, rather than adding Lantus to the existing 70/30 regimen [ 1 ].
Alternative Approaches
- According to the 2017 American Diabetes Association standards of medical care in diabetes, further options for treatment intensification include adding a single injection of rapid-acting insulin analogue before the largest meal, adding a GLP-1–receptor agonist, or stopping basal insulin and starting twice-daily premixed insulin [ 1 ].
- The choice of insulin regimen should be individualized based on the patient's specific needs and circumstances, taking into account factors such as lifestyle, meal patterns, and ability to administer injections [ 1 ].
From the Research
Insulin Regimens
- The use of Lantus (insulin glargine) with insulin 70/30 is still a viable option in certain cases, as evidenced by studies comparing the efficacy of different insulin regimens 2, 3.
- Insulin 70/30, also known as biphasic insulin aspart 30, is a premixed insulin that combines rapid-acting and intermediate-acting insulin 2.
- Lantus, on the other hand, is a long-acting basal insulin analogue that provides a relatively constant level of insulin throughout the day 3.
Efficacy and Safety
- Studies have shown that biphasic insulin aspart 30 can provide improved postprandial glucose control compared to other insulin regimens, including Lantus 2.
- However, Lantus has been shown to provide equivalent or better glycemic control compared to NPH insulin, with a lower risk of hypoglycemia 3.
- The combination of Lantus with insulin 70/30 may be considered in certain cases, such as in patients who require both basal and prandial insulin coverage 4.
Clinical Considerations
- The choice of insulin regimen should be individualized based on the patient's specific needs and circumstances 3, 5.
- Factors such as the patient's lifestyle, diet, and activity level should be taken into account when selecting an insulin regimen 5.
- The use of insulin analogues, such as Lantus and insulin 70/30, can provide improved glycemic control and reduced risk of hypoglycemia compared to traditional insulin regimens 2, 3, 5.