Lantus lows

Written by

Sat, September 15, 2007

I have 52 years, with 21 years of insulin dependent diabetes, 5 years using Lantus.

I use 3 rapid insulin bolus in day (pre-meals), and a lantus dose at night, some times I have hipoglycemias that can be easily managed with food.

8 days ago I get my SC lantus shoot at midnight and go to sleep, around 30 minutes later I feel a severe hypoglycemia (40 mg), who doesn´t relieved with food and lots of candies, I ended in a Hospital (ICU), getting repeated IV bolus of dextrose (the glycemia rise for moments and fall again), the situation relived a few hours later.

No one knew what had happened, the next day I found the syringe I used for the Lantus injection clogged with blood.

The only explanation I found is that accidentally I inyect Lantus in a small vessel in my leg, but is a possibility that has to be pointed in the literature of Lantus because of the serious complications it can have.

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Gretchen Becker

9/17/07 11:46am

Hi Jose,

I've written a blog on Lantus lows. You can find it here.

Dr. Bill Quick

9/17/07 3:27pm

Sorry to hear. Sounds scary, doesn't it? Blaming the Lantus might be the wrong conclusion, however.

Several thoughts:

1) you don't give your precise doses of Lantus vs. your premeal boluses, nor what your exercise was like that evening, so it's a bit tough to figure out exactly what happened.

2) is there any chance you injected your rapid-acting insulin INSTEAD OF your Lantus -- if so, it would all fit together very well on how you crashed so severely.

3) you might be less likely to have a recurrence if you divide your Lantus dose in half, and take half in the morning and half in the evening. Talk to your physician about this.

Hope this helps!

JoseM

9/17/07 6:28pm

Dear Dr. Quick:

The two previous days I received 8 units premeal of Novolin R with a penfill, in that specific day I didn´t do any special excercice work, and the administration of the Lantus Insuline ( 40 units since years ago) in the night was done with a SYRINGE, so it was no way to make a wrong administration. One of the odd things happened is that the hypoglycemia didn´t respond to the usual administration of oral food, and it was present repeatedly after the adminstration of IV dextrose bolus, and doctors need to give me a continuos infusion for around 3 hours with dextrose, until I didn´t get hypoglycemia.

Normaly if a diabetic have a hipoglycemic status it is relieved soon and fast with the proper steps.

It was very scary for me and my family, I hope it never happened again to me, or to any one else.

I´m starting any way to check twice to don´t do the SC lantus adminstration in a vein accidentaly, being or not the cause of my problem.

Again, thank you for your words

Jose

Gretchen Becker

9/17/07 6:46pm

Lantus injected into a blood vessel acts just like R. And 40 units of R would be a whopping dose!

Several of us have had these Lantus lows, and I agree with you that there should be more publicity about them.

Derek Paice even graphed his Lantus low on his Web site

http://www.dapaice.com
Click on Potpourri for diabetes tests

Dr. Bill Quick

9/20/07 8:12am

Jose:

Thanks for the additional information. I am now inclined to agree with Gretchen that your event was what she calls a "Lantus Low."

The Lantus Prescribing Information (available here) discusses this in generalities, but doesn't seem to discuss that this can happen from standard injections accidentally getting into the bloodstream: "Intravenous administration of the usual subcutaneous dose could result in severe hypoglycemia."

Since you ended up in a hospital, your episode qualifies as what is called a "Serious Adverse Event." And granted what you've described, I think that everyone will agree that your SAE is related to use of the Lantus. I'd advise that your physician or diabetes nurse (or yourself) contact the manufacturer, sanofi-aventis, and notify their pharmacovigilance department of what happened; alternatively a report can be filed at the FDA's "MedWatch" website. If you notify sanofi-aventis of an SAE, they are required to promptly notify the FDA and other similar Health Authorities world-wide.

If enough of these reports pile up at the Health Authorities, sanofi-aventis will be forced to change their label so physicians, nurse educators, and patients will be aware that this phenomenon is occurring. I'd suspect the label should be changed so there's a very clear additional sentence in the hypoglycemia section (and in the patient information!) that would read something like this:

"Sudden severe hypoglycemia resulting in hospitalization has been reported after accidental intravenous injection during attempted subcutaneous injection. Patients should be made aware of this phenomenon, and if unexpected severe hypoglycemia occurs shortly after Lantus administration, patients should be observed in a medical setting, and promptly treated with glucagon or intravenous glucose."

BTW, if anyone is thinking I'm anti-Lantus, let me add that I personally use Lantus for treatment of my own diabetes. But I'll warn my wife and family to doublecheck that I don't flake out soon after shooting up!

szuzu1969

8/14/08 5:30pm

Thanks for all the information from everyone. I am recently diagnosed Type II and my sugar dropped to 21 after my lantus shot. We have been trying to figure out what happened but suspected it was a vein injection. Thanks again.

JoseM

8/14/08 9:06pm

I hope the information I posted could help to someone, I would recommend you that if you inject Lantus SUBCUTANEOUSLY, always take a doble chek to see if it´s not inyected in a small vein, since that related episode I never got that severe low again.

Keep your strengt to mannage your Diabetes.

Jose

Brian J

11/ 3/07 2:21pm

Hi Jose. I am also 52 and have been a Type 1 for the past 20 years. Its not often you meet someone who also got it past 30.

I also take Novorapid pre-meals(usually about 9 units) and take 28 units of Lantus at 4 pm each day. I have only been using Lantus for 2 years.

I have had a couple of real lows at 6 pm and could never figure out why before. I didn't even think it was because of the Lantus entering the blood stream early. But the lows were fixed and responded in the typical way with eating more carbs.

Maybe in your case you weren't getting enough sugar to match the 40 units of Lantus. Usually an IV bolus is only 25 gms of 50% dextrose. You would need quite a few boluses to counteract the 40 units of Lantus. And doctors always wait quite awhile before giving the next dose to avoid hyperglycemia.

After hearing your story, I think I am going to start to split my Lantus dose and take it twice a day. Also, if I was you, I wouldn't take it before bed anymore. I would take it earlier, so at least you would be awake to treat it.

JoseM

11/ 4/07 8:39pm

Hi Brian:

It´s also good for me to hear a person with similar diabetes story (in age).

After this event, my endocrinologist change in some way the adminstration of insulin, I´m still having my 3 shoots of Novorapid pre meals, an the lantus bolus in the aftenoon, only 34 units. Since then I didn´t get any severe lows (I re-started to check if I´m not in a vein), but for some unknown reasons, my glucose levels start to raise, and I´m trying to control that.

I don´t know if you have a problem I have, after so many years of inyections, I do it so mechanicaly, that some times I forgott if I have done the insuline shot, even if I write my glucose levels in a notebook. I´m still tryng to find a trick to don´t do that and not miss the insulin shots.

Nice to hear about you,

José

Lantus lows

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