I Forgot to Take my Lantus Last Night

Diabetes is one of the most widespread non-communicable diseases. It is affecting millions of people all around the world. It is the major cause of morbidity and mortality in all ages especially the older population.

A strict and active lifestyle is necessary to maintain a healthy life. Proper monitoring of the drug administration is also necessary to maintain a healthy blood sugar level.

However, you can forget to take your Lantus shot of insulin accidentally. This might hamper the maintenance of a stable blood sugar level.

Diabetes and Types

Diabetes is a heterogeneous group of non-communicable diseases that causes persistent high levels of glucose in the blood, resulting from a diversity of etiology.

It may lead to several complications such as cardiovascular, renal, neurological, ocular, and others such as intercurrent infections.

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Diabetes is mainly of two types. Type-1 diabetes is insulin-dependent diabetes mellitus(IDDM) which mainly occurs in children and adolescents and Type-2 diabetes is non-insulin dependent diabetes mellitus(NIDDM) which is observed in the older population.

Other than that we have Gestational diabetes mellitus which occurs in women during pregnancy and impaired glucose tolerance.

Treatment options for Diabetes Mellitus

Metformin would be the first drug of choice for type-2 diabetes mellitus. If significant effects are not observed then we may proceed to insulin as well as sulfonylureas for the second line defense.

A healthy lifestyle and diet must be accompanied by drugs for the treatment to be successful.

In the case of Type-1 diabetes, we can’t stabilize the condition through metformin.

So need direct administration of insulin. Along with insulin the treatment includes cutting down on carbohydrates, an active lifestyle, and monitoring the blood sugar frequently.

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What is Lantus?

Lantus is one of the go-to types of insulin out there in the market. Its generic name is insulin glargine which is commonly used to treat type-1 and type-2 diabetes mellitus. It can also be used to treat diabetes in children above 2 years of age.

Insulin glargine is long-acting insulin also known as ultralente analog insulin. The Lantus chemical structure includes glycine and two arginines which is similar to the genetic recombination of humans.

Lantus was the first genetically engineered synthetic insulin that was made available for clinical use. It is the most recommended form of insulin in the United Kingdom.

How Does Lantus work?

All insulins including Insulin Glargine, in this case, ‘Lantus’ mainly work by influencing glucose metabolism. It regulates the proper breakdown of glucose.

Insulin stimulates the uptake of glucose in the peripheral sites especially by the fat and skeletal muscles which lowers down the glucose content of the blood.

Lantus

It also reduces the excessive production of glucose and similar products by the liver known as hepatic glucogenesis. Insulin inhibits the breakdown of fat in the fat cells named adipocytes, it also inhibits the breakdown of protein and stimulates the protein synthesis. All of this contributes to the absorption of glucose.

This long-acting insulin does not dissolve in normal physiological pH which ranged 7.4 in the pH spectrum. It is initially generated at a pH of 4 which makes it soluble in acidic solution It has an isoelectric point of pH 5.4.

The arginine amino acid contributes to the shifting of the isoelectric pH to 6.7 As a result, it crystallizes upon entry on the subcutaneous site of administration allowing a slow release of the drug.

It prolongs the time of absorption which in turn delays the initiation of action. It forms a much more rounded peak in the plasma concentration hence it is able to stabilize the blood sugar levels efficiently and has a more continuous supply of insulin.

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Indication of Lantus

Lantus is generally provided to patients with insulin-dependent diabetes mellitus (type-1). It can be administered to both adults and children above the age of 2.

This drug can also be used to treat adults with non-insulin dependent diabetes mellitus who would need a long-acting slow-release source of insulin to tackle hyperglycemia. 

Dosage and administration

  • Patients with Type 2 diabetes mellitus with no history of using insulin should start by using 0.2 units per kg body weight. It can be used up to 10 units administered once per day. The dosage can be adjusted according to the needs of the patient. Usage of other drugs such as short-acting insulins or other oral drugs should be monitored and adjusted while using them with Lantus.
  • In the case of Type 1 diabetic patients, the dose should be one-third of the insulin requirement per day. Short-acting insulin must be administered as well to ensure proper blood glucose control.
  • Blood glucose must regularly be monitored and the dosage of the drug must be adjusted according to the patient’s metabolic needs.
  • Lantus must be administered subcutaneously once daily. But make sure to take the shot at the same time every day.
  • Lantus administration does not have to be uncomfortable. Choose the fatty less sensitive areas of your body. You can use the back of your upper arm which has more fat accumulation. You can also choose the outer side of your thighs or anywhere on your stomach avoiding a 2-inch radius area around your navel.
  • The dosage pattern may need to be adjusted according to physiological changes, illness, or changes in physical activity or routine.

Reasons for missing a shot

You might be someone who is more or less careful and consistent in your medication. However, there might be several instances when you might forget to take your shot.

For example, your insulin pen might be broken, you might oversleep during the time of taking your dose, you might run out of insulin, there might not be someone to assist you with the process or you might not have your insulin kit near you.

Effects of missing a dose

If you forget to take your Lantus shot or if you have administered less than the indicated dose then your blood sugar levels will increase above normal causing the formation of hyperglycemia.

If you face symptoms like tiredness, dizziness, excessive thirst, excessive urination, fast heartbeat, low blood pressure, stomach pain, sleepiness, rapid and deep breathing, or loss of consciousness then immediately seek help from your doctor. Hyperglycemia and ketoacidosis need hospital support for proper treatment.

What to do if you miss a dose?

You should be fine if you administer the dose within 2 hours of the actual administration time. If something like this happens you must frequently check your blood sugar level. Also, check for ketones in your urine if it is possible.

 Do not take double doses at a time to cover up for the missed dose as it would do more harm than good. You must seek the help of your doctor if you are unsure of what to do. There are possibilities of developing hypoglycemia so you should monitor your symptoms.

If it has been more than two hours you should contact your healthcare professional just to be on the safe side. Your blood sugar may be rising to dangerous levels. You might have to take short-acting insulin to tone down the effects.

Effects of Overdosing

If you take more than the recommended dose then you may develop hypoglycemia which would cause your blood sugar levels to drop. If that happens then you must frequently check your blood sugar level. For a temporary solution, you may increase the intake of food to provide more supply of sugar.

You may suffer from a fast heartbeat, palpitation, clammy skin, excessive sweating, dizziness, excessive hunger, a lapse of concentration, headache, numbness, nausea, vomiting, trembling visual disorder, para aesthesia, tingling sensation, etc. All of these symptoms indicate hypoglycemia.

What to do if you overdose?

To correct the condition you should not take any insulin shots for a time being. You should immediately take some sugar 10-30 grams at max. After that have a fulfilling meal consisting of rice or pasta which would supply a good amount of glucose content to your blood.

When should you not take Lantus?

Lantus is a widely used drug. However, there are some cases in which this drug can not be prescribed. Lantus should not be taken if you are allergic to insulin or the ingredients used in the drug. You should not take the drug if you are suffering from a hypoglycemic episode.

Side effects of Lantus

Insulin glargine may have these common side effects

  • Blurry vision
  • Sleepiness
  • Nausea
  • Headache
  • Difficulty focusing
  • Feeling of drunkenness
  • Tachycardia
  • Sweating
  • Cold and clammy skin
  • Inadequate sleep
  • Tiredness weakness
  • Shaking of hands and legs
  • Seizures
  • Weight gain
  • hypoglycemia

Immediately take the help of your doctor if the following signs and symptoms persist.

  1. If a severe allergic reaction occurs. The site of the administration is inflamed. There is a presence of itching, redness, swelling, and rashes, especially of the tongue or thought. Or if you have trouble breathing.
  2. If you are facing symptoms of hyperglycemia. The symptoms might include excessive thirst, excessive urination with the presence of ketone bodies in the urine. Face being flushed, increased heart rate, etc. Call your doctor immediately as you might need to be prescribed an adjusted dosage.

You need to keep in mind while facing minor side effects that, these drugs were prescribed to you because the effectiveness of the drugs overpowers the minor side effects.

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Final Thoughts

There might be several reasons for which you might have forgotten to take your Lantus shot last night.

It is advisable to let your healthcare professional know about it so that you can take proper decisions and discuss the options.

However, monitor your blood sugar level and keep an eye out for adverse symptoms. Last but not least always keep an emergency number handy.

FAQs 

What type of insulin is Lantus?

Lantus is a long-acting insulin analog used to treat patients with type-1 and type-2 diabetes mellitus.

Why is Lantus taken at night?

Lantus is taken at night because the FDA approved the dosage that way. The trials and studies that were conducted before approval administered the drug at night and observed maximum effectiveness. However, the drug can be taken anytime during the day but it should be administered at the same time every day.

How long does it take Lantus to show its effect?

As Lantus is a long-acting drug it has a slow-release mechanism. It takes about 4 hours to show its effects and can keep working up to 24 hours until the next dose.

Is Lantus a good insulin?

All drugs have effects and side effects. The effect of insulin depends on the metabolic and physiological needs of a person. Saying that Lantus has shown significant effectiveness in controlling blood sugar levels.

It is one of the most popular insulin brands in the UK. So it is advisable that you must consult with your doctor to confirm if Lantus is good for you considering your needs.

Hey! My name is Shaila. I am a fourth-year medical student all the way from Malaysia. Apart from meeting the patients in the ward, I would love to engage with the readers by writing out articles during my leisure time. Content writing has always had a soft spot in me, as I love spilling out my thoughts that I could actually put into words. I also keep up with my blog on the medical school lifestyle. In fact, writing isn't a hobby, it is a blessing.

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