By: Radha McLean
People who inject insulin can confuse Lantus (insulin glargine) with short-acting Regular insulin or rapid-acting Humalog (insulin lispro) or NovoLog (insulin aspart) because they are all clear in color, warn doctors from the Yale University School of Medicine.
In a letter published in the February 2002 issue of Diabetes Care, Marcy A. Adlersberg, MD, and colleagues report two cases of Lantus users who injected rapid-acting Humalog instead of Lantus at bedtime. Both cases resulted in severe low blood glucose, and one user required hospitalization after nausea prevented her from ingesting enough carbohydrates to counteract falling blood-glucose levels.
Although Lantus comes in a vial that is taller and thinner than other insulin vials available in the United States and has purple print on the label to distinguish it from other insulins, the users mistook it nonetheless, the researchers note.
“We recommend that patients should be made aware of the potential danger of confusing glargine with their [rapid-acting and] short-acting insulins and educated in strategies to help avoid such accidents,” they further state. “We also recommend that the manufacturer of glargine insulin, Aventis Pharmaceuticals, in cooperation with the Food and Drug Administration, consider further alternative packaging or perhaps even solution tinting to more easily distinguish it from the widely used short-acting preparations.”
Clinical adviser’s note: Here is one more reason that insulin pens may be “your best shot” (see “Your Best Shot?” April 2002, p. 44). Many people who inject a rapid-acting insulin analog (Humalog or NovoLog) for mealtime bolus needs use the convenient, portable, discreet insulin pen delivery systems. Many of these same people use Lantus at bedtime for their basal, background insulin needs and inject the Lantus with a traditional insulin syringe. No confusion here between the mealtime pen delivery and the bedtime vial/syringe delivery systems. But stay tuned, because Aventis, the maker of Lantus, plans to introduce a Lantus prefilled insulin pen in the future. Let’s hope it will look distinctly different from all other insulin pens.