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Re: [IP] Response to Lantus if Pump Breaks Down

----- Original Message -----
From: "Taryn Israel Nechanicky"

>That being the case, why would it take 4 days
> to "kick in", and why would it take longer than 24 hours to work its way
> of the system?  My doctor just recommended to me today that I keep Lantus
> basal) and Novolog (for bolus) around as a backup to my pump.  I start
> tomorrow.  Yeah!
> Thanks,
> Taryn

It is well-established that insulins containing crystalline zinc have to
build up a 'depot' in the system before they start to be effective. The same
is true of Latus, but even more so. That is why it is recommended that
dosage adjustments are made only every 3 or 4 days with these insulins. Is
your doctor an endo? I would suggest getting him to talk to Aventis. Having
said that, I suppose it is true that Lantus should prevent you heading
towards DKA during the first few days even if your blood sugars remain
substantially higher during the initial stabilization period than they would
for the same amount of Lantus after a week or so. When you resume pumping I
would expect your insulin requirements to be somewhat lower for a few days
until the Lantus has worked itself out of your system. With NPH it takes
around 22 hours for the effect to be entirely gone even though its
antihyperglycemic activity after 16 hours is very small. Since it should not
normally  take more than a couple of days to find a replacement pump I don't
think that any of the zinc-based long-acting insulins (except 100% amorphous
semilente, if you can find it) or Lantus are suitable.

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