Lantus is a brand-name prescription medication containing insulin glargine, a long-acting insulin, used to improve blood sugar levels in adults and children ages 6 years and older with type 1 diabetes, and adults with type 2 diabetes. While effective in managing diabetes, concerns about weight gain are common among individuals using insulin, including Lantus. This article delves into the relationship between Lantus and weight gain, exploring the reasons behind this phenomenon and offering strategies to mitigate it.
How Lantus Works and Its Impact on Weight
Insulin regulates how the body absorbs sugar, also known as glucose. Before diabetes is treated or when diabetes is not being treated effectively, you may be passing a lot of glucose out in your urine. This means some of the calories that you are eating are not being absorbed and are being passed out of your body. When you take insulin, sugar can enter your cells, which makes the sugar levels in your blood go down. But if you take in more calories than you need to keep a healthy weight, your cells will get more sugar than they need. This also happens in people who don't have diabetes.
Once your diabetes is being treated efficiently, your body is able to hold onto any glucose that your body doesn’t need by storing it, which can be a cause of weight gain. Weight gain is a common side effect seen with all insulins, not just Lantus. This is a normal healthy process because insulin causes your body to store sugar for future energy needs.
Clinical Evidence: Lantus and Weight Changes
In clinical studies, the average weight gain was:
- Up to 1.5 pounds (lb) in adults with type 1 diabetes who took Lantus over 16 to 28 weeks.
- Up to 4.8 lb in children with type 1 diabetes who took Lantus and regular insulin for 28 weeks.
- Up to 4.4 lb in adults with type 2 diabetes who took Lantus for 1 year.
The ORIGIN (The Outcome Reduction with Initial Glargine Intervention trial) study followed patients for a median time of 6.2 years. A post hoc subgroup analysis using data of obese and non-obese participants from a large multi-centre (4555 participants with T2DM), multi-national 24-week randomized controlled trial of investigator titrated insulin glargine versus patient self-managed titrated insulin glargine revealed that there was a significant reduction in glycated haemoglobin (HbA1c) from baseline in both subgroups but no significant difference between subgroups (1.15 vs. 1.15%, p = 0.50). Overall, there was a 1.21 kg (s.d. 3.3) increase in weight in individuals who were non-obese and a 1.08 kg (s.d. 3.9) increase in obese individuals (p = 0.67). There was no significant difference in the proportion of participants achieving an HbA1c of <7.0% at 6 months in both the subgroups (28.8 vs. 27.1%, p = 0.20). In multiple logistic regression, BMI was not a prognostic factor in achieving a target of HbA1c < or = 7.0%. There was no significant difference in severe hypoglycaemic episodes between obese and non-obese subgroups (1.3 vs. 1.0%); however, significantly more non-obese individuals experienced nocturnal hypoglycaemic episodes(4.5 vs. In this study, treatment with insulin glargine in people with T2DM was associated with a significant reduction in HbA1c without differential increase in weight gain in obese and non-obese subgroups.
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Strategies to Manage Weight Gain While on Lantus
Weight control is possible, even when taking insulin. Eating healthy foods and being physically active most days of the week can help you not gain weight.
- Consult with a Healthcare Professional: Discuss dietary adjustments with your healthcare provider to ensure you're consuming the appropriate number of calories for your daily needs. To help reduce the chances of weight gain when on Lantus it is important to discuss with your health care profession about how to change your diet so that you are only taking in the number of calories your body needs for the day. That way your body shouldn’t have any excess calories to store away, which would cause weight gain.
- Calorie Counting: Eating and drinking fewer calories helps you prevent weight gain. Keep fruits, vegetables, and whole grains in your refrigerator and pantry.
- Balanced Meal Planning: Plan for every meal to have the right mix of starches, fruits and vegetables, proteins, and fats.
- Portion Control: Shrink the sizes of your portions, don't take second helpings and drink water instead of high-calorie drinks.
- Avoid Skipping Meals: Don't try to cut calories by skipping meals. When you skip a meal, you're more likely to make unhealthy diet choices at the next mealtime because you're too hungry.
- Physical Activity: Physical activity burns calories. A recommended goal for most adults is at least 150 minutes a week (or 30 minutes five days a week) of moderately intense aerobic activity plus muscle-strengthening exercises at least two times a week. Aerobic activities can include walking, bicycling, water aerobics, dancing or gardening. Also, ask your provider how to handle exercise. Physical activity helps your body use insulin more efficiently. Depending on how much exercise you're planning on doing, you may need to cut back on your insulin dosage or have a snack.
- Medication Review: Ask your provider about other diabetes medicines. Some diabetes medicines that help regulate blood sugar levels may help you lose weight and lower your insulin dosage. Examples of these medicines include metformin (Fortamet, Glumetza, others), exenatide (Byetta), liraglutide (Victoza, Saxenda), dulaglutide (Trulicity), sitagliptin (Januvia), saxagliptin (Onglyza), canagliflozin (Invokana), dapagliflozin (Farxiga), empagliflozin (Jardiance) and pramlintide (Symlin).
- Adhere to Prescribed Dosage: Take your insulin only as directed. Don't skip or reduce your insulin dosages to stop weight gain. Although you might lose pounds if you take less insulin than prescribed, the risks are serious.
Alternatives to Lantus
Other drugs are available that can treat your condition. Some may be better suited for you than others. If you’re interested in finding an alternative to Lantus, talk with your doctor. They can tell you about other medications that may work well for you.
Examples of other insulins that may be used to improve blood sugar levels in people with type 1 or type 2 diabetes include:
- Long-acting insulins: insulin glargine (Basaglar, Toujeo), insulin degludec (Tresiba), insulin detemir (Levemir)
- Intermediate-acting insulins: insulin NPH (Humulin N, Novolin N)
- Short-acting insulins: insulin regular (human) (Humulin R, Novolin R)
- Rapid-acting insulins: insulin aspart (Fiasp, NovoLog), insulin glulisine (Apidra), insulin lispro (Admelog, Humalog)
Several premixed insulin products are also available. They contain long-acting insulins and shorter-acting insulins. These combination medications help control baseline blood sugar levels and any blood sugar spikes that can occur around mealtime.
Examples of non-insulin diabetes medications that can be used to improve blood sugar levels in people with type 1 or type 2 diabetes include:
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- pramlintide (Symlin)
- liraglutide (Saxenda, Victoza)
- exenatide (Bydureon, Byetta)
- canagliflozin (Invokana)
- dapagliflozin (Farxiga)
There are also combination medications that contain insulin. They can be used to improve blood sugar levels in people with type 2 diabetes, including:
- insulin glargine and lixisenatide (Soliqua)
- insulin degludec and liraglutide (Xultophy 100/3.6)
Lantus vs. Other Insulin Options
- Basaglar: Basaglar and Lantus both injections that contain insulin glargine, a long-acting form of insulin to help control blood sugar levels in type 1 and type 2 diabetes. Basaglar is considered a "follow-on" to Lantus but is not a biosimilar, according to the FDA. This means your doctor will need to write a prescription for one or the other as they cannot be substituted at the pharmacy.
- Toujeo: Both Toujeo and Lantus are long-acting insulins that contain glargine, however Toujeo is more concentrated containing 300 units per mL of glargine, compared to Lantus’s 100 units per mL. When you take this into account the cost of Toujeo and Lantus works out approximately the same (real cost value $30.76/mL for Toujeo compared with $30.23/mL for Lantus).
- Levemir: The Food and Drug Administration (FDA) has approved both Lantus and Levemir to improve blood sugar levels in children and adults with type 1 diabetes. Lantus is approved for children ages 6 years and older with type 1 diabetes. Levemir is approved for children ages 2 years and older with type 1 diabetes. Lantus is approved to treat adults with type 2 diabetes. Levemir is approved to treat both children and adults with type 2 diabetes. Lantus and Levemir are both long-acting insulins. This means that they work the same way in the body. They both help control blood sugar levels for up to 24 hours or longer. Lantus contains the drug insulin glargine. Levemir contains the drug insulin detemir.
Important Considerations While Using Lantus
- Potential Side Effects: The most common side effect of insulin, including Lantus, is low blood sugar (hypoglycemia), which may be serious. It may cause harm to your heart or brain. Lantus may cause serious side effects that can lead to death, such as severe allergic reactions.
- Injection Site Rotation: Change (rotate) your injection sites within the area you chose with each dose to reduce your risk of getting lipodystrophy (pitted or thickened skin) and localized cutaneous amyloidosis (skin with lumps) at the injection sites.
- Heart Failure: Heart failure can occur if you are taking insulin together with certain medicines called TZDs (thiazolidinediones), even if you have never had heart failure or other heart problems. If you already have heart failure, it may get worse while you take TZDs with Lantus. Your treatment with TZDs and Lantus may need to be changed or stopped by your doctor if you have new or worsening heart failure.
- Blood Sugar Monitoring: Test your blood sugar levels while using insulin, such as Lantus.
- Avoidance of Dose Changes Without Consultation: Do not make any changes to your dose or type of insulin without talking to your healthcare provider.
- Proper Use of Lantus: Do NOT dilute or mix Lantus with any other insulin or solution. It will not work as intended and you may lose blood sugar control, which could be serious. Lantus must only be used if the solution is clear and colorless with no particles visible.
- Driving and Operating Machinery: While using Lantus, do not drive or operate heavy machinery until you know how Lantus affects you.
- Pen Sharing: Lantus SoloSTAR is a disposable single-patient-use prefilled insulin pen. Do not share your pen(s) with other people, even if the needle has been changed.
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