Monday, March 29, 2010

The L Word

I was totally understanding, and still am, of why Jonathan doesn't like his injections.  I would think that the vast majority of individuals that must routinely have injections probably don't enjoy them.  With this inherent dislike, combined with a 4 year old's take on the situation, it's totally understandable why he'd make some noise about his impending shot.

What I failed to understand though was, after a few months he was really good about getting his injections, in fact he rarely ever makes a fuss anymore unless he's already in a bad mood, but there is one exception - Lantus.  The mere mention of Lantus can make him cringe.  Lantus is the long-acting insulin that he takes for his basil replacement.  It's only given once a day, yet at every meal he asks if he has to have Lantus, apparently hoping the answer is "No".

Lantus, like his Novo-Rapid for bolus, is a clear colourless liquid in a 3ml pen-fill vial, but it's a completely different insulin.  It is also administered slightly differently.  Because Sanofi-Aventis' pens are graduated in 1 unit increments and we were doing adjustments in 1/2 units, we use a syringe to inject Lantus.  At first I thought that maybe the needles were different.  But they are both 32ga, and they are both made by the same company.  They appear to be relatively the same length.

After hearing more about some other insulin regimens and getting curious, I did some further reading and learned a little more about Lantus.  I'm no expert, and to paste everything I read here would make this by far my longest post yet, but the key thing I learned relative to Jonathan's extra dislike of this particular injection is that Lantus is formulated at an acidic pH of 4 (it is this formulation and the post-injection transition to neutrality that give it it's "time-release" effect).  To put this in perspective, pure water is neutral at pH7, tomato juice is approximately pH4.

Well now, this makes a little sense.  Lantus stings a bit.  I'm not sure if injecting myself just to find out how much sting is a good idea, but he stops protesting once the needle is in.

I wish it didn't have to be like this, and until it doesn't I will keep working on it, but in the mean time I'm glad it makes a little more sense.

A side note for Jonathan's grandmother who undoubtedly fretting over the torture she's inflicted upon him during his recent visits: A) This is not optional, he needs it.  B) He won't end up with long term psychological damage because of this.  And C) His injection is 0.04ml (it would take 123 shots to fill a teaspoon).

I guess in a way though, all of this is a form of torture.  Perhaps not in the traditional sense of the word, but undeserved pain and suffering none the less.  God we really need a cure!


  1. We're not on Lantus, but I hear if you let it warm up to almost room temperature, it stings less. Have you tried that yet?

  2. My daughter has a hard time with the Lantus too, she always asks if it's gonna be the ouchy one. I found that distraction works best for keeping her mind off the burning.And we always keep it at room temp (for 28 days), heard it burns way more if it's cold.

  3. Poor guy! My mother in law worried herself sick about the shots, but once she did a few she felt more relaxed about it. Time heals, even a grandmas heart can survive this disease.

  4. I have hear that too about Lantus a few times however Cara has never mentioned "the burn" feeling.

    We also keep our room temp for 28 days.

  5. okay yeah lantus burns and that is one reason I wont use it I do humalog and it does just fine . why does your dr like lantus ? is that why Johnathan is on it ? Im sorry if it seems like Im being nosy just wondering really .

  6. We were using Lantus and then switched to Levemir is it is much better. So now we do a combination of Humalog for mealtime and Levemir before bed.

  7. No worries Phonelady.
    We, and the Dr., like Lantus, because of it's somewhat level release over the 20 or so hour period. Levemir is another we know of, but the Lantus has worked really well and he doesn't seem to have any adverse reactions to it (ain't broke, don't fix, I guess). We do keep it at room temp for the month so from that end it's not as bad.

    We were offered NPH, but I'm terrified of the peak at school and their inability to test.

    If I had to but a label on his issue with Lantus, I'd call it more of a pet peeve than anything else, but we tolerates it well for a kid.

  8. Interesting. I don't remember Joe saying anything about it when he was 3, but he was only on it for 2 months...then the pump.

    Good luck...and very interesting post. Thanks for sharing.