Changing over to Levemir from Lantus

[Type1Bri]

Had a DSN appointment this morning g to discuss a run of high BS readings. Ironed out most issues all except for FBS being too high upon waking in the mornings and the occasional afternoon hypo. Upshot of it all is I seem to need more basal overnight and less in the afternoon, now lantus was never going to offer that flexibility, answer is try switching to Levimer
I was taken 16u lantus at 11pm and once the high FBS had been corrected upon waking, that held Mr pretty steady
I am thinking of splitting my new Levimer as 10 units at 11pm before bed, 6 units at 11am
Thoughts most welcome please

 

[richyb]

I have been on Levimer for a number of years. I was taking 16 in morning and 6 at night. I weigh just under 11 stone. But what is good for one is not good for all, everyone is different. The night time dose deffinately adjusted my during the night basal.

Take care, best to get advice from your DSN

 

[Type1Bri]

Thanks for the reply richyb
I have spoken with the dsn, was just after other people's experiences really, I would always adjust my own insulin on my own ideas/thoughts/readings, valid point well made tho, we are all different and it certainly isn't a one size fits all regime

 

[pinewood]

Why not try splitting Lantus before moving on to trying Levemir?

 

[Type1Bri]

I suggested that but the hospital were not keen on that idea and started saying it was only licensed for once a day etc etc, I wasn't in a particularly argumentative mood to push my point over this morning lol

 

[steve_p6]

At those doses Levemir does tail off after 8 hours. I would expect the overnight to meet your needs on managing the highs but keep an eye on the evenings as the 11am lower dose may run out of legs.

 

[Type1Bri]

At those doses Levemir does tail off after 8 hours. I would expect the overnight to meet your needs on managing the highs but keep an eye on the evenings as the 11am lower dose may run out of legs.

Great answer thanks Steve. I was thinking along those lines after reading dome of Tim2000s postings

 

[tim2000s]

Upshot of it all is I seem to need more basal overnight and less in the afternoon, now lantus was never going to offer that flexibility, answer is try switching to Levimer

That's pretty much the opposite of what the circadian cycle for most peopleis! Very few people need more insulin overnight than during the day.

What you'll probably find with that split is that the 10u lasts longer than 12 hours and the 6u lasts less than 12 hours. Taking the 10u at 11pm, it's likely to expire somewhere around 1-2pm while the 6u is likely to expire somewhere around 9pm.

What is often recommended with Levemir is to take the morning dose when you get up in order to multiply the basal that you need versus the dawn/getting up phenomenon, which isn't something you'd necessarily do if taking the evening dose at 11pm.

With regard to your Lantus, the absorption rate (according to Sanofi) looks like the below at 0.4u/kg body weight, (the amount of glucose required to counter the insulin is what's shown):

 

[Type1Bri]

What you'll probably find with that split is that the 10u lasts longer than 12 hours and the 6u lasts less than 12 hours. Taking the 10u at 11pm, it's likely to expire somewhere around 1-2pm while the 6u is likely to expire somewhere around 9pm.

That was my thinking regards the advice my DSN gave today. She said take at bedtime 10u then upon waking take the other 6u as a starting point. I am not sure this would be my best option so was thinking of doing a 12hr split 11pm and 11am. As I always wake with high FBS at the moment on Lantus my theory was take a higher dose at 11pm to stop me waking so high in the morning

 

[tim2000s]

That was my thinking regards the advice my DSN gave today. She said take at bedtime 10u then upon waking take the other 6u as a starting point. I am not sure this would be my best option so was thinking of doing a 12hr split 11pm and 11am. As I always wake with high FBS at the moment on Lantus my theory was take a higher dose at 11pm to stop me waking so high in the morning

@Type1Bri Levemir has a more pronounced peak than Lantus at around 4-8 hours. If you dose at 11pm, the peak may kick in against DP. The tricky bit is whether that will be too much when you don't need it. At least you've the libre to double check.

 

[Daibell]

Hi. My DN advised only one Levemir injection per day and not splitting it and I take that late night. I'm not sure why, but it works fine for me and saves one injection. If you Google the web you can see 3D plots of Levemir performance. Yes it peaks around 8 hours and starts running out at 15 hours'ish. I just tweak my evening Bolus to take account of the lower Basal in the blood. Works fine for me.

 

[noblehead]

Thoughts most welcome please

Most people do to have to split-dose when using levemir @Type1Bri.

I switched from lantus to levemir several tears back, at the time I started off on the same dose that I was using with lantus and tried all sorts of splits but kept having to increase the dosage, my DSN said at the time that most who make the switch find that they need more levemir than than they did with lantus and said that I shouldn't be surprised if I needed a third more, so don't be alarmed if you end up with a higher basal dose.

 

[robert72]

Most people do to have to split-dose when using levemir @Type1Bri.

I switched from lantus to levemir several tears back, at the time I started off on the same dose that I was using with lantus and tried all sorts of splits but kept having to increase the dosage, my DSN said at the time that most who make the switch find that they need more levemir than than they did with lantus and said that I shouldn't be surprised if I needed a third more, so don't be alarmed if you end up with a higher basal dose.

I was much the same - needed 25% more. I am sure Bri that you'll figure it out within a few days

 

[Type1Bri]

I was much the same - needed 25% more. I am sure Bri that you'll figure it out within a few days

Just done my first 10 units, going to bed on a 6.3, fingers crossed for a smooth night!!!

 

[Type1Bri]

Well either that was a fluke or 10 is my magic dose. Bed at 11pm 5.9, 3am 6.2, 6.30am 6.9 and libre pretty flat

 

[tim2000s]

Well either that was a fluke or 10 is my magic dose. Bed at 11pm 5.9, 3am 6.2, 6.30am 6.9 and libre pretty flat

Great news Bri. Keep an eye though. The Lantus will not be 100% out of your system (based on the data we have) so you'll need to check tomorrow as well.

Also keep an eye on 8-12 today as that's when it's most likely that the overnight dose will be expiring based on your timings.

 

[Type1Bri]

Yeah I was just thinking the same about the lantus
I am taking next dose at 11am today so will keep a close eye, thanks Tim

 

[AndyS]

Great news there Bri, as Tim said keep an eye on things tomorrow and later today since it may take a short while to settle from the switch.

When I switched over I think things got a lot more predictable around 2 days after the switch but even so that is a great result straight off. Hopefully now you can fiddle both day and night and get them aligned to what you need.

[EDIT] Actually if that was me I would tag on an extra unit at night but I like to try and get it flat since I don't do breakfast but I know you tend to do a morning bolus to cover the DP so I guess 10 probably works better for you

/A

 

[AndyS]

Actually meant to ask. How are you finding your energy levels this morning?

When I changed I almost sprang out of bed and felt I had a lot more energy and didn't feel like I had cotton wool stuffed in my head.

/A

 

[Type1Bri]

Definitely slept better last night