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Lantus to Levemir Transition

Discussion in 'Type 1 Diabetes' started by AndyS, Feb 8, 2011.

  1. AndyS

    AndyS Well-Known Member

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    Hi Folks,

    So it seems that I am being moved from Lantus to Levemir.
    DSN has said that I basically switch and do half my normal Lantus dose tonight and then tomorrow morning do the other half an continue from there.

    Now I understand that this should, in theory, mean that my NovoRapid ratios will drop from their current value of 1.25u:10g, 1.5u:10g and 2u:10g for breakfast, lunch and dinner.
    Essentially I guess I will be doing a lot more testing and going back to some of the things I had to do when I first got diagnosed to figure out where everything sits again.

    I was wondering if anyone out there has made this same switch and what kind of advice could you offer.

    What, if anything, should I be aware of or watch out for that the HCPs haven't warned me about?

    Cheers

    Andy
  2. sugar2

    sugar2 Active Member

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    Hi Andy,You seem to have it pretty well sussed out...I am surprised that they have advised you to doa 50:50 split.....for me, they made me reduce the basla levle down, then split it, then gradually increase the am and pm amounts until they suited me. Mind youm, the reason for my move from lantus to levimir was very high morning readings...like it was running out, and I also did not do my split injections 12 hours apart...hence why I ended up an almost 30:70 split. Took lots of trial and error, but was worth the change!
  3. AndyS

    AndyS Well-Known Member

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    Hi Sugar2,

    They have mainly done this because my evening dose ratios are so vastly different from my morning ratios.

    I beleive the theory is that I am running out before the 24 hours is up and so I am essentially mopping up the difference with my rapid after dinner.
    I guess they think that maybe doing it this way will smooth my readings a little bit but I guess we will see.

    On the plus side the first dose these evening was quite nice. I had kind of gotten used to the 15-20 minute sting after lantus so not having it was a pleasent change.

    I will see how it goes but I think tomorrow will be a high day since I am going to try dropping my rapid ratios a little, always fun if you are changing multiple things I guess. I see a future with lots of omlets and such in it while I get to grips with this again... fortunately I do a wicked souffle omlet :)

    Cheers

    Andy
  4. ewan

    ewan Active Member

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    Hi Andy, sorry this is'nt helpful to you, but i have just been changed from lantus to lev by gp, but he told me to take lev in one dose like the lantus? i have read on here that most do take 2 doses?

    i plan to start on the weekend, so interested how you get on

    good luck
  5. AndyS

    AndyS Well-Known Member

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    Interesting.

    I think that we are being swapped onto Levimir for different reasons.
    Today will be first full day so should start to get some good data to feedback.

    One thing I was told is that changes with Levemir take much faster so you dont have to do the 3 day wait and see as you do with Latus.

    Will post back later or tomorrow once I see how it has affected my rapid requirements.

    Cheers

    Andy
  6. Curleous

    Curleous Member

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    Keep us updated please as i maybe swapping from lantus too. My morning readings are harldly ever below 7 and increasing the lantus seems to have no effect..

    Cheers

    Andy
  7. AndyS

    AndyS Well-Known Member

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    Will do once I get a couple of days in and stablize.

    So far so good though.
    Morning BG was 5.1
    Breakfast I dropped my ratio down to 1u:10g (down from 1.25:10g)
    2Hours after breakfast was 8mmol/l which is an improvement. Previously I have been higher ans it has taken longer to come down.
    4 Hours after was down to 6.3
    Before Lunch was 5.3

    Just had lunch and dosed at 1u:10g again.

    As for other observations:
    Levemir hurt a lot less when injecting, no sting / burn which was a very pleasent change.
    Today I feel like I have a bit more energy and it seems that my thought process is a little clearer. It's odd but I will admit very subjective and could merely be down to having a better nights sleep.

    I will update as things go but fairly positive so far.

    /A
  8. HLW

    HLW Active Member

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    I was put on one dose of levemir to start, but was told it probably wouldnt last long enough and I would probably have to take two doses.
  9. AndyS

    AndyS Well-Known Member

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    Good morning,

    Well the first complete day is now done and I have a second night down too and so far I am very happy.

    First some history, this is what I was on and what I was seeing:
    Lantus : 34u
    Novorapid:
    Breakfast : 1.25u : 10g
    Lunch : 1.5u : 10g
    Dinner : 2u : 10g

    BG readings taken 2 hours after eating would often be 8 or 9, sometimes higher. Most days it would take 4 or 5 hours for my sugar to come back down to a sensible level, usually just before the next meal.
    The theory was that my glargine was running out much sooner than it should have done.

    HOW TO TRANSITION?
    My idea after discussion with my DSN was to continue as normal that evening, do a 50:50 split with the levemir and start on a baseline 1u:10g the following morning.

    So this is how I handled the transition, starting Tuesday evening.
    Ate dinner and dosed using my usual ratio of 2u : 10g
    At 7pm when I would normally have done 34u of Lantus I took 17 of Levemir.
    Sugars at bedtime was 6.9

    Wednesday morning:
    Fatsing sugars were 4.1.
    Took 17u Levemir
    Quick 3g snack before heading out the house. (I grab breakfast at work)
    Sugar Before Breakfast was 6.0 (I usually see a slight rise after taking my thyroxine in the mornings)
    Had breakfast (40g) and dosed using 1u : 10g
    2 hours after breakfast 8
    3 Hours after breakfast 6.3
    Before lunch 5.3
    Had lunch, 55g and dosed 1u : 10g
    4 hours later 5.9u
    Before dinner 3.7 :shock: well kinda expected. Unexpected exercise running around sorting some stuff out when I got home
    Dinner, 60g and dosed 1u : 10g
    Levemir 17u
    2 hours after dinner 7.9
    3 hours after dinner 7.5
    Before bed 6.4
    Snack of 3g since I like to be above 7 before bed, this should push me to 7.4(ish)

    Thursday:
    Fasting sugars 4.1.

    So while this is just a single day and really I would need more to get a more accurate picture I think this is already much better than before.
    I am essentially on less insulin than I was with the Lantus and I must admit I am not missing the Lantus sting.

    I think that the transition was pretty smooth really and it looks like it is taking the peaks off my BG between meals which also means I should hopefully see fewer hypos.
    My early thoughts are that I may be able to back off a unit or two on my evening dose of levemir which should mean I don't drop as quick overnight and I will certainly try it at the weekend when I would like to get a lie in.

    On the more subjective side my sleep seems to be much better with the levemir and I feel like I have more energy.
    I have noticed that I had slightly lightheaded sensation which I thought were hypos coming but turned out not to be. Friends and co-workers have commented that I seem to have more of a bounce in my step and am more cheerful. My suspicion is this is more linked to the sleep than the levemir
    These things were unexpected since I was doing quite well on the Lantus but it is all early days and I will just have to continue to track things but as I have repeatedly said, I am really happy with this so far.

    Hope anyone else that is going to be doing the same has the same experience.

    Cheers

    Andy
  10. AndyS

    AndyS Well-Known Member

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    Quick update.

    Since I saw 2 nights with a consistent drop between bed and morning of around 2mmol/l I figured I would drop the evening shot by 1ui so I am now on 17morning and 16evening.

    Bedtime I was at 6.7
    Morning was 6.4

    RESULT!

    Will leave these values to soak for a few days and see if they work well but am very pleased all round.
    My meal ratios are now 1ui : 10g CHO so within an average 24 hour period I am now taking around 10ui less insulin, which is quite a drop really.

    Curleous I hope this gives you some ideas on what you can do. Hopefully you can see how the split will allow you to manage your night time levels with more accuracy and then also use your morning dose to look after the day.
    If you do swap over I hope you have a good experience too since this is probably the best thing that has happened to me since diagnosis.

    Good luck

    Andy
  11. Curleous

    Curleous Member

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    Nice one ....can i ask that you let us all know how you feel in a few weeks time as to whether the control is still good and whether or not you feel any better with been on the new insulin. I am becoming increasingly concerned with weight gain on Lantus as it just seems to be creeping on all the time although regular exercise and a well controlled diet.

    Cheers

    Curleous
  12. AndyS

    AndyS Well-Known Member

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    Sure no problem.

    I keep a pretty detailed log of everything that I eat, dose etc so I can probably post the stats & graphs so you can see the difference.
    In the couple of days I have had so far though it looks like my average has remained the same except that the highs and lows have come in and so my graph is smoothed a bit.

    Will post again end of next week.

    Cheers

    Andy
  13. ewan

    ewan Active Member

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    This morning i swoped from lantus to levemir, my blood was at 0830 10.8, took 24u of L and 5u of Nova rapid, had a cracker and a bit of stilton, (small) at 10.30 boold was 12.2.

    BUT despite a very very lousey nights sleep, my constand painful headache cleared almost totaly instantly (I had for the last 6 months).

    (I'm begining to look at carbs and insulin amounts, after 30 years of being DB, thanks to this forum and its posters, and have only changed my insulin due to the information on this forum!!!!!
  14. ewan

    ewan Active Member

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    Andy, sorry if this is hi jacking your thread

    Okay, had a bit of cheese and 1 crcker for breakfast. no lunch, but have had a big tea (though not that hungry) worked out pre tea nova rapid based on your (Andy) calcs, gave 28units

    resultsso far

    0830 blood 10.8 had 5u of nova rapid and 24 lavemir, cracker and cheese.
    1030 12.2
    1230 9.2
    1500 8.8
    1800 4.8 28u of nova rapid and a large portion of spegeti bol
    2000 3.7
    2230 3.8 ice cream (obviously too large a dose of NR)

    see what happens later

    head ache has slightly come back, hovering in back groud
  15. AndyS

    AndyS Well-Known Member

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    Hijack away :)

    I wonder if the headache that came back there was more of a brittle hangover?

    Are you doing a single dose of Lev or are y ou splitting it?
    Also what are your ratios for your NR? I am just trying imagine a plate of pasta that comes out for 28ui and it sounds like a hell of a lot to me. But then that is based on my new 1:10g ratios, if you are doing 2:20g then I can see where it isn't all that much.

    Try keeping the changes relative small for the moment.
    Do you know what your relationship is for BG per unit of insulin?

    Cheers

    A
  16. ewan

    ewan Active Member

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    Hi andy,

    Brittle hangover, i do drink every day (late evening) prob double recomended units. if thats what you are refering to (1450 just googled it, could well be the prob)

    I thought of followed what you posted re insulin and cals (i think but prob got wrong) any how it was wrong, did think at the time 'thats a lot'

    Am taking or have taken a single dose of Lav in the morning, today 26 units my BS was 13 when i got up (think i over compensated with short bread last night) i also took this morning 7u novarapid.

    time blood dose food

    07 30 13. 26 L 7Nr no food coffee
    10 30 9.5
    12 30 6.2 going to have lunch, work out cals on (new iphone app) will try ? 1 unit Nr = 10g
    took 4 units Nr then had 2 fried eggs on 2 pieces of bread

    really dont know about headaches, though started when i missed a dose of lantus was like a migraine all day, then had 2 more on seperate days then they stayed, but yesturday when i had my first dose of levemir, i could feel it going, now seems to be on and off, will try this for a while then perhaps will go back to animal insulins.

    Been DB 30 years, first time i have even thought about cals etc (forum)

    THANKS for all your help and comments, i find it really helpful
  17. AndyS

    AndyS Well-Known Member

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    Hi ewan,

    Looks like you are getting there.
    Just to confirm that you are counting total Carbohydrate, not Calories or Sugar?

    I would be wary of allowing an iPhone app to calculate your Basal insulin doses, my experience is that you need to build up a good chunck of data about an individual before you can make computer predictions, even then they should be treated as guides since you know what your body is telling you.

    Maybe the headaches are just a reaction to your sugars yoyoing a bit, are you keeping your fluid intake up?

    If you havent looked at it already this is an excellent resource: http://www.bdec-e-learning.com/
    It will give you a lot of the basics on how to better calculate your doses.
    I think possibly what you need to establish is exactly what effect 10g of Carbohydrate will has on your sugars, then you will know how much food to correct with if you are a little low in the evenings.

    One thing I have found that helps is to have a "Go to food". A meal that I know the exact values for and I know how it releases its carbs with me.
    When I am having a rough patch I will resort to these for a few days until I get things back in line.
    Usually at this point I have found that in fact my ratios have changed or something like that.

    The 1u Insulin to 10g Carbohydrate I mentioned is a good default to start from. You can then monitor after a few days and see what happens then adjust.
    If you are finding that your ratios of Rapid to Food are going higher in the evenings then it may be worth discussing with your DSN splitting the dose so that you have half in the evening and half in the morning since the Lev may be running out.

    Again this is a default and it seems most people, including me now, don't have a 50%:50% split for levemir.
    As I mentioned earlier in the thread I found that my sugars were dropping 2 to 3mmol/l overnight when I was on 50:50 so I dropped 1 unit off my evening Lev and this seems to keep me pretty stable overnight now.

    Good luck, I think you are getting there just don't expect it to happen quickly. The results I have and the decisions I make are based on detailed logs that extend back months so I can see patterns.
    Don't make knee jerk changes based on 1 datapoint, if you see the same behaviour for several days then you can be pretty sure you have a pattern to work with.

    Cheers

    /A
  18. ewan

    ewan Active Member

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    Andy, your advice is brill, i think today was much better, i ? that headaches are a result of low sugar, will do as you recomend re cals, logs and alterations etc.

    though tne thing i really noticed today was i felt brighter, and a fog that i used to battle through had gone, (dont think was due only to the sunny day).

    thanks again for your help 'invaluable'
  19. ewan

    ewan Active Member

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    okay, still having slight probs stablising my BS but i think generally not to bad for me, the result id i do feel a lot better in my head, no fog, the head aches are less recon i was becoming depressed.

    generally very pleased.
  20. noblehead

    noblehead Forum Regular

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    Sounds like the change was worthwhile! :)

    Nigel

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