Lantus to Levemir Transition

[ewan]

Nigel, yes, but i have worked out what i miss ' i think' my old spikey long acting, as if i remember right, i new when to eat and things were taken care off.

if you know what i mean, but levamer has given me a massive boost, even did some hobbies and cleaned things that i have been meaning to do for months, have more energy.

so good

cheers

Ewan

 

[janabelle]

That's great news Ewan
I'm so glad you're feeling better! With any luck we'll soon have some sunny days for you to enjoy cycling without a foggy head oops, you prob meant the motor sort didn't u-soz.

Jus

 

[pinkjinks58]

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!!!!!

this forum has really helped me as well!!

I was told at my diabetic clinic yesterday that I'm being moved onto Levemir and was hoping there would be some more people in my position... which this thread proves that there is.

after 20 years of diabetes I finally feel like I'm getting somewhere, and i'm really starting to look after myself (25 years old and have been in denial for a LONG time)!!

I hope this all works out for us.

 

[ewan]

Pinkjinks,

Gosh, if i 've read your post right, you have been DB since 5years, I hope it goes well for you! you dont say what insulin your swoping from ? i take it lantus (silly me)

it has released me, my head is normal, as others have said they thought they were depressed when on it, i really think i was, and life was so hard work, i now really feel normal, if i had realised i would changed ages ago!!

I did like an old insulin i was on (name forgotton) but it had 'spikes' so just eat when it spiked, and was 1 injection or 2 a day ! now more like 4.

Anyway rambling over! good luck, this forum is brilliant!!!! but we need to remember that what works for one may not work for us, but at the very least others point us on the right direction, and i would not have changed my insulin if it was'nt for this forum, so am very gratefull to it and people like yourself who post.

the best of luck and take care

Ewan

 

[AndyS]

Hi Pinkjinks,

Levemir does seem to have a number of benefits though it isn't really best for everyone.
Did they tell you at the clinic the reason they are moving you to Levemir.

This is something I think is very important for us. We should take a more active role in our treatment and be more aware of what is happening and also why. You should never be scared to challenge the HCPs and get them to justify their actions.

In my case this is exactly what happened.
I am doing a DAFNE course this week and in my pre-assesment we discussed my insulins at that time.
I was on 34u Lantus and my Novorapid ratios were:
Breakfast 1u to 10g CHO
Lunch 1.5u to 10g CHO
Dinner 2u to 10g CHO.

This profile would tend to indicate that my lantus was not actually making the full 24 hour period.
If I tried to increase it I would start to see overnight hypos.
The thing with Levemir is that it has a much shorter half life so you can make changes much faster. With Lantus you have to make a change then let it settle for 3 days or more to see the full effect of the change.

Levemir does not in theory last a full 24 hours but this, as with many things, depends a great deal on the individual.

The nice thing with Levemir is you can adjust your basal insulin to suit what is going on.
For example I have fiddled my night time dose so that I tak 18u at night and my BG stays pretty much the same over night which is ideal.
In a normal working day I need around 16u but if I am going to have a day out and about either walking or some other activity which raises my physical activity I back it off a unit or two and this seems to prevent my sugars dropping into the Hypo range.
Of course this works with the split dose.

It is worth finding out what the reason is for the switch to Levemir. If nothing else it gives you a better idea of what the HCPs are thinking and you know they are not just doing it that way because it is their preffered insulin.

Like Ewan I found that I had more energy and also it felt like a fog had lifted. Admittedly I didn't even realise it was there but the big thing for me is I am now taking around 10u or more Less NovoRapid a day and am finding I am able to lose a little weight now which is great

Good luck on the new stuff and hope that you find it helps.

Andy

 

[eshaw]

For those of you who mention highs in the morning that may also be attributed to the 'dawn phenomenon' where for some people in the morning the liver releases sugar. I found out that was the cause of my highs when I went on the DAFNE course and was constantly monitoring it, and saw the pattern. The Lantus seemed to handle this well for a while and just needed to add a couple of units to my novarapid, to handle it. However, I changed to Levemir because I kept getting hypos, which became more of a problem than the sugar release.

I think it will take me some time to work out how to handle the dawn highs with the Levemir, and what ratios to take. So far I wake with a high when taking a 50:50 split. I've heard some people do a 50:50 split and others 30:70. I guess it's a case of close monitoring and tweeking until it's right. rarely I hear of people taking one shot, and personally unless a GP specialises in Diabetes I would seek advice from a diabetes Nurse or specialist who deal with it day in day out.

 

[AndyS]

Fair point. I beleive that the release of various hormones in the morning can have the effect of increasing your insulin resistence in the morning so essentially making your body need more insulin to do the same job.

I am not on a 13U / 19U split, not sure what thet equates to and to be honest I think treating it as a percentage split is only useful when starting out on the 2 doses. I pretty much treat the 2 Levemir shots in isolation and then look at patterns for the next 10 to 12 hours.
It works quite nicely doing that since if your value are perfect during the day but climb overnight then you know you only need to adjust 1 value and leave the other be.

/A

 

[the_exile]

Hi all,

Long time lurker, not posted often but felt I had to add to this thread as I'm also going through the Lantus to Levemir transistion, started a couple of weeks ago and steadily doing 1 tweak at a time to bring things under control.

Was on 30 units of Lantus in January, went onto DAFNE in January and they cut that back to 24 (1 unit per hour is the benchmark), and reset all my ratios to 1:1, I was just looking at food and going "ummm, 20 units should cover that", I must admit that old habits die hard but I am doing well with the carb counting (still call them exchanges, was diagnosed when I was 7, 21 years ago, yikes!.

Lantus was making me feel rubbish for a while, but had no clue there were other backgrounds I could try, a lot of others at DAFNE were on Levemir and raved about it so thought I'd give it a try.

I split the 24 units of Lantus into 12 units at 8am and 8pm on Levemir, BG levels quickly shot up so it's now 16 in the morning and 20 units at night, the 16 units are great early morning and through lunchtime but BG rises again towards 4-5pm, so think I may need to fiddle with lunchtime ratio rather than take more AM Levemir as the early morning and lunchtime BG readings are so good. Evening meal I'm still working on the BG readings and ratios, still 1:1 at the moment but need a few more days worth of results to spot consistent patterns and adjust.

So as of this moment I'm on:

Levemir AM: 16units
Levemir PM: 20 units
Breakfast ratio:1:1
Lunchtime ratio 1:1 (think this will be going up 1.25:1 soon)
Dinner ratio 1:1

All in all I'm a big fan of Levemir and it's flexability, no more major stinging which I got with Lantus and feel a lot better in myself, although Levemir may work for some people I'd say it should be one of the last resorts as it obviously isn't coincedence that it affects everyone the same in making them feel so rubbish, will try and keep this updated with progress

 

[the_exile]

Thought I'd post the last 3 days of my diary to show how things looked from that perspective all ratios are 1:1 at the moment which is why that column is blank. Hopefully this comes out ok and doesn't look all over the place!

Site ID Time BG CP QA BI Ratio Type
386607 May 16, 2011 08:00 12.9 2 4 16 BFAST
386609 May 16, 2011 11:00 4.5 5 SNACK
386611 May 16, 2011 12:30 8.9 7 7 LUNCH
387989 May 16, 2011 15:00 4 4 SNACK
387991 May 16, 2011 17:45 15.1 10+8 14+8 DINNR
387993 May 16, 2011 20:00 20 BI
387995 May 16, 2011 23:50 12.6 1 BED

387997 May 17, 2011 08:00 3.8 9 8 16 BFAST
388487 May 17, 2011 12:30 9.3 13 14 LUNCH
390291 May 17, 2011 17:00 11.7 BEFEX
390293 May 17, 2011 18:00 12.8 18 20 DINNR
390297 May 17, 2011 20:00 8 8 20 BI

390307 May 18, 2011 08:00 12.5 3 5 16 BFAST
390309 May 18, 2011 10:00 3 3 SNACK
390311 May 18, 2011 12:45 8.6 9 9 LUNCH
390305 May 18, 2011 23:40 12.1 BED

 

[AndyS]

Hmm there is a fair bit of change here isn't there.

I couldn't really understand what was going on in this entry:

387991 May 16, 2011 17:45 15.1 10+8 14+8 DINNR

Looking at the 17th I would actually treat the 8pm reading with caution since it is only a couple of hours after the meal. Remember most of the Quick Acting insulins will still be doing something for up to 5 hours or so. I tend to leave the evening test as late as I can as I found that only 2 hours after the meal things are still changing and depending on what I ate or where I injected it can vary wildly.

What is going on here?

390297 May 17, 2011 20:00 8 8 20 BI

It looks like you have BM of 8 and gave 8 QA and 20 BI which can't be right can it?
The thing that stands out to me is that there isn't really enough information here to see any kind of pattern.

You might find it usefull if for a few days you try and do your evening test 3 or even 4 hours after your meal so that most of the QA is gone and any changes are to do with BI insulin since it looks like you need to do a little work there.

I think maybe the easier option is to focus on just either evening or daytime BI and get that right. My preference is get the evening one right first so you know you are stable overnight then look at daytime.

Cheers

Andy

 

[the_exile]

Hi Andy,

Yeah my diary copy and paste didn't work very well, that 17th of may entry was 8cp's, 8 qa, no blood test and 20 Background. Hence I didn't bother with a blood test as I knew the qa from 2 hours previous would still be doing it's thing.

What I've found over the past few weeks is that 20 BI at night is keeping me steady, unbelievably steady, test last night was 8.6, test this morning was 8.6, and it's been like that for a while now, no raising or dropping of blood glucose overnight at all. Still experimenting with it to see if there's drops or rises in any specific places, trying to spot patterns before I change anything.

I've raised my lunchtime ratio to 1.25 to 1, everything else the same as it was previously and I'm seeing some good results, still a bit to go but so far I'm prefering Levemir big time over Lantus, feel so much better within myself, not as sluggish and tired, sleeping better etc.

 

[AndyS]

Hiya,

Great to hear you managed to get the night time BI nailed. I managed the same for a good long while but something has changed so that I am changing it all again.

Sounds like you are gradually getting the daytime one sorted too. Hope you manage to get that one as good as night time.

Good luck

A