Levemir

[Lynz84]

Hi All

I am on toujeo which is good but because its 30+ hrs, when I need to make an adjustment it takes days for the adjustment to take effect.

My consultant has suggested split dose levemir with injections in the evening and morning. For any of you who are doing this, is levemir a good choice and does it keep u stable for the 24 hrs if the dose is split?

 

[catapillar]

Before pumping I was on levemir and it did a good job for me.

I'm not really sure I follow your question

does it keep u stable for the 24 hrs if the dose is split?

Levemir lasts around 12 hours, so you take it twice a day, 12 hours apart ideally.

You aren't splitting a 24 hour dose, you are taking what you need to keep you stable for the next 12 hours. So I would take a higher dose in the morning and a lower dose to go to bed because I have a history of nocturnal hypos.

Levemir is nice and flexible so if you know you are going on a long hike or some other activity you can take less that morning and there will be less in you - so changes in the dose take effect immediately.

 

[DunePlodder]

I moved from Lantus to Levemir & for me it was a big, big improvement. I never saw the near horizontal lines I get now when I was using Lantus, especially overnight.
I did find though that I had to use much higher dosages which initially concerned me. However I've come to the conclusion that if it works, then it's fine.

 

[tim2000s]

@Lynz84 This was a topic I put together when I moved from Lantus to Levemir. You may find it helpful.

http://www.diabetes.co.uk/forum/thr...pefully-providing-some-lessons-learned.70039/

 

[Lynz84]

@Lynz84 This was a topic I put together when I moved from Lantus to Levemir. You may find it helpful.

http://www.diabetes.co.uk/forum/thr...pefully-providing-some-lessons-learned.70039/

Hi Tim2000s

Thanks so much for this! I was previously on levemir but it was running out after 20 hrs so I was put on toujeo as a trial. I was interested to see if split dose works but still not convinced!

 

[SimonCrox]

Split dose levemir is a useful option. One thing to be aware of is that it is probably not quite as strong as lantus. A paper by Julio Rosenstock and Melanie Davis showed folk often needed 50% more levemir than lantus; so be prepared to escalate dose. Levemir might be marginally more consistent than lantus - a useful factor.

 

[Lynz84]

Split dose levemir is a useful option. One thing to be aware of is that it is probably not quite as strong as lantus. A paper by Julio Rosenstock and Melanie Davis showed folk often needed 50% more levemir than lantus; so be prepared to escalate dose. Levemir might be marginally more consistent than lantus - a useful factor.

Hi Simon.
Thanks so much for this! Its all so much information sometimes!

 

[SimonCrox]

Hi Simon.
Thanks so much for this! Its all so much information sometimes!

Yes, that is the catch for patients and healthcare professionals. Things are often shades of grey not black and white. And new things are being found all the time

 

[Ann1982]

I moved from Lantus to Levemir & for me it was a big, big improvement. I never saw the near horizontal lines I get now when I was using Lantus, especially overnight.
I did find though that I had to use much higher dosages which initially concerned me. However I've come to the conclusion that if it works, then it's fine.

I too have bigger doses of levemir than lantus but it works for me too.

 

[22nw22]

Levemir would do the opposite. Decrease it I think the sugar is high increase it it goes quite low vice versa. I do not recommend Levemir. I am now on Tresiba.

 

[tim2000s]

Split dose levemir is a useful option. One thing to be aware of is that it is probably not quite as strong as lantus. A paper by Julio Rosenstock and Melanie Davis showed folk often needed 50% more levemir than lantus; so be prepared to escalate dose. Levemir might be marginally more consistent than lantus - a useful factor.

Simon, in terms of "consistency" I'd use the absorption data that was collected back in around 2004. Lantus and NPH are very similar in terms of variability of absorption, in that they are both really quite variable, whereas Levemir was shown to be a lot less variable and much more consistent in how it is absorbed (research paper here and the 2004 ADA article). Tresiba also benefits from this.

There's certainly a lot of evidence that people often need more (although I didn't find this to be the case).

 

[SimonCrox]

Simon, in terms of "consistency" I'd use the absorption data that was collected back in around 2004. Lantus and NPH are very similar in terms of variability of absorption, in that they are both really quite variable, whereas Levemir was shown to be a lot less variable and much more consistent in how it is absorbed (research paper here and the 2004 ADA article). Tresiba also benefits from this.

There's certainly a lot of evidence that people often need more (although I didn't find this to be the case).

Thanks - that is interesting. Clinically, the Fritsche paper showed am lantus better than pm lantus better than pm NPH both in terms of HbA1c reduction and fewer hypos (so the difference in am and pm lantus shows it is not a smooth 24 hour profile) - this was in T2DM. You don't have the refernce for the 2004 data? I totally agree that levemir is a bit less variable than lantus.

 

[tim2000s]

@Lynz84 for what it's worth, this is the difference between the two for me. The last month of Lantus:

The first month of Levemir:

The key thing was that my broader range of values tracked the median with Levemir, whereas with Lantus, it was much less correlated.

 

[tim2000s]

You don't have the refernce for the 2004 data? I totally agree that levemir is a bit less variable than lantus.

The 2004 ADA article was the publishing of the paper. You should find the references within that.

 

[SimonCrox]

The 2004 ADA article was the publishing of the paper. You should find the references within that.

Thanks for this - most helpful - Best wishes

 

[Lynz84]

@Lynz84 for what it's worth, this is the difference between the two for me. The last month of Lantus:

The first month of Levemir:

The key thing was that my broader range of values tracked the median with Levemir, whereas with Lantus, it was much less correlated.

Hi Tim2000

Thanks so much for this!!!