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Lower HbA1c on Twice Daily Basal (DAFNE Report )

Heathenlass

Heathenlass

Well-Known Member
Messages
1,631
Type of diabetes
Type 1
Treatment type
Insulin
I posted this link in another thread, but I think it'a interesting enough to warrant a thread on it's own :

http://www.dafneonline.co.uk/BackgroundInsulininDAFNE.pdf

What is appears to be saying is that there was no difference found in the effects of which type of basal has on the HbA1C, but a better , lower one is achieved on a twice daily regime .

It's always puzzled me that HCP's have known for a long time that the duration of both Glargine and Levemir is less than 24 hours duration, therefore leaving X hours basal free until the next dose. Surely that makes control more difficult ?:confused:

Signy
 
Really can't see the sense in taking it twice daily if one dose lasts 24 hours, I take lantus and have done for several years and take it just once a day, that gives me a good 24 coverage and split dosing would only complicate matters.

However when I briefly tried levemir it didn't seem to last much more than 12 hours and so had to split-dose, even then I still couldn't get my bg levels down so changed back to lantus, levemir is well known not to last 24 hours as where with lantus its a mixed bag.
 
noblehead said:
Really can't see the sense in taking it twice daily if one dose lasts 24 hours, I take lantus and have done for several years and take it just once a day, that gives me a good 24 coverage and split dosing would only complicate matters.

However when I briefly tried levemir it didn't seem to last much more than 12 hours and so had to split-dose, even then I still couldn't get my bg levels down so changed back to lantus, levemir is well known not to last 24 hours as where with lantus its a mixed bag.
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That's the thing - Lantus was initially marketed at lasting 24 hours, therefore only a once daily dose. We are all so different though that it became apparent that for many it just wasn't lasting that long. In addition there is the hypo problem reported by so many . and other factors that required a split dose of what is meant to be single dose.

I appreciate that for some people it will last the full 24 hours and be fairly level acting, but for others, this has not been the case.

Signy
 
Sorry, I also meant to say that I suspect for many people who are struggling to get good control on a once daily dose, that these are the ones that a split dose would benefit and therefore a lower HbA1c..

Signy
(Trying to think with a background of thrash metal loving, combat booted trolls clog dancing on uncarpeted floors. At least that's what it sounds like ! ) :banghead:
 
I take Levemir at around 10.30pm every day which seems to give me a fairly constant BG in the morning before breakfast of between 5.5 and 7.5 mmol/ and I have never had any hypo problems during the night. However, I have always suspected that my Levemir is running low during the evening hours because I have had to adjust my bolus ratio from 1:10 (1 unit Novorapid to 10g of carbs) to 1.5:10 at my evening meal. Also I have to work **** hard to attain a decent BG reading at bedtime even on the increased ratio.
My HbA1c is within range so I am probably best advised to leave things as they are, but it's interesting to note that some people think Levemir doesn't last 24 hours in all people.
 
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Heathenlass said:
That's the thing - Lantus was initially marketed at lasting 24 hours, therefore only a once daily dose. We are all so different though that it became apparent that for many it just wasn't lasting that long. In addition there is the hypo problem reported by so many . and other factors that required a split dose of what is meant to be single dose.

I appreciate that for some people it will last the full 24 hours and be fairly level acting, but for others, this has not been the case.

Signy
Click to expand...

Yeah I get what you saying, you mean that the manufacturer and HCP's should make patients more aware that it doesn't always last for a 24 hour period, that makes sense Heathenlass :)
 
noblehead said:
Yeah I get what you saying, you mean that the manufacturer and HCP's should make patients more aware that it doesn't always last for a 24 hour period, that makes sense Heathenlass :)
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Yes, pretty much :)
It was certainly my experience that it didn't last that long, and also in me it had a definite sharp peak . But then, I just have to be different :D

Interestingly, I had a chat with my DSN today, and she was saying that they may have to re evaluate the DAFNE advice given , not to bolus for vegetables and protein, as the experience gained with pump users was showing otherwise in some people . The carrot was shown to be a culprit in spiking, and shock horror! The potato ! :eek::D That I think, is no news to many of us :p:D

Signy
 
iHs said:
Its for everyone to do what works for them and not quite so much as what works according to s report on the web

Sent from the Diabetes Forum App
Click to expand...

I agree - but it would be better for HCP's to take note of what people say is working or not working for them , instead dismissing their experiences because it doesn't fit what the insulin companies say, and dismissing experiences "outside the box" as being due to bad management.

Signy
 
I think how long any insulin lasts for you is very much dependent on the amount you take. I take relatively small doses of basal (Levemir) and it gets nowhere near 24 hours - 14 - 16 if I'm lucky, but I suspect far closer to 12. Obviously I split dose morning and evening. I've never tried Lantus, but i strongly suspect that wouldn't last to long for me either. My bolus (Apidra) is done within 3 hours tops - nowhere near the 5 hours the manufacturers claim.

I read on this forum some months back that the manufacturers base their claims for the length of time insulin lasts on the average male taking somewhat large doses - they don't provide the data for smaller people such as women and they don't test against the small doses many low-carbers take. I can't remember who posted that information, but I was very surprised by it.

Smidge
 
Heathenlass said:
Yes, pretty much :)
It was certainly my experience that it didn't last that long, and also in me it had a definite sharp peak . But then, I just have to be different :D

Interestingly, I had a chat with my DSN today, and she was saying that they may have to re evaluate the DAFNE advice given , not to bolus for vegetables and protein, as the experience gained with pump users was showing otherwise in some people . The carrot was shown to be a culprit in spiking, and shock horror! The potato ! :eek::D That I think, is no news to many of us :p:D
Click to expand...


Nothing wrong with being different ;)

When you have a decent amount of veg on the plate the carbs can add up, we mentioned this on our course and the DSN agreed, it's the same for pulses and it must be taken into consideration when calculating the bolus dose.
 
smidge said:
I think how long any insulin lasts for you is very much dependent on the amount you take. I take relatively small doses of basal (Levemir) and it gets nowhere near 24 hours - 14 - 16 if I'm lucky, but I suspect far closer to 12. Obviously I split dose morning and evening. I've never tried Lantus, but i strongly suspect that wouldn't last to long for me either. My bolus (Apidra) is done within 3 hours tops - nowhere near the 5 hours the manufacturers claim.

I read on this forum some months back that the manufacturers base their claims for the length of time insulin lasts on the average male taking somewhat large doses - they don't provide the data for smaller people such as women and they don't test against the small doses many low-carbers take. I can't remember who posted that information, but I was very surprised by it.

Smidge
Click to expand...

Good point !:) That probably accounts for the problems I had with it, as I was on quite a small dose

Signy
 
Umm. Just read through this thread and i take levemir. Only take one shot per 24hr. And was thinking of splitting my dose for better coverage. However lol.. Would it not make more sense to just roll back my levemir injection time 6hrs per day to get complete coverage instead of injecting twice? Thought one of you guys might know why thats not a done thing :-/

Type 1 Diabetic: (Novorapid/Levemir) Diagnosed 2014: Extremely handsome: Always smiling :-)
 
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