Type 1 Need some advice on changing Levemir to Toujeo

[Angeldust]

Just looking for some rough guidelines and quick advice please. I have no access to help at the minute. But have always been very competent managing, figuring and sorting doses and all the rest of it.
Did anyone else switch from Levemir (6u AM and 4u PM so im on tiny doses) to toujeo, what were these doses and the times you take/took ?

Can you make any kind of comparison and most importantly, did toujeo once/24hrs seem to completely level out your background? I can never, ever know this without even being allowed to as much as trial a CGM. Postcode lottery losers of the entire UK sadly.

 

[Angeldust]

anybody at all?? Really sorry but i have no access to a DSN or anybody right now and won't for a few weeks but obviously will go through everything with them. I just really need some advice and rough guidelines to get going.
I normally take 6u levemir 10am and 4u at 10pm. Totalling 10units of levemir in 24 hours. I took only 4 of toujeo at 10pm, woke at 22. So i'm feeling horrendous. I remember being told that you need to use much less toujeo than equivalent lantus units -

is anyone able to help at all?

 

[ert]

I think you need to stay on your Levemir until you have access to a DN or diabetes consultant to ask about changes.
In the meantime, this thread appears to suggest to take the dosage in the morning rather than at night time, to avoid hypos:
https://www.diabetes.co.uk/forum/threads/switching-from-levemir-to-toujeo-having-a-nightmare.165044/

There is a calculation guide here to discuss with your DN:
https://www.sanofidiabetes.co.uk/-/...e/toujeo/download-pdf/How-To-Start-Toujeo.pdf
But again, don't change until you have access to medical advice.

 

[oldgreymare]

Unfortunately I don't have any experience with toujeo, but I switched from Levemir to Tresiba. NOT the same insulin as toujeo, as Tresiba has a different release mechanism and meant to be ultra long lasting (slow release). I was on 12-14u Levemir total split twice a day. Given no advice how to switch over, did effectively cold turkey substituting a single Tresiba shot and discontinuing Levemir. Then spent two days borderline DKA with very high levels - in hindsight, I suspect that the residual Levemir in my system had finished before enough of the Tresiba was released. Now stabilised with dose of 10-11u Tresiba each morning. So consider a gradual switch from Levemir? This link (Canadian site) suggests it takes 5 days for tuojeo to reach steady state control. https://www.canadianinsulin.com/articles/toujeo-vs-levemir.html

Also are you correctly calibrating your doses for the different concentrations? I think tuojeo is 300u/ml, while levemir is 100u/ml - double check!

 

[Angeldust]

I think you need to stay on your Levemir until you have access to a DN or diabetes consultant to ask about changes.
In the meantime, this thread appears to suggest to take the dosage in the morning rather than at night time, to avoid hypos:
https://www.diabetes.co.uk/forum/threads/switching-from-levemir-to-toujeo-having-a-nightmare.165044/

There is a calculation guide here to discuss with your DN:
https://www.sanofidiabetes.co.uk/-/...e/toujeo/download-pdf/How-To-Start-Toujeo.pdf
But again, don't change until you have access to medical advice.

thank you! I hear you but it's not an option for me right now hence asking on here. I have no idea when I can get back to the UK. I'm very ill at the moment, can't get levemir here (why does everywhere else in western europe feel soo much more advanced!? they all have (t1) mandatory free libres and all seem to be on either Tresiba or Toujeo (which my health board refused me cos of "cost", ***?) but I refuse lantus and levemir now and it's time for either Tresiba or Toujeo. I could only get toujeo here in Belgium. Also upon waking realised it's better for me to take in the morning as opposed to night time. I'm honestly better working out what I need going on my own instinct. I had levemir mailed to me and am certain it all got damaged in the post. I also switched myself from novorapid to Fiasp (also declined by my health board...WHY? i have every single serious complication going) and best insulin I have ever used. I didn;t have any problem with switching over or dosages or anything.

I'm certain the levemir wasn't working and i've lost so much weight from having gastroparesis that all these injections are just too much on me. So I need either tresiba or toujeo. I asked for tresiba but they don't use it here.

 

[Angeldust]

Unfortunately I don't have any experience with toujeo, but I switched from Levemir to Tresiba. NOT the same insulin as toujeo, as Tresiba has a different release mechanism and meant to be ultra long lasting (slow release). I was on 12-14u Levemir total split twice a day. Given no advice how to switch over, did effectively cold turkey substituting a single Tresiba shot and discontinuing Levemir. Then spent two days borderline DKA with very high levels - in hindsight, I suspect that the residual Levemir in my system had finished before enough of the Tresiba was released. Now stabilised with dose of 10-11u Tresiba each morning. So consider a gradual switch from Levemir? This link (Canadian site) suggests it takes 5 days for tuojeo to reach steady state control. https://www.canadianinsulin.com/articles/toujeo-vs-levemir.html

Also are you correctly calibrating your doses for the different concentrations? I think tuojeo is 300u/ml, while levemir is 100u/ml - double check!

thank you for replying !! Tresiba is what I wanted and am going to try fighting again to get put on it when I can get back home. WHY am I being refused funding for any kind of newer insulin!? it's mad...)
But I'm so fed up with levemir that I will make the change now. I expected a few rough days. I took 6 more units when I woke and will see again exactly 24hrs and see what's happening and know it will take a good few days to level out. Thanks I will keep a good eye out to make sure I'm not at risk of DKA and going to set alarms for through the night for the next few days. **** how much I want and need a CGM....

Edit: yes thanks, I was aware of the change in regards to the toujeo being a super concentrated insulin. It is indeed 300u/ml.

 

[alanj]

Try Sanofi diabetes 24 hour care line Freephone 24hour 0800 35 25 25. I take 20units of toujuo at night, what I have found is timing it can take up 5 hours to work and you take it up to 3 hours before or after your usual time. As for the insulin you take I haven't had any experience with

 

[oldgreymare]

thank you for replying !! Tresiba is what I wanted and am going to try fighting again to get put on it when I can get back home. WHY am I being refused funding for any kind of newer insulin!? it's mad...)
But I'm so fed up with levemir that I will make the change now. I expected a few rough days. I took 6 more units when I woke and will see again exactly 24hrs and see what's happening and know it will take a good few days to level out. Thanks I will keep a good eye out to make sure I'm not at risk of DKA and going to set alarms for through the night for the next few days. **** how much I want and need a CGM....

Edit: yes thanks, I was aware of the change in regards to the toujeo being a super concentrated insulin. It is indeed 300u/ml.

If you are going ahead please test very frequently - are you Ok administering correction doses safely with Fiasp? Also perhaps try to keep to a steady routine for the first week or so, until you are truly comfortable with Toujeo. I did revert to Levemir for a month or so, because I felt I was suffering worse upper respiratory tract symptoms (apparently one of the most common insulin side effects?) with Tresiba. But my baseline control deteriorated, so transitioned back to Tresiba, but the catarrh is a constant annoyance.

If you are into getting detailed personal control of your blood sugars, Sugar Surfing by Stephen W. Ponder is immensely insightful, BUT this approach does require a Libre or CGM (I self fund a Dexcom G6) to be actionable. Take care and let us know how you are getting on.

 

[Angeldust]

If you are going ahead please test very frequently - are you Ok administering correction doses safely with Fiasp? Also perhaps try to keep to a steady routine for the first week or so, until you are truly comfortable with Toujeo. I did revert to Levemir for a month or so, because I felt I was suffering worse upper respiratory tract symptoms (apparently one of the most common insulin side effects?) with Tresiba. But my baseline control deteriorated, so transitioned back to Tresiba, but the catarrh is a constant annoyance.

If you are into getting detailed personal control of your blood sugars, Sugar Surfing by Stephen W. Ponder is immensely insightful, BUT this approach does require a Libre or CGM (I self fund a Dexcom G6) to be actionable. Take care and let us know how you are getting on.

Thanks so much! no matter what I do, it feels impossible right now. I've been in a solid gastroparesis flareup every single day vomiting for over a year solid now. My funding to have specialists and the lifechanging surgery that made me better and at least live some kind of life just robbed away from me like the flick of a switch. I'm so bitter at my local health board for pretty much everything and so scared of dying now as i've dropped to 37kg ..and they still won't help. So I am never in a state where I truly know what's going on with my stomach not emptying. I've had to do it all the hard way as we don't even have an endo... one gets sent to us from Glasgow once a year for only a few hours!!!!!! ....he's fantastic and i just wish i could move to anywhere normal where i'd have doctors and life could improve.

Good with corrections-no issue there or with any of the rapid stuff but like with any change, was expecting a weeks circle of hypos and rebounds. hypos and rebounds. It is feeling impossible without having a cgm for it. I don't know if my hypo before was from a mis-correction or the toujeo. I only took 6 units! at 10am the last two days now. I thought that was such a low amount that i'd be getting a whole bunch of HIs. Hypo AFTER eating!! both today (sunday.. it's stupid o clock and im scared to sleep with no cgm) and yesterday at 8pm and much lower than normal - under 5mmol going to bed. Everything's all over the place with the gastroparesis and i feel defeated already - my number1 reason for wanting to make the change being to improve things for the **** stomach and gut. This insulin cost me so much it feels criminal! I will stick it out a few more days until I can start to get a clearer picture. I'm trying to eat the same thing at the same times also. Am in such a vicious circle. up at 15 again now which i know is from drinking a coke because i was on the verge of hypo just as I was falling asleep. UGH. I wonder if there's any way i can trial a CGM (i sadly can't afford one) so that I can see exactly what is happening. The NHS won't help out, that much is certain. Mid morning to dinner time been just fine.

Thanks so much again! I'll check that out.

 

[Angeldust]

Hey, just checking back in! Unfortunately from having gastroparesis I am always going to have such erratic periods and hope that I can eat at regular times - there have been so, so many days the last year plus, where I can't even keep water down,
I'm nauseous and in pain but the pattern is starting to show. My sugars were good (a lil low for me - I would have hypo'd out so many times if I wasn't able to eat today. I feel safer around 7 though obviously I want to be able to have them closer to 5. But provided that I was able to eat and drink a couple times today, it staved off the hypos and they remained between 4 (I had a 3.9 in the afternoon but as long as they're not happening in the night I can stop it going bad and avoid the inevitable rebound) and stuck to the same food at the same times. Been eating later than I would like, though. It all seems to be slowly settling in - a few more days and I will have a much better picture. So I will try 6units toujeo again tomorrow at 10am and that will be day 3 (4 including the first when I took it a little at night instead).

I have been worrying before sleeping though, that's when I feel safer when they are around 7. If I go to bed under 5mmol I am guaranteed a hypo. If I hypo again tonight I will try 5 or even 4 units instead of 6 tomorrow .. but that just sounds like an almost non existent dose!? But I can say with certainty I feel much better that they've pretty much remained in range all day!

 

[Angeldust]

spoke too soon, I took the amount of fiasp which should have covered the carbs but as it was unlabelled food and I had to completely guess the carbs, I think it was 1unit fiasp too much. At least I've caught it and can treat it easy without expecting rebound. I'll still stick to the 6u toujeo again at 10am tomorrow since I've been happy with the readings throughout the whole day and if I get any more night hypos I will know I need to cut it down more. Any suggestions welcome by the way <3 but I think I will get there soon with this ..,

Edit: bad hypo. Tomorrow, given I can eat, i will stick to labelled foods that I know for absolute certain the amount of carbs in - though it is looking like it's probably a little bit too much toujeo for me but I've definitely taken a unit or two too much fiasp. Dripping in sweat and got super shakes, can't stand up. Dropped very hard so, so fast (i took the same amount of fiasp as I normally would for what I ate!? ,,, and background just seems so minute at a dose of merely 4 or 5units. I guess it's very, very concentrated indeed.