Help with changing insulin

[Michele01]

Hi - please can you help?

I've been type 1 for several years and have managed my bcg really well using Levemir (twice a day) and Novorapid (with each meal). I've just had a review with my consultant who has swapped the Levemir for Toujeo (once a day). I was advised to use 32 units of Toujeo (previously I had a total of 44 units with Levemir). I've been using Toujeo now for about 2 weeks and have noticed that I'm having to increase my dose of Novorapid considerably with each meal (going from an average of 16/18 units to 24/26). I've also found that I'm having to run my bcg high before bedtime to avoid a hypo during the night which isn't ideal.

So I'm consider two things and wondered if, in your experience, I am doing the right thing:

1. Firstly I think I need to increase the Toujeo from 32 to at least 36 and see what happens during the day (possibly going up to as much as 40 but gradually keeping an eye on my daily levels).
2. Swapping taking the Toujeo to first thing in the morning rather than at bedtime - I'm doing this assuming that it won't be as "strong" as the 24 hours are reducing so an increased dose will help during the day but shouldn't cause hypos at night.

Lastly, how do I switch from evening to morning? Should I just miss one evening dose and then take in the morning when I get up OR should I just add the additional 4 units now this morning (to bring the Toujeo from 32 to 36) and then hope that keeps things in check until tomorrow morning?

I hope all of that makes sense and would welcome your input.

Thanks in advance.

Michele

 

[Fairygodmother]

Hi @Michele01, I don’t use Toujeo myself and therefore am unfamiliar with its profile. Have you looked online for information about its peaks and troughs, if any? It sounds as though you definitely need help though. Are you in the U.K.? If you are then could you make an appointment to see your DSN and ask advice from them?
If you’re not in the U.K., who other than your Consultant, do you see about medication and advice?
We can’t tell you what doses to take as most of us are not medically trained, but maybe there are some other Toujeo users who can say what they did when making a swap from another insulin. However, we’re all different.
Perhaps if you put the word Toujeo in the title of your post it would bring them to you. Good luck.

 

[Juicyj]

Hi @Michele01

Unfortunately I cannot give you dosing advice as its against forum rules, however my advice with changing basal is that they generally start off with a lower dose gradually increasing until you find your perfect level, to check if your background needs adjusting then do some basal testing, remember any adjustments need 3-4 days to settle in so don't rush into anything, in regards to AM vs PM, I don't know the profile of this so cannot comment so please check this with your DSN.

 

[Michele01]

Thank you both for your replies. I have just spoken with my diabetic nurse and sent her my spreadsheet with all readings and what insulin I've taken and she's going to come back to me. Initially she agrees that the dose of Toujeo can't be right as my Novorapid is doubling and she also thinks that taking the Toujeo at night isn't right for me. She's going to speak to the consultant and come back to me. Thanks again.

 

[Juicyj]

Hi @Michele01 Good call contacting your DSN, it's best to err on the side of safety, looking at the profile it's a long acting insulin up to 36 hours, so wouldn't make much difference whether your am or pm, hope it settles in soon, it's a pain feeling out of control with your levels.

 

[Michele01]

Hi @Michele01 Good call contacting your DSN, it's best to err on the side of safety, looking at the profile it's a long acting insulin up to 36 hours, so wouldn't make much difference whether your am or pm, hope it settles in soon, it's a pain feeling out of control with your levels.

Thank you. My DSN has suggested taking another 4 units now and then moving from PM to AM but honestly, I'm not happy that my Novorapid has doubled and I'm going on holiday in 2 weeks so I'm going to revert back to Levemir starting tomorrow morning to see if I can get my levels back to some normality. They've squeezed me in with the consultant for next week so I'll chat it through with him then but I seriously don't want to go on holiday with out of control levels.

I've been reading posts regarding Toujeo and it seems to be hit and miss whether it helps or not. So I'm not going to muck around - I'm reverting back to my trusty friend Levemir!

 

[slip]

Just be careful going back to levemir in the morning, you'll potentially still have some toujeo sloshing around. Can I ask what the reason was for changing to Toujeo in the first place if you were doing well on Levemir?

 

[Michele01]

Just be careful going back to levemir in the morning, you'll potentially still have some toujeo sloshing around. Can I ask what the reason was for changing to Toujeo in the first place if you were doing well on Levemir?

Thanks @slip. I agreed with my nurse that I wouldn't take any Toujeo tonight and will run high and just take the Levemir in the morning - so it will be around 32 hours since my last Toujeo before starting on the Levemir again. I'm not sure why my consultant wanted me to swap other than I was saying I was fed up with injecting 5 times a day so he suggested by using Toujeo it would cut out one injection. To be honest it's been lovely having one less and it injects very smoothly but honestly the battle I'm having with my levels doesn't justify it.