Levemir

[kathryn123]

Hi I have been diabetic for over 20 years now and I have just recently gone onto Levemir after being on Lantus for about 6 years or more. I seem to be finding if I do one injection a day I seem to be on the high side but when I do another injection 12 hours later I find I am having hypos. I have done slight adjustments but just cant get it right. Has anybody got any ideas what else to try with this Levemir?
Kathryn

 

[iHs]

Hello Kathryn

To get good control using Levemir, it really needs to be used bedtime and before breakfast. That is why yr bg is a bit high during the morning onwards.

Tonight when you go to bed give yourself your usual 100% levemir dose but in the morning start to give yourself 50% of your bedtime dose. You will have to watch out for going a bit low in the morning as the levemir will also be active with your bolus insulin. In the evening before bed then give yourself the other 50% levemir. The 50/50 is not completely acurate for everyone so you will have to tinker a bit to get the basal/bolus ratio as you require it.

 

[janabelle]

Hi Kathryn,
I was wondering why first of all you were put on Lantus, and why you have now switched to Levemir?
I've been insulin dependent for nearly 20 years this coming March, and been on synthetic "human" insulins from the start. Never been really well controlled on them, I was switched to Lantus in 2004 by my hospital diabetic clinic-with claims it was the best thing since sliced bread for diabetes management! What a **** time I had on it, you can read my previous posts if you've got a spare lifetime!
I forced my consultant to prescribe me Pork Insulin this May, and my control is the best I've ever had. I have never felt better and have bags of energy. I have lost nearly a stone since going on it, which is great, because it was always a battle to lose weight before. I was always slim before diagnosis, and for the first time in my adult life I feel in control of my diabetes, eating and weight. I can't emphasise enough what a huge difference changing to animal insulin has made to my life. I just wish I'd been offered it when I was first diagnosed-didn't seem to be an option and even less so now.
Jus

 

[martinbuchan]

Also, it seems many peple have to have a 20-30% increased dose of levemir compared to lantus. You may be on too little, as well as having to work out timing of dosing and ratio of dosing. I changed from 66 unit per day of lantus to 22/44 levemir. Control was worse until I started on 100 units once pe day of levemir. Now down to 82 units levemir once a day - seems better (last weeks HbA1C 5.8%).


The morning dose of twice daily levemir was designed to counteract the natural late morning insulin resistance causing mild hyperglycaemia. Something I did not find in my own case.

Also, my diabetologist says there is more evidence now with levemir, that increasing the dose will also prolong the insulin effect (does that seem logical?) and not just produce a larger effect.

I might go back to lantus as a pen would last for an extra day a therefore be a bit cheaper. I saw a new lantus pen recently that goes up to 80 units with one plunge. Usueful for a large user such as myself. The old pen only went upto 40 units.

 

[janabelle]

Thought we were talking about Levemir and Lantus, yet I keep hearing the word Insulin being used!!???
Take note-these products may reduce blood sugar by whatever means, but they are definately not Insulin!
Jus

 

[martinbuchan]

I will continue to call analoque insulins by the term insulin.

 

[matty1959]

Also, it seems many peple have to have a 20-30% increased dose of levemir compared to lantus. You may be on too little, as well as having to work out timing of dosing and ratio of dosing. I changed from 66 unit per day of lantus to 22/44 levemir. Control was worse until I started on 100 units once pe day of levemir. Now down to 82 units levemir once a day - seems better (last weeks HbA1C 5.8%).


The morning dose of twice daily levemir was designed to counteract the natural late morning insulin resistance causing mild hyperglycaemia. Something I did not find in my own case.

Also, my diabetologist says there is more evidence now with levemir, that increasing the dose will also prolong the insulin effect (does that seem logical?) and not just produce a larger effect.

I might go back to lantus as a pen would last for an extra day a therefore be a bit cheaper. I saw a new lantus pen recently that goes up to 80 units with one plunge. Usueful for a large user such as myself. The old pen only went upto 40 units.

surely you have an nhs exemption certificate......if not you should have one as all diabetic meds are exempt.

 

[janabelle]

I will continue to call analoque insulins by the term insulin.

Marty, didnt mean to cause offence in my last message, just stating a fact. I think people should be made aware that these products are NOT insulin and I don't think people should be misled. It's even less helpful when companies like Novo Nordisk call their Analogue Insulins by the term "Modern Insulins".
I have my own pet name for these products-poison, and I'll stick to calling them that, following my experience.
Sorry Kathryn I've lost the thread a bit! I'll leave it at that.
Jus

 

[martinbuchan]

Hi

yes I do have an NHS exemption certificate. Why waste money? Also, its just more convenient to have each pen last 25% longer. I have not seen any clear benefit of Levemir over Lantus personally.

My diabetologist has just put his first few insulin users on Byetta, I might be next. That will be about the same cost as my current levemir use.

I don't think it is helpful to scare people about insulin. Its hard enough being diabetic without inducing more anxiety. I am pretty convinced that I am better off taking modern analoque insulin a as I do not have a predictable lifestyle. Its working for me as I presented with a HbA1C of 13%, and has gone to 5.8% last month (over the last 2 years). This despite having a chronic bone infection in my foot and possible charcot arthropathy of the same foot.

I doubt everyone can be on the same regime and there are certainly people who have not adjusted well on moving from old regimes to new insulins.

Remember the problems with animal/human derived growth hormone? Personally I am quite relieved not to be taking a mammalian derived product. Rather not have to take anything at all reallly, but that isn't an option. Byetta is not real lizard spit, if it was I might be put off.

Everyone has to make up there own mind on this. In my knee clinic I offer 2 kinds of Hyaluronic acid injection- Synvisc is chicken derived, Duralane is non animal derived. It is important to some people (not just vegans) to know of this.

 

[janabelle]

Marty
I would rather be informed about what drugs I am taking, and frankly I find it far more frightening that us diabetic patients are being misled. After nearly 20 years on insulin, and 3 children I am well aware of how hard it is living with diabetes.
There may have been problems with growth hormone, but I havent heard of any of the like with purified animal insulins and they have been around for many many years. Tried and tested and proven safe over these years, in my opinion these new analogues have been licensed without enough long term studies, yet with huge financial investment.
As for doctors, I'm afraid my faith and trust in them has been shaken.It was my hospital consultant who told me over 15 years ago that my diabetes would probably always be brittle. I had been on synthetic "human" insulin for over 4 years then.. My experience was that my diabetes control was up and down like a yo-yo, even if I did the same thing each day and ate the same each day. This same consultant told me 3 years ago that is was ok for my blood sugar to rise to 15 every day, yet there is a chart on the wall in her clinic which states that a blood sugar over 9 is dangerous! She ignored the symptoms I told her about; severe exhaustion, nausea, tremor, muscle pains, unpredictable "hypo days",general malaise and poor quality of life, and prescribed me antidepressants. I now have excellent predictable blood sugar control every day- never had that in 19 years on synthetic insulins.
I had become chronicly ill since starting on Lantus but had failed to make the connection until earlier this year. Thanks to the IDDT and my clever biomedical scientist husband. Shame my consultant, who I've been under for 16 years thought the answer to my problems was antidepressants. How predictable and depressing.
People should know that having type-1 diabetes does not mean you have to feel ill and exhausted. I thought it was a symptom of being a diabetic on insulin. It is not!
Sorry Kathryn, I've gone right off the thread, so I'll leave it at that.
Jus

 

[martinbuchan]

Personally, I have never been misled on the type of insulin on offer.

 

[lionrampant]

The question is, how many doctors know?

 

[martinbuchan]

Hi

you will often read in my posts I refer to my Type 1 neighbour (a paediatrician as well). Been on insulin for 25 years or so. HbA1C 4.5%-5.5% - usually under 5%. Currently she is on lantus/novorapid. Loves these insulins compared to the more traditional regimes. Much more flexible and gave her the same fabulous control. Myself, for 2 years I have only known lantus / novorapid or levemir/novorapid on top of my metformin. My last HbA1C 5.8% 2 weeks ago. I know I can improve still, still lose weight (2 stone this year) adn smooth out any hypos. How can this be a bad advert for analoque insulins? Of course, I could be better on a differnent regime, but I have no pressure to change my regime. Sensibly, if one has a problem period, then change the regime under advice.

I don't think there has been any drug that is 100% safe or efficacious.

My question for levemir this month is that I increased from 80 to 86 units and my morning BS raised. I am sure I show more of a morning effect now compared to 2 years ago. Also, I may start Byetta soon, the whole regime will be up ended again. I predict a 1/3 drop in basal and and I hope for a 50%+ drop in bolus (usually on 40-50 novorapid per day). I am not aiming for any decrease in HBA1c, but want to use less insulin and lose more weight.

I think it is good to point out that analoque insulins are not the be all and end all of treatment. But I don't want people put off a useful treatment option.

 

[timo2]

Hi all,

Apparently the correct name for insulin analogues is "insulin receptor ligands", although the
term "insulin analogues" usually suffices to distinguish them from 100% genuine "insulin".

Regards,
timo.

 

[sugar2]

Hi Kathryn et al,

Im a levimir fan, as it works well for me. Have you tried doing 2 levimir injections, of approx 1/2 what your single injection was and depending when you are having the hypos, adjusting the short acting insulin?

Yup, I know that its not insulin, in the scientific sense, but it works as a generic term. I certainly don't feel conned! If animal insulins suit you best, then make sure you are not forced onto anything else, but for me, levimir and novorapid work well...although I am trying to find out if a pump would be even better!

Good luck Kathryn and thank you Marty for your useful posts!