Levemir

[Charles Robin]

Hi All!

For as long as I can remember, I have been taking Lantus as my basal insulin. Anyone checking out my blog will see that I used to have tons of hypos, which were all my own fault. For the past year, I have been following a low carbohydrate diet, based largely on the advice given in Dr Richard Bernstein's book. My control is much, much better than it has ever been. But the truth is, I'm still not there yet. I wasn't experiencing many hypos until the last couple of months. Since about late November, that seems to have changed. They are easy to deal with, and nothing like the nightmares I used to have. However, there should not be a need for me to go into the threes if there is a solution. I'm eating sensibly, and have played around with my bolus insulin. The problem is, there doesn't seem to be much of a pattern. This has got me to wondering, is my Lantus doing its job?

Rereading Dr Bernstein's book, I see that he does not actually recommend Lantus. I have also seen a few people post about positive experiences with Levemir. The way Dr Bernstein suggests doing things is a dose of Levemir to cover the night, and a dose to cover the day. He actually splits his Levemir in half at bed time, and gives the other half four hours after going to bed. This is to counteract the dawn phenomenon. I was just wondering, does anyone follow this way of doing things? Or have any experiences of switching from Lantus to Levemir? (I take 18 units of Lantus once a day at the moment). Thanks for any advice

 

[Charles Robin]

I should also probably mention that I rotate my injection sites, always give my Lantus at 7pm, and change the needle after every injection.

 

[noblehead]

Personally I found levemir to be next to useless insulin and went back to lantus, ended up injecting nearly twice the dose and still couldn't get my bg under control (despite split dosing), but experience tells us that what works for one may not work for another, so if your having problems with your control using lantus then it's worth trying levemir Charles, alternatively you could ask to try the new basal insulin called Tresiba.

 

[Charles Robin]

Personally I found levemir to be next to useless insulin and went back to lantus, ended up injecting nearly twice the dose and still couldn't get my bg under control (despite split dosing), but experience tells us that what works for one may not work for another, so if your having problems with your control using lantus then it's worth trying levemir Charles, alternatively you could ask to try the new basal insulin called Tresiba.

I'll have to have a read, thanks for the heads up. In the meantime, I'm trying a radical approach... Actually noting down my results again to look for patterns! Seriously, I pick up bad habits like a magnet picks up screws.

 

[Charles Robin]

Thus far my experiments have made things more erratic rather than less, eek! Today particularly, I just seemed to want to go low. Less short acting for meals tomorrow I think. If that fails, smaller Lantus dose. If that fails, change of prescription. A cunning plan I hope...

 

[tim2000s]

This is my experience of doing what you are, moving from lantus to levemir: http://www.diabetes.co.uk/forum/thr...pefully-providing-some-lessons-learned.70039/

It might be worth a read. The quick summary is that I've discovered that lantus wasn't controlling my glucose levels predictably and had been causing issues for some time with both lows and highs. This thread has done of the issues lantus users have seen
http://www.diabetes.co.uk/forum/threads/lantus-users.67760/

I've found levemir has a much more predictable release action, but it doesn't quite last 12 hours. Anyway, have a read. Hope it is useful.

 

[noblehead]

@Charles Robin, the insulin I mentioned (tresiba) is said to have a really flat profile compared to levemir and lantus, @robert72 is on this insulin and speaks highly of it, hopefully by tagging him he'll respond to your post.

 

[Charles Robin]

Thanks Tim and Noblehead, that's some really useful information. My main question to anyone using Tresiba would be how often they inject it. The website claims it can last for up to 42 hours.

 

[drahawkins_1973]

Sorry this is going to be a long post but I’ve been meaning to send an update for a few days so may as well get it done in one post 
I’ve moved over to Tresiba from Levemir a week or two ago because my levemir wasn’t lasting 24 hours and I was too sensitive to it to do a split dose(only 4 units once per day). It’s taking me a little while to sort my Tresiba dosage out but now I have its working really well for me.

My DSN suggested a lower dose initially compared to levemir but actually I’ve since figured out I need exactly the same units so a straight unit for unit swap would have worked ok. This is kind of explained in the paper I attached below which I only found yesterday unfortunately.

I also couldn’t get my head around how the thing worked and why you don’t get stacking and again this is explained in the paper. Its all about your body reaching steady state. This takes about 2-3 days and then your body reaches equilibrium i.e. the amount you inject is balanced with the amount that is absorbed and you don’t get further build up in,
Through a bit of trial and error I have found that I need the exact same dose of Tresiba as levemir and I take it once a day at the same time in the exact same way that I did my levemir.

Anyway now for the good bit!
As I say I am still really new to Tresiba but up to now what a difference. My sugars are really stable all day. I’ve done a fair bit of basal testing and they are pretty flat!
And a massively unexpected bonus is the effect it has on my morning sugars. Before, I used to get the dreaded DP so regardless of what I went to bed at I’d be up to 8-10 by the time I got out of bed. The last few days my morning readings have been within 1 mmol of my night time readings. I can’t remember the last time I woke up with bod sugars at 5 or 6!!

I also used to need double the amount of QA insulin in the morning compared to the rest of the day but that too has changed. I’ve cut my morning QA in almost in half so it’s helping with my resistance to insulin in the morning too.

So, so far so good and I hope this continues.

But please do read the info in the paper attached as I found it really helpful to understand how the Tresiba works.

All the best.
Andrea

 

[novorapidboi26]

I was on Lantus for about a month in 2009, then switched to Levemir, why?

Lantus didn't last the full 24 hours, which is actually normal for most folk.........

Looking back I could have stayed on Lantus, as it was the split dose that I was needing...............another reason for going on Levemir was that the HCPs said changing a Lantus dose would need 2-3 days to see the effect............I am still unsure if this is actually true though.....

I would say try as many insulin as you need to get the job done, which for basal insulin, is to hold you steady during the absence of carbs.....

what I do believe in though is that a spit is the best way to go for the majority of people who live active lifestyles, like a drink and so on.........

 

[Charles Robin]

Sorry this is going to be a long post but I’ve been meaning to send an update for a few days so may as well get it done in one post 
I’ve moved over to Tresiba from Levemir a week or two ago because my levemir wasn’t lasting 24 hours and I was too sensitive to it to do a split dose(only 4 units once per day). It’s taking me a little while to sort my Tresiba dosage out but now I have its working really well for me.

My DSN suggested a lower dose initially compared to levemir but actually I’ve since figured out I need exactly the same units so a straight unit for unit swap would have worked ok. This is kind of explained in the paper I attached below which I only found yesterday unfortunately.

I also couldn’t get my head around how the thing worked and why you don’t get stacking and again this is explained in the paper. Its all about your body reaching steady state. This takes about 2-3 days and then your body reaches equilibrium i.e. the amount you inject is balanced with the amount that is absorbed and you don’t get further build up in,
Through a bit of trial and error I have found that I need the exact same dose of Tresiba as levemir and I take it once a day at the same time in the exact same way that I did my levemir.

Anyway now for the good bit!
As I say I am still really new to Tresiba but up to now what a difference. My sugars are really stable all day. I’ve done a fair bit of basal testing and they are pretty flat!
And a massively unexpected bonus is the effect it has on my morning sugars. Before, I used to get the dreaded DP so regardless of what I went to bed at I’d be up to 8-10 by the time I got out of bed. The last few days my morning readings have been within 1 mmol of my night time readings. I can’t remember the last time I woke up with bod sugars at 5 or 6!!

I also used to need double the amount of QA insulin in the morning compared to the rest of the day but that too has changed. I’ve cut my morning QA in almost in half so it’s helping with my resistance to insulin in the morning too.

So, so far so good and I hope this continues.

But please do read the info in the paper attached as I found it really helpful to understand how the Tresiba works.

All the best.
Andrea

Thanks, that's a great post. I have read through the article you linked and it all looks promising! I never believe something on word alone though, so I guess the best thing for me to do is try it out and see how it goes. I'm due my annual checkup with my GP now anyway, and then have diabetic clinic at the hospital in March. What I'll probably do is ask for Tresiba to be added to my prescription, but for Lantus to be left on for now as well. That way, if I find I start injecting Tresiba, and tentacles start growing from my ears, I can switch back without a problem.

 

[tim2000s]

Just a warning, many diabetic clinics won't put you onto Tresiba unless you have a bad history of hypos and are hypo unaware, as it is unfortunately still a very expensive option and Levemir is deemed to work "well enough" (yes even T1s get issues with things costing too much, pump anyone?). It was registered as having an "almost significant" improvement in nocturnal hypoglycaemia compared to Lantus.

It also comes with some cardio vascular safety concerns that require ongoing monitoring so wasn't given an unlimited license in the UK, rather a limited one with need to review the cardio vascular safety concerns.

In terms of cost, it is roughly 1.75 times the cost of Lantus and Levemir.

There's an interesting Scottish government paper here:http://www.scottishmedicines.org.uk...udec_Tresiba_FINAL_March_2013_for_website.pdf

 

[Charles Robin]

Just a warning, many diabetic clinics won't put you onto Tresiba unless you have a bad history of hypos and are hypo unaware, as it is unfortunately still a very expensive option and Levemir is deemed to work "well enough" (yes even T1s get issues with things costing too much, pump anyone?). It was registered as having an "almost significant" improvement in nocturnal hypoglycaemia compared to Lantus.

It also comes with some cardio vascular safety concerns that require ongoing monitoring so wasn't given an unlimited license in the UK, rather a limited one with need to review the cardio vascular safety concerns.

In terms of cost, it is roughly 1.75 times the cost of Lantus and Levemir.

There's an interesting Scottish government paper here:http://www.scottishmedicines.org.uk...udec_Tresiba_FINAL_March_2013_for_website.pdf

Cheers for the heads up. I've now got an appointment next Friday to review my diabetic control. I'll be bringing my diabetic diary with me, and will make a strong case for trying out the Tresiba. Usually, my surgery is very good at prescribing what I ask for. I think they realised early on that I'm extremely driven, and can be more of a problem than I'm worth if I believe I need something and it's being withheld .

 

[tim2000s]

Cheers for the heads up. I've now got an appointment next Friday to review my diabetic control. I'll be bringing my diabetic diary with me, and will make a strong case for trying out the Tresiba. Usually, my surgery is very good at prescribing what I ask for. I think they realised early on that I'm extremely driven, and can be more of a problem than I'm worth if I believe I need something and it's being withheld .

Good luck with this one. My GP turned around and said that he couldn't prescribe Tresiba as it was outside his knowledge, so you may find that your GP has a similar issue and will refer you to a diabetic clinic.

 

[jackois]

Hi Charles, I'm on Lantus and moved to a split dose regime after suffering low blood sugars through the night. I take my evening dose at ten and it's two thirds of my total dose. The other third I give around three in the afternoon.

This has cured the incidence of low blood sugar through the night give a steady 5 - 5.5 reading with next to no early morning rise that I attributed to a liver dump after prolonged low blood sugar. The afternoon dose has done away with the slow rise I was seeing in the evening & allowed me to reduce my evening meal bolus...

hope this helps.

 

[robert72]

@Charles Robin

I switched over to Tresiba last summer because I found that Lantus could be erratic. I had been on Lantus since 2003 and always suspected that it could be inconsistent, although at times it could work very well. Anyway, I have found Tresiba to be very smooth and consistent by comparison.

When I switched over, I was on 12u of Lantus, so I dropped to 9u Tresiba and titrated up to 10u. I note in the PDF that Andrea posted that folks with HbA1c's below 8 might need to start with a 20% lower dose when switching, so bear that in mind.

I had tried Levemir a few years ago and whilst I found it more consistent than Lantus, I developed allergic lumps at my infection sites so swapped back to Lantus. As @tim2000s says, Tresiba is considerably more expensive than Lantus/Levemir, so you might need to make a case for asking to try it. My GP said he wouldn't let me try it as he had no experience of it, so I had to get referred back to a Diabetic clinic who were happy to take responsibility... possibly because it wasn't from their budget

 

[robert72]

Sorry this is going to be a long post but I’ve been meaning to send an update for a few days so may as well get it done in one post 
I’ve moved over to Tresiba from Levemir a week or two ago because my levemir wasn’t lasting 24 hours and I was too sensitive to it to do a split dose(only 4 units once per day). It’s taking me a little while to sort my Tresiba dosage out but now I have its working really well for me.

My DSN suggested a lower dose initially compared to levemir but actually I’ve since figured out I need exactly the same units so a straight unit for unit swap would have worked ok. This is kind of explained in the paper I attached below which I only found yesterday unfortunately.

I also couldn’t get my head around how the thing worked and why you don’t get stacking and again this is explained in the paper. Its all about your body reaching steady state. This takes about 2-3 days and then your body reaches equilibrium i.e. the amount you inject is balanced with the amount that is absorbed and you don’t get further build up in,
Through a bit of trial and error I have found that I need the exact same dose of Tresiba as levemir and I take it once a day at the same time in the exact same way that I did my levemir.

Anyway now for the good bit!
As I say I am still really new to Tresiba but up to now what a difference. My sugars are really stable all day. I’ve done a fair bit of basal testing and they are pretty flat!
And a massively unexpected bonus is the effect it has on my morning sugars. Before, I used to get the dreaded DP so regardless of what I went to bed at I’d be up to 8-10 by the time I got out of bed. The last few days my morning readings have been within 1 mmol of my night time readings. I can’t remember the last time I woke up with bod sugars at 5 or 6!!

I also used to need double the amount of QA insulin in the morning compared to the rest of the day but that too has changed. I’ve cut my morning QA in almost in half so it’s helping with my resistance to insulin in the morning too.

So, so far so good and I hope this continues.

But please do read the info in the paper attached as I found it really helpful to understand how the Tresiba works.

All the best.
Andrea

Glad to hear you are doing well on Tresiba Andrea - and thanks for posting the PDF.

 

[Daibell]

Hi. As a side point, the latest NICE Diabetes Pathways DEC 2014 draft update recommends using Detemir (= Levemir) as the preferred Basal to try first. I don't know why it is preferred over Lantus

 

[Charles Robin]

Thanks everyone, really helpful advice as always! I'll see what they say this time next week at the GP's. If they won't prescribe Tresiba I will give Levemir a go. I have my diabetic clinic at hospital at the end of March. I have to say my team are actually brilliant there. They were skeptical of my low carb diet, but agreed to work with me and see what happened. I see the dietician every 4 months and she supports me. My diabetic specialist also now gives the thumbs up for me going low carb. I'm therefore hopeful that if the GP doesn't like the idea of funding Tresiba, my diabetic team at hospital can give me some backup.

 

[monkehwife]

I switched from lantus to levemir after bad reactions to the lantus. I have split the levemir dose in the past but this didn't work well for me, my BG is much better controlled taking the full dose at bedtime. However, I do have a good friend that must split her levemir dose into morning and evening as the trailing off of the basal does have a big impact in her levels during the day.