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Long acting insulin options

Applenerd81

Well-Known Member
Messages
205
Location
North East
Type of diabetes
Type 1
Treatment type
Insulin
Dislikes
Carbs
I'm going to be going back to MDI for a while as my pump is being recalled.

Not happy going back to Lantus/Glargine as I've found it so unpredictable especially around exercise and dawn phenomenon.

What are the other long acting insulins out there and what are their pros and cons?

Any advice regarding long acting insulins much appreciated!
 
Tresiba is a new basal insulin which by all accounts is very good, it lasts up to 42 hours aftter injecting but still needs to be injected once a day.
 
On Lantus, I had dreadful hypos at times. On Levemir, the hypos were much milder
 
If you are doing a lot of exercise, is recommend levemir. I've found the flexibility of it to be great with loads of exercise. I use it as two separate basals to give that extra flexibility.
 
tim2000s said:
If you are doing a lot of exercise, is recommend levemir. I've found the flexibility of it to be great with loads of exercise. I use it as two separate basals to give that extra flexibility.
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How do you mean? Like 2 strengths?
 
It might be better for you to remain on Lantus for the time being as then that will justify the need for you to have a pump
 
I often went low overnight with Lantus and had unexplained erratic readings.

I changed to Tresiba last summer and have found that is has a very flat profile.

 
Applenerd81 said:
How do you mean? Like 2 strengths?
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No, two shots separated by 12 hours, each with a duration of 12 hours. Levemir doesn't last 24 hours, and smaller doses exhaust inside 12. So I use it like this. It's way more effective for me. Unfortunately it also makes getting a pump harder.

But as @iHs says, if you want a pump, stay on Lantus. Overnight Hypos are a trigger for pump use.
 
robert72 said:
I changed to Tresiba last summer and have found that is has a very flat profile.
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That's fine if you have a flat basal profile
As OP has Dawn P then the other option is to look at the insultard/Isophane/NPH or what ever they call it these days.
 
I've already been offered another pump but I'm planning to wait a month/two for Cellnovo. My consultant is already on board with me having pump therapy/alternative pump.

I'd rather not go back to having random hypos again and would prefer the best (MDI) option for now... I've gotten so used to having stable sugars with the pump, really am dreading switching back.
 
CarbsRok said:
That's fine if you have a flat basal profile
As OP has Dawn P then the other option is to look at the insultard/Isophane/NPH or what ever they call it these days.
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Fair enough - just telling what's out there.
 
Okay, to put it another way, my consultant reckoned that levemir was a better option given the exercise I do than Tresiba due to the lack of flexibility in Tresiba (aside from the cost and new product issues). Given my experience now with Levemir I can see the point.
 

As your only switching back to MDI for a couple of months your consultant might prescribe Tresiba as it is a lot more expensive than other basal insulin's, ask them if this is possible and explain that you've had previous problems using lantus.

When I switched from lantus to levemir a few years back I found it was like injecting water despite split-dosing and taking nearly twice as much insulin as I was when using lantus........ my bg wouldn't come down, but that said you may get away with it so both insulins could be a temporary option.
 


Something with a peak and then flat the rest of the day would be ideal!
 
Applenerd81 said:
View attachment 12811

Something with a peak and then flat the rest of the day would be ideal!
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If you go to bed late eg. midnight you could try a Levemir dose at bedtime and then another one when you get up.
Well actually maybe not, this pattern works with Lantus but not so much with Levemir because of its shorter action. With Levemir you can't really let it go more than 12 hours like you can with Lantus, so with Levemir you are pretty much forced into evenly spaced 12 hour intervals for injection. Whereas when doing split doses, Lantus has more flexibility on timing and more flexibility on making the two doses different sizes.

But you don't get on with Lantus so I suppose that's not an option. So I guess try a larger Levemir at bedtime, or shortly before, and a smaller Levemir 12 hours later.
 
I've not split doses before, have always had 24iu (Lantus) generally just before bed (9-11.30pm). So should I try 50/50 before bed and once up?

Majority of my hypos generally around 2am and usually on evenings after sport.

The other option I'm thinking of trying is a 2iu humalog bolus upon waking.
 
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Are you doing this with Lantus?
 
So you have a combination of a DP peak starting at 5am, and sometimes hypos at 2am? That's quite tricky to deal with using any injected basal.

However, if the hypos depend on the sport or exertion that means you can adapt and reduce your night time basal on a sport night, or take some carbs before bed. So you can probably manage it. 12u of basal at bedtime and 12u of basal 12 hrs later (Levemir) or in the morning (Lantus) would take the edge off that DP. Then tweak it from there until you get it as good as you can. It's never going to be as good as a pump.

Someone needs to invent a delayed-action bolus insulin for dealing with DP. Something you take at night that kicks in 6hrs later.
 

The hypos are likely caused by my previous diet being rich in carbs and high bolus amounts. Low carb (and low meal bolus) should hopefully in theory reduce the hypo risk.

The dp issue is the tricky one. A glass of wine before bed helps, I've read (cider) vinegar can help too.

Exercise makes everything very difficult!
 
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