Type 2 Phasing out Levemir?

nannoo_bird

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Saw my DN this week, she told me that they may discontinue Levemir as it has been found that it does not last the 24 hours it states it does. Anyone else heard this, and any idea what could replace it?
 

eventhorizon

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I hope not. I like the 12 - 18 hour profile action. Gives more flexibility.
 

noblehead

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Saw my DN this week, she told me that they may discontinue Levemir as it has been found that it does not last the 24 hours it states it does. Anyone else heard this, and any idea what could replace it?

Novo Nordisk who make Levemir brought out a new basal insulin around 2-3 years ago called Tresiba, this new insulin is said to last up to 42 hours (but is still injected once daily) compared to Levemir which only lasts up to 18 hours and has to be injected twice daily in most cases, I've not heard any news about Levemir being discontinued.
 

catapillar

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Levemir doesn't state that it lasts 24 hours, the patient information leaflets say it can last up to 24 hours. The leaflets also say it can be taken twice daily. It's pretty well recognised that levemir doesn't last 24 hours and the nice guidelines for its use say it should be prescribed for twice daily shots. I think your DSN is just being confused. There are plenty of alternative basal insulins, but this isn't necessarily a reason to require an alternative. Levemir is not being phased out, it remains available on bnf, it remains the basal of choice in nice guidelines for type 1.
 
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GrantGam

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I must agree with @eventhorizon, although it's a pain at times that Levemir does not last 24 hours - the saving grace of that flaw is easier adjustment for increased carbohydrate intake or sporadic exercise with a split dose regime. Although this is handy, I'd be very interested in trying Tresiba and will be requesting that at my next clinic appt.

With regards to discontinuing Levemir, that simply won't happen @nannoo_bird. What you may find though, is that when the patent expires on what we now know as 'Levemir' - that it's simply sold as 'insulin detemir' as opposed to the current Novo Nordisk trademark title of 'Levemir'. I think the same thing is happening (or has happened) with Lantus insulin?
 
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I just have one Levemir injection before bed, 9 or 10 units.
 
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Daibell

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Hi. Most of us know that Levemir doesn't last 24 hours. I only inject once a day but increase my Bolus as needed as the Levemir action tails-off - simple and saves an injection.
 

EllsKBells

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My nurse has said in the past that whether or not you are suitable for Tresiba depends on how regularly you need to change your basal dose. Levemir is good for people who need more flexibility, and as Catapillar has said above, it is still in the NICE guidelines as the long acting of choice.

I wish you luck with getting Tresiba @GrantGam - I suppose it depends on your CCG how willing they are to prescribe it. It has made a fairly big difference for me, as I was really, really struggling with how 'peaky' Levemir can be, but I know the cost of it does cause eyebrows to be raised.
 

GrantGam

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Thanks for your reply @EllsKBells:)

My basal dose tends to stay fairly stable, I normally eat between 130-200ish grams of carbs per day so I don't need much alteration of my basal profile. And when I occasionally (sounds terrible) introduce regular exercise - then I tend to reduce my I:C ratio either side of the exercise session to compensate for the excess basal from my typical dose.

My clinic are very good and actually referred me for a pump last time, which I was extremely chuffed about because I have a respectable HbA1c and we're often overlooked for that reason alone. For that reason, I'm hoping that they'll also be willing to consider a more expensive basal insulin for me.

I also suffer with the Levemir peak, usually between 5-8 hours - which ultimately means it's very awkward for me to increase it to compensate for my DP, I just get nocturnal hypos... Correct me if I'm wrong, but I've heard that Tresiba has a slight peak at 12 hours? That could be perfect for putting a dent in my DP:)
 

steve_p6

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For myself I have found the Tresiba was making the BGs drop in the period 6-12 hours after injecting. Whether that was the Tresiba or just my personal cycle I cant say but it happens whether I inject morning or evening. That said its still much better than Levemir for me.
 

GrantGam

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For myself I have found the Tresiba was making the BGs drop in the period 6-12 hours after injecting. Whether that was the Tresiba or just my personal cycle I cant say but it happens whether I inject morning or evening. That said its still much better than Levemir for me.
You're still using Tresiba then @steve_p6? I'm quite excited about this basal insulin as I've heard great reviews. In your opinion, what's the main plus over Levemir?

Apologies if I'm derailing here...
 

steve_p6

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Simply that it is much flatter and consistent over 24 hours than twice a day Levemir and just the single shot.
I believe it's still a little more expensive than Levemir but it is CCG approved. A few basal graphs of the Levemir peak should be able to support your case.
 

GrantGam

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Simply that it is much flatter and consistent over 24 hours than twice a day Levemir and just the single shot.
I believe it's still a little more expensive than Levemir but it is CCG approved. A few basal graphs of the Levemir peak should be able to support your case.
Many thanks @steve_p6:)