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QUestion for people who have switch from Lantus to Levemir

S

staffsmatt

Well-Known Member
Hi all, I've recently changed from using lantus (had been using it for years) to levemir and apart from the red wields, which are getting less and less each day, I feel much, much better....

Before I changed over I was having quite a few symptoms of depression (obsessing about really daft things, really worrying that I / loved ones would die of whatever horrible disease was on the TV at that moment etc...) since switching over I'm not..

Has anyone else had similar experiences? I've done a bit of Googleing but the results are a bit inconclusive.....

Thanks all,

Matt
 
Re: QUestion for people who have switch from Lantus to Levem

Hi, I found this website have a read. Good luck tracey
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Lantus and Levemir: What's the Difference?
Linda von Wartburg
Jul 17, 2007

Lantus and Levemir have a lot in common. Both are basal insulin formulas, which means that they last for a long time in the body and act as background insulin, with a slow feed that mimics the constant low output of insulin produced by a healthy pancreas.

Both are insulin analogues, which means that their insulin molecules are analogous to human insulin, but engineered, or recombined, with slight differences that slow their absorption.

Lantus is a clear formula made with glargine, a genetically modified form of human insulin, dissolved in a special solution. Levemir is also a clear formula, but it contains dissolved detemir, a different form of genetically modified insulin.

Human insulin is made of two amino acid chains, called A and B, that have two disulfide bonds between them. In glargine, one amino acid has been switched out, and two extra amino acids have been added to one end of the B chain. The modifications make glargine soluble at an acidic pH, but much less soluble at the neutral pH that's found in the body

To make Lantus, first the glargine is produced by a vat of E. coli bacteria. Then it's purified and added to a watery solution containing a little zinc and some glycerol; a dash of hydrochloric acid is also added to make it acidic, bringing its pH down to about 4. At that degree of acidity, glargine completely dissolves into the watery solution, which is why the vial is clear.

After you inject it into your subcutaneous tissue, the acidic solution is neutralized by your body to a neutral pH. Because glargine is not soluble at a neutral pH, it precipitates out into a form that's not soluble in subcutaneous fat, and there forms a relatively insoluble depot. From that pool, or depot, of precipitated glargine in the tissues, small amounts slowly move back into solution over time and then to the bloodstream.

Levemir is made with insulin detemir. Insulin determir is created by recombinant DNA technology just like glargine, but is produced by baker's yeast instead of E.coli. It's a clear solution that contains, in addition to the insulin detemir, some zinc, mannitol, other chemicals, and a bit of hydrochloric acid or sodium hydroxide to adjust its pH to neutral. Insulin detemir differs from human insulin in that one amino acid has been omitted from the end of the B chain, and a fatty acid has been attached to the spot instead.

Unlike glargine, detemir does not form a precipitate upon injection. Instead, detemir's action is extended because its altered form makes it stick to itself in the subcutaneous depot (the injection site), so it's slowly absorbed. Once the detemir molecules dissociate from each other, they readily enter the blood circulation, but there the added fatty acid binds to albumin.

More than 98 percent of detemir in the bloodstream is bound to albumin. With the albumin stuck to it, the insulin cannot function. Because it slowly dissociates from the albumin, it is available to the body over an extended period.

Whether Lantus is better than Levemir, or vice versa, is debatable. Levemir is generally supposed to be injected twice daily (although it's approved by the FDA for once or twice daily) and Lantus once. According to Dr. Richard Bernstein, however, Lantus also usually works better if injected twice a day. The acidic nature of Lantus can sometimes cause stinging at the injection site, and both formulas cause allergic reactions in rare cases.

Most trials of the effectiveness of Lantus and Levemir have compared the two insulins to NPH insulin. NPH is a suspension of crystals in a solution, so it needs to be thoroughly shaken before use to distribute the crystals evenly. Some studies have failed to demonstrate any difference between in Lantus and NPH with regard to evenness of absorption.

Other studies have shown that compared to Lantus and Levemir, NPH has a variable absorption rate and a more pronounced peak. At night especially, hypoglycemia can occur if low glucose from exercise or alcohol consumption coincides with the NPH peak.

In some studies, Levemir has demonstrated less variable, steadier blood glucose-lowering effects compared to both NPH insulin and Lantus. Comparing Levemir with Lantus when used with a fast-acting insulin in patients with type 1 diabetes, Levemir had a lower risk of major hypoglycemia and nocturnal hypoglycemia, but the risk of hypoglycemia overall was comparable. The blood sugar control provided by the two insulins was similar as well.

Categories: Beginners, Blood Glucose, Blood Sugar, Diabetes, Insulin, Lantus, Low Blood Sugar, Professional Issues, Type 1 Issues


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Comments 95 comments - Jul 17, 2007
 
Re: QUestion for people who have switch from Lantus to Levem

Hi Matt :D Welcome to the forum

I have just recently changed from Lantus to Levemir , as I was having no end of problems with (now I realise) the Lantus.

Not only has my control improved immeasurably, no more night time hypo's, much steadier control, not afraid of my Bolus insulin anymore ,to name a few :D I just feel 100% physically better. I felt ROUGH on the Lantus and really just thought that was my lot really and it was how my Diabetes had progressed and I had just better get used to it....Well not so :wink:

I can't say I ever felt depressed on the Lantus, or anxious at all, just no energy, like really big energy crashes :( and a feeling of malaise all the time...it was instantaneous the feeling of well being from my 2nd injection on the Levemir...and I find the split injections a lot more flexible.

Can I ask why you changed onto the Levemir? And hoe you feel on it now?
 
Re: QUestion for people who have switch from Lantus to Levem

Main reason for change was that I read that others that had changed stopped having sudden drops of blood sugar (seems to be the same for me as well!).

I do feel much better now I'm on the levemir, hopefully the irritation from the injection sites will clear up soon, but even with it I feel loads better... I'm not splitting mine (Diabetic nurse basically said that they are the two are the same basic profile and to just swap over using the same amount of units as with lantus, which so far seems to be working...)
 
Re: QUestion for people who have switch from Lantus to Levem

I'm not sure about loss of good mood but I found I was a lot more prone to hypos while on Lantus (which would explain why I was moody if I was) and I needed to split dose Lantus because after I took it at 10pm, it would run out around 2pm the next day. I established this not long after doing my DAFNE course.

Levemir has been much better. It's almost as if I'm less sensitive to Levemir compared to Lantus so I'm able to cope much better....
 
Re: QUestion for people who have switch from Lantus to Levem

Hey Matt

Yes I have heard it, and read about it a lot now concerning Lantus...but not much negative about Levemir, thats not saying there is none out there..but I haven't searched to be honest ,for the simple reason I feel so much better and more stable on the Levemir, it is enough for me right now.

Yes my DSN also said just to have the one injection, but I take my Basal first thing in the Morning , due to having to do that from my Lantus days really because of the sudden drops and fits in the night...but to be honest maybe I will give the Levemir a go on just the one injection on a night and see how I go. I did read Levemir had a bit of a shorter profile than Lantus.
It is working for me now in the split dose..12 units on a morning and between 10 and 8 units depending how busy I have been throughout the day ,on a night...I think I would have to up my Bolus at my lunch time/evening meal if I just did the one injection on a night...but I might give it a try and see..but for now it's nice just coasting :D :lol: Haven't done this in a while, and I'm enjoying it :wink:

Glad to here you have also found success with the change, hope it stays that way for you :D
 
Re: QUestion for people who have switch from Lantus to Levem

Otenaba :D

Yes, I know what you mean about being more sensitive to Lantus....it was like rocket fuel for me :shock: Glad you are having more success also with the Levemir.
 
Re: QUestion for people who have switch from Lantus to Levem

Keep in mind that responses here might not be representative of the population - i.e. there will be considerable sample bias because a) people who are doing fine on Lantus will not post here and b) people who were doing fine on Lantus and are suffering from side effects after switching to Levemir for no reason at all don't exist.
Also, don't quote Bernstein if you want me to take you seriously.
 
Re: QUestion for people who have switch from Lantus to Levem

AMBrennan said:
Also, don't quote Bernstein if you want me to take you seriously.
Click to expand...

am not up on the politics behind this comment, can you give me a quick summary of why you say this?
 
Re: QUestion for people who have switch from Lantus to Levem

Fallenstar said:
Otenaba :D

Yes, I know what you mean about being more sensitive to Lantus....it was like rocket fuel for me :shock: Glad you are having more success also with the Levemir.
Click to expand...

I'm glad too, for both of us. :)

My DSN was the one who suggested that I change over after establishing that I was having to split dose Lantus - to quote, "Levemir is an insulin more designed for split dose". I wasn't going to argue with that lol.

I do wonder sometimes if I could have worked out the Lantus puzzle if I persisted but oh well, I was on it for a very long time so I gave myself plenty of chance to try! ^_^
 
Re: QUestion for people who have switch from Lantus to Levem

AMBrennan said:
Keep in mind that responses here might not be representative of the population - i.e. there will be considerable sample bias because a) people who are doing fine on Lantus will not post here and b) people who were doing fine on Lantus and are suffering from side effects after switching to Levemir for no reason at all don't exist.....
Click to expand...


its definitely the furthest thing from any sort of accurate representation, but that there is response like this at all (mood changes/depression, lack of energy) is troubling, to say the least.


as for folks who change for no reason, its not all that uncommon for folks to have to change due strictly to the whims of others. its not unheard of for a company to drop four different insulins off the menu in one fell swoop, second thoughts pertaining only to ballooning stock values.

presumably one of those folks had side effects, no?
 
Re: QUestion for people who have switch from Lantus to Levem

Hi and many thanks for those who have posted and especially anyone who can advise.
Very recently ,In exasperation with the diabetic nurse specialist,I pointed out that
despite being put on Lantus last December (started at 10 and quickly up to 40 units ?) My control was still erratic and had almost NO explanation.Excepting for the upset stomaches mostly caused by 12 years on metformin and other oral tablets.
My HBA was over 10 and I was probably 3 years too late going onto insulin.
Eventually in May I was taken off ALL oral tablets.
The bad news was that after a few short months on Lantus I actually returned to my earlier fasting readings of 12 to 14.Despite going up to 42units a day in one dose.At this point ,I lost any little faith in the process and was given Apidra to try in addition.
Eventually I managed to get lower readings ((single figures at first) and then down to 5.5.To me this was almost a hypo and
I managed another hypo two days later.Wow.First time in 10 years I got that low.
By now I am taking 40u Lantus and two x 22 units Apidra.(NO More)
Initially I felt a little more fatigued but then it accelerated to the stage I had started at 15 years ago.ie 11 hours night sleep and
2 hours during the day,exhausted.
My specialist nurse decided I needed diet advice ? even though Ive read every book you could imagine and understand the whole process probably better than they do..(I even proved that to them and my main complaint is that they do not understand it themselves until they were diabetic) note, I havent changes weight in 16 years.


However one brilliant point emerged .She was told , by me that the fatigue is the problem not keeping the scores to a nice tidy pattern.After giving her a few more symptoms,She suggested I read upon CFS and low and behold I hit ALL 25 symptoms.
NOW at this point I was shocked and realized this problem predates my Diabetes diagnosis by several years.(I retired at 49 years of age and have never been able to work since) I am now 66 so this has gone on a long time.
The doctor as usual doesnt really believe in ME ,so 9 blood tests later with nothing to show ,Im told Im alright?...
No I am not having that so I am being referred off YET again .
note a previous Doctor had a similair opinion and also dismissed the yupee flu theory.He considered Byetta.
Then forgot to refer me?.

So just as I thought they had cracked it,AGAIN, I am now up to three sleeps in a day and getting DESPERATE, I missed my Apidra injection prior to my meal last nightawoke feeling better,So today I just took the Lantus and Low and behold I feel much much better today and I am typing this up during the afternoon as I have NOT had a sleep today.

It seems Im not alone with this fatigue problem which may indeed be diabetes related or not,either way ,a thank you for those that have posted as I am Not going to give up again.
I will print off this and previous postings and go back in to see a Doctor.Being fobbed off with specialist nurses seems the cheapo UK way at the moment.
 
Re: QUestion for people who have switch from Lantus to Levem

Just an update for anyone else who has followed this thread for a similair reason to me.

My Specialist nurse has accepted that I had started to react to Lantus AND Apidra.
I was concerned about having similair reactions to Two insulins but it may be they are made similair way.
It also transpires that the family history of DB is widespread for us.Even skipped a generation.? on the only non diabetic
in the family.
Lessons I learned from coming off both insulins for a while and retrying was as follows.
Previously the more I took over a certain quantity, 32units Lantus the more the readings rose.
NOW any Lantus sends my readings higher..
Any Lantus I took in any volume <8u had side effects which means it certainly went worse quite quickly.
The Apidra was only safe for me,ie No reaction etc if I took a paltry 8-10 units once a day with a gap of a day between doses.
It had almost NO effect on the fasting readings.
So all in all they eventually became a definite No No .
I am currently awaiting Levemir etc and start all over again getting base level correct.(As if I ever had it right?)
Also been told that I Will get a meeting with and Endio in a month.
Hopefully I should be getting things under better under control by then.
It does however seem that not resolving the problem earlier has been a backward step and my results without insulin are now higher than previous non insulin spell not that long ago.
So if you are having these side effects I would suggest you act a lot quicker than me.
Many thanks again for all those who reported their problems so well.
 
I switched from lantus to Levemir a little over 5 years ago, I had been on a pump for a short time in between with disastrous effects.
The Levemir gave me security during the night, as - with taking it at 10am it was no longer working by 2am so night time hypos where drastically reduced.
At the start of this year I started on a split dose, which I was reluctant to try but was talked into it because with having no long acting working after 2am some mornings my bloods where higher than the meter goes.

I only have a small dose at 10pm but it has made a big difference - until my endo increased the dose and I began having night time hypos again resulting in all kinds of injuries.

I am currently in the process of researching degludec, which is supposed to drastically reduce night time hypos- I'm a bit reluctant to change because it is super long acting at 42hrs + & you still inject everyday.
They are calling it a smart insulin. LOL
 
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