Switching from Lantus to Levemir - Help needed!

[Dillinger]

Hello,

Last weekend I received my new prescription for Levemir having used Lantus for the last few years. I wanted to change because of a number of the reported side effects, and in particular the slightly random effects of Lantus. My understanding was the Levemir has a flatter profile, leads to less weight gain and doesn't do the random spike two step that Lantus does now and again...

So, it seems I need a lot more Levemir than Lantus; I used to be on 22 units of Lantus taken at 8:00 pm. Now I split the Levemir and have been increasing the amount pretty much daily to get fasting levels down (they went up to about 12 mmol/l) and going from split doses of 11 units am/pm I am on 14 units am/pm, and anticipate having to raise that further as this morning 2 hours after breakfast my bloods were still 12.5 mmol/l

If I go up to 16 units or higher, does that actually undo the point of changing; i.e. is having to take so much insulin actually going to be to my detriment to gain a point or so improvement in my HbA1c? I'm almost at 1.5 times the Lantus dose (and still running far too high), and possibly this could get closer to twice the Lantus dose.

I take about 6 units of Novorapid as the bolus insulin with meals.

Alternatively does it take a while to 'bed in' and my body become responsive to this insulin?

What do people think?

Thanks

Dillinger

 

[lucati]

Hey,

A few years ago I changed from Lantus to Levemir, but can't exactly recall how much of a change I had to make, but I know it can be difficult at first.

How many units of Novorapid would you say you are taking roughly every day?

 

[LittleSue]

Increasing your dose daily seems rather fast, it can take a couple of days for your levels to settle after a dose change. Although Levemir does have a fairly even action it can cause a drop, maybe later in the night than other medium/long acting insulins. Its also possible you've overdone it and may be going hypo in the night and rebounding - erratic rises by breakfast time would point to this, but by changing dose so frequently its impossible to tell. Also what time do you take the evening Levemir? Maybe you need to take it later in the evening.

In your position I'd leave the dose the same for about 3 days and do some tests at various times during the night before increasing it any further, to get an idea of when your bs is rising. I understand you want to get things sorted asap, but sometimes its better to observe a while before changing things.

It may just be that you need considerably more Levemir than you did Lantus, that's not unusual. Whether the change is worthwhile for you depends on the other factors such as side-effects, weight gain, stability etc.

 

[jimmyt1988]

Firstly, 12.5 mmol/l isnt going to kill you whilst going through a change from lantus to levemir which is what i had a while back.

Basically, follow the procedure your doctor recommended.. and if you need to raise them coz your sugars arent right.. Then raise them.

If you do it too far, put them back slightly and adjust as needed.

Its absolutely understandable to have such a blood reading whilst going through changes in your diabetic routines.. As a 20 year old being diabetic for 12 years.. It's all part of the process.

Yes levemir is much much better, and has been for my 16 other friends who have gone through the change.

Especially for people taking 2 doses of Levemir each day (morning and evening) + 3 other doses of short term novorapid. The spikes went since i was on lantus and i hardly ever need to worry about my sugars going high because once youve found that correct dose, your set until your next body change and from then on its small dose changes.

Anyway, have fun with your new levemir, its a real ease to use.

OH also remember, if you do go high, take like a mega small dose of insulin to get your levels down.. I was reluctant to do so firstly coz all the doctors were saying you should take 3 novorapid and 1 levemir.. but hell, i just decided to make the change myself after I was too happy eating sugary treats and the typical **** teenagers eat, and now i have complete control over my life..

If i am 6.5mmol/l and i have a cake.. I have 2 units of novorapid on my injection.. 2 hours later.. my sugar is still 6.5mmol/l . Years ago i would have been scared to and have just avoided the cake.. but now I realise that we are just trying to imitate what our bodies do.. So regular doses is not what out body does (apart from the background dose which must stay the same-ish), our body creates insulin whenever we eat something.. So do the same for your own body, just be careful about it. And if going to bed dont take the risk and just dont eat the cake..

 

[randomange]

I'm doing this exact thing at the moment. I switched to levemir three weeks ago after a DAFNE course, because my problem with lantus is that it's not flexible enough and it takes too long for a dose change to kick in. The over-riding opinion on the course was the levemir was a more flexible option and that the effect of changing your dose could be seen far quicker.

The advice I was given was to change doses every two days until my levels were stable, but I admit that at the beginning I changed every day, mainly because I was waking up with sugars over 17 and testing postive for ketones.

I am now on almost three times as much levemir as I was lantus, and my fasting levels are still high. I've tested in the middle of the night, and I know it's not a rebound. I'm now thinking that I actually have a dawn phenomenon that the lantus dealt with better than the levemir. My day time levels seem to have settled, however I'm needing way more insulin to cover carbs than I was before, so overall I'm on a lot more insulin than I was before, and I know it has to increase, and yet I'm seeing poorer numbers that I have in months. I'm now giving serious thought to changing back to lantus.

I agree with what the others have said - it may take a while until your levels have stabilised, and I think it's not uncommon to need more levemir than lantus. I think it's very much each to their own as well. I would be quite happy to take more levemir if my levels were flatter, but I'm just a bit uncomfortable with *all* of my insulin needs increasing. I would say keep going, and give it a little bit longer to see what happens, but I completely understand your frustrations!

 

[Dillinger]

Thanks everyone for the replies.

My levels are pretty consistent; i.e. going to bed with a certain level and waking up with the same, so I don't really think that I hypoing in the night and getting a glucose dump (as I would have thought the bloods would be way up with that, rather than 12's I've been getting?).

I'll keep monitoring and messing around with it; but wow Randomange - 3 times the Lantus level sounds a lot; is that having any effect on your weight? I'd be interested to hear how things go with you as I think we could be in the same boat.

Possibly I'm just being too sensitive to how much insulin I think is 'too much'...

I'll post again with more results

All the best

Dillinger

 

[randomange]

If you're staying fairly stable overnight, it sounds like you just need to go to bed on a better number and you should wake up the same, so maybe it's more your daytime or your insulin:carb ratios that need changing?

I have the opposite problem, in that my daytime levels are mostly ok, and I've tested and I stay pretty level if I don't eat. However, this did involve me changing my insulin:carb ratios. I also cannot get stable levels overnight. I can go to bed on a somewhat ok number, and I wake up a lot higher. The increase in insulin hasn't really had any effect on my weight, but then I think I've been eating less.

I think I'm the same as you in that I'm a bit sensitive as to how much insulin is too much! It just seems like such a huge increase, and I think that's what's getting to me. And mostly, I think it's the increase in insulin:carn ratios that is bugging me the most. I'm pretty much at the top end of what Dafne recommends. I've spoken to my DSN about it, and she's not sure why I would need *so* much more insulin, but isn't particularly concerned. She has said, though, that there's no reason why I can't switch back to lantus if I'm still feeling so stressed about it. I said I'll give it another couple of days and see what happens.

I hope you manage to get things settled down.

 

[Dillinger]

Hello,

Ok, it took about a week to 10 days to calm down but now I'm feeling very good about this; most of my bloods are now between 4-6 and my Novorapid requirements have come down.

Currently on 16 units of Levemir 8:00 am and 8:00 pm and 5 units of Novorapid with each meal. The Levemir then is 32 units versus 22 units of Lantus; which is pretty much exactly as people predicted for the increase.

Most pleasingly overnight I'm not getting any dips or shenanigans (as yet...), was 5.5 at 11:45 when I went to bed last night (I took a mouthful of apple juice just in case), was woken at 4:00 am by my infant son so tested and it was 6.2 then and this morning at 8:00 it was 4.6.

If I can maintain this, hopefully I will be back in the 5% club in a few months.

I may have to drop the night time dose a bit as I'm not particularly keen on having to eat/drink anything sweet before going to bed, but I'm pleased to say it's all looking good.

No hypos yet either!

Dillinger

 

[Dillinger]

Hypo sensitivity is coming back I think as well - could feel it at 3.8 the other day, when previously it would be in the low 3's or even 2's before it really registered.

Still a triffle too lardy, but can't have everything...

I'm liking this Levemir stuff...

 

[iHs]

Hello Dillinger

Like yourself I too am getting a tiny bit better control using Levemir as the basal instead of Lantus. I was using Apidra as my bolus but am having a trial with Novorapid for a few weeks. Am pleased to say that hypo wise I am now much better off.

On going to bed though I still eat a small amount of carb as I am too worried that I will go off to hypo land if I dont eat. Basal insulin is good but its still a slow acting insulin with a fancy name so be careful. Its better to have peace of mind.

 

[LittleSue]

Hi again
Glad it's working out for you.