Any support for generic Levemir?

[rebrascora]

I know I am not the only member of this forum who uses and appreciates the flexibility of Levemir and as most of you will know, it is being discontinued by NovoNordisk and replacement options are quite limited. The patent is running out so there is a very slight possibility of a generic being produced, but we should not hold our breath for this to happen. I am wondering if there is anything we can do to encourage an insulin manufacturer to produce a generic. Perhaps lobby MPs or write to manufacturers. I was discussing this with my consultant this week and whilst he wasn't optimistic he thought it might be worth a try.

@Inka Can you remind me of the name of the British manufacturer of insulin who produces isophane please? It seems they might be the most likely place to start and in the current climate where the production of weight loss injections has become a bigger money maker than insulin, a company that isn't part of that market might be the most likely to pick up the insulin slack. Also in the current global situation, it might be reassuring to have more home produced insulin.

I know I am probably spitting in the wind but I really love my Levemir and don't want to replace it with something else if I can absolutely help it. Just wondering if anyone else feels the same and has any ideas on how to go about it?

 

[Inka]

@rebrascora It’s Wockhardt 🙂 They produce insulins and other products too. They produce isophane insulin, yes, but also regular insulin (Hypurin Porcine Neutral), which is very good.

 

[Inka]

I don’t know if any of the current insulin manufacturers will make a bio-similar of Levemir. NovoNordisk obviously won’t, Sanofi probably won’t, so it would be one of the others. Of course, the second question then will be is it any good? Some people here already use bio-similars like Trurapi but some have had problems, either with the insulin or the delivery method (ie pen).

I did read an interesting article/thread about splitting Tresiba elsewhere on the internet. I know it’s not supposed to be split but apparently a number of people do.

 

[Robin]

I’m torn between wanting a biosimilar of Levemir, which wouldn’t come in anything as good as the Novopen Echo, and carrying on with the Echo and trying to make Tresiba work for me. Levemir isn’t the perfect solution for me, but it’s the best fit I’ve found so far, if I meet it half way. I may give Tresiba a whirl, even though it would mean a whole new approach, and then think again if I can’t make it work. I’m not going back to Lantus or biosimilar!

I’m not sure what is going to happen in the USA. I read that Levemir was the only basal approved for pregnancy, and that it is quite popular over there. Maybe our best hope is if someone makes a biosimilar with the US market in mind.

 

[rebrascora]

I don’t know if any of the current insulin manufacturers will make a bio-similar of Levemir. NovoNordisk obviously won’t, Sanofi probably won’t, so it would be one of the others. Of course, the second question then will be is it any good? Some people here already use bio-similars like Trurapi but some have had problems, either with the insulin or the delivery method (ie pen).

I did read an interesting article/thread about splitting Tresiba elsewhere on the internet. I know it’s not supposed to be split but apparently a number of people do.

Trurapi is biosimilar to NovoRapid so it is a bolus insulin not a basal.

I think people who split Tresiba and find a benefit may be kidding themselves, but splitting it doesn't alter the fact that each dose is active for at least 30 hours, so doesn't provide that flexibility that I love about Levemir which is that I can change my doses from day to day and day to night and see real time benefit from those adjustments.

I will try the NPH insulins like Humulin I if a generic doesn't happen and my consultant thinks they will be a good fit for me but his concern is that they may not be available for much longer either. I know you have said in the past that Wockhardt are committed to providing an alternative for people who need it but no one can really guarantee they will continue to do so. At the end of the day they are all businesses that have to make a profit.

If all else fails I can go back to my experiment of last summer and just use Fiasp but really don't want to give up on Levemir just yet if there is a tiny glimmer of hope.

 

[rebrascora]

I’m torn between wanting a biosimilar of Levemir, which wouldn’t come in anything as good as the Novopen Echo, and carrying on with the Echo and trying to make Tresiba work for me. Levemir isn’t the perfect solution for me, but it’s the best fit I’ve found so far, if I meet it half way. I may give Tresiba a whirl, even though it would mean a whole new approach, and then think again if I can’t make it work. I’m not going back to Lantus or biosimilar!

I’m not sure what is going to happen in the USA. I read that Levemir was the only basal approved for pregnancy, and that it is quite popular over there. Maybe our best hope is if someone makes a biosimilar with the US market in mind.

Yes, I will be gutted to lose the use of my NovoPen Echo and that is certainly a consideration but I am really pretty sure Tresiba is not for me and my consultant could see that too and also discounted it.

I doubt the US market will develop a generic Determir because I think most people will be on insulin pumps there due to them having health insurance and even here in the UK most Type 1 pregnant women are offered pumps I believe so the basal market is declining, so I very much doubt a US company would develop a generic.

 

[helli]

Trurapi is biosimilar to NovoRapid so it is a bolus insulin not a basal.

It is but it was only used as an example of bio similars only being "similar" rather than identical as seen by those who have problems with it.

I think if I was on MDI, I would be equally frustrated by the Levemir retirement.
I still have Lantus as my pump backup. It is ok in emergency but I would not like that to be replaced by the Glargine bio similar. Any unknown would be a concern and reverting to MDI intentionally just to check it out seems unnecessary. So fingers crossed Sanofi doesn't retire Lantus any time soon.

 

[Inka]

Yes, I know Trurapi is a bolus insulin. It was the first biosimilars that sprang to mind that had been mentioned a fair bit on the forum 🙂 My point was a bio-similar won’t be exactly the same.

If you ‘gave up’ you could use a regular insulin rather than Fiasp as that could cover your basal through the day (because it acts longer). Of course, that doesn’t sort your nighttime dose but as you take less then, it might not be so much of an issue.

 

[nonethewiser]

Can't help with alternatives @rebrascora as before pump was using lantus & almost sure your not keen on that basal.

As a recommendation maybe now is a good time to consider changing to a pump if your diabetes team are supportive of idea, they really are life changing when it comes down to basal delivery, more so during night if your bg levels tend to be erratic in the early hours.

Worth considering if nothing else.

 

[rebrascora]

Can't help with alternatives @rebrascora as before pump was using lantus & almost sure your not keen on that basal.

As a recommendation maybe now is a good time to consider changing to a pump if your diabetes team are supportive of idea, they really are life changing when it comes down to basal delivery, more so during night if your bg levels tend to be erratic in the early hours.

Worth considering if nothing else.

Many thanks for suggestion but already considered and discounted. I am just one of those people who prefers manual. I am the same with cars and tools etc.

 

[nonethewiser]

Many thanks for suggestion but already considered and discounted. I am just one of those people who prefers manual. I am the same with cars and tools etc.

Had a feeling you would say that lol.

Tbh I totally get what you mean, many a time will use handsaw to cut wood rather than electric one sitting in shed, we are old school @rebrascora

 

[John Gray]

Personally, I am wondering whether Levemir actually does anything for me now!

I changed to Fiasp (~10-20u per meal) from NovoRapid, and have been on Mounjaro (5mg) for many months, and tried just not taking Levemir (29u, morning and evening) for a week or two, with little apparent effect. I asked the specialist diabetic nurse in the local hospital's diabetes clinic about this, and she wasn't surprised.

I doubt @rebrascora is on Mounjaro, so this is probably completely irrelevant to her!
But if a person is on an insulin pump, is it not the case that long-lasting insulins are irrelevant for them?

 

[silentsquirrel]

Personally, I am wondering whether Levemir actually does anything for me now!

I changed to Fiasp (~10-20u per meal) from NovoRapid, and have been on Mounjaro (5mg) for many months, and tried just not taking Levemir (29u, morning and evening) for a week or two, with little apparent effect. I asked the specialist diabetic nurse in the local hospital's diabetes clinic about this, and she wasn't surprised.

I doubt @rebrascora is on Mounjaro, so this is probably completely irrelevant to her!
But if a person is on an insulin pump, is it not the case that long-lasting insulins are irrelevant for them?

You are correct that people on pumps do not take long-lasting insulin, but they DO take basal insulin - their basal is supplied by the same short-acting insulin that is also used to bolus for their meals, delivered in tiny doses at very frequent intervals over day and night, rather than the blunt instrument of one or two doses in the 24 hours that those of us on MDI inject. So the short-acting insulin in their pumps is both basal and bolus.

 

[SB2015]

But if a person is on an insulin pump, is it not the case that long-lasting insulins are irrelevant for them

But @rebrascora does not use a pump so is dependent on a long acting insulin to inject.

You are right John that for those of using pumps our background insulin (basal) is delivered using quick acting insulin dribbled in throughout the 24 hours according to a profile set by the user or adjusted throughout the day by the hybrid closed loop. Like others I have Levemir in a pen as my basal insulin available in case my pump fails.

It is interesting that you are now able to manage with no basal insulin d it may be that your pancreas is able to provide enough background insulin for you. That would not be possible for someone with T1/3c as we do not produce any insulin so need some sort of basal insulin provision, either a long acting insulin by injection once/twice a day, or through our pumps.

 

[rebrascora]

Personally, I am wondering whether Levemir actually does anything for me now!

I changed to Fiasp (~10-20u per meal) from NovoRapid, and have been on Mounjaro (5mg) for many months, and tried just not taking Levemir (29u, morning and evening) for a week or two, with little apparent effect. I asked the specialist diabetic nurse in the local hospital's diabetes clinic about this, and she wasn't surprised.

I doubt @rebrascora is on Mounjaro, so this is probably completely irrelevant to her!
But if a person is on an insulin pump, is it not the case that long-lasting insulins are irrelevant for them?

As a Type 2 you may still be producing quite a bit of your own insulin and you are perhaps having to inject extra to overcome insulin resistance. Plus the Mounjaro will be helping to reduce your insulin needs. If I even take just 2units less Levemir on a morning I will need about 10 extra units of Fiasp during the day in corrections to keep my levels in range, so I find Levemir very effective.

Yes, that will be part of the reason why they are discontinuing Levemir. Because the basal insulin market for Type 1s is diminishing as more and more people go onto pumps and I think probably few Type 2s need the flexibility of Levemir and are being put onto Toujeo or Tresiba if they need basal insulin. Toujeo is triple strength Glargine (Lantus), so would be a very blunt tool to fine tune and Tresiba lasts about 36hours so again, very little flexibility for someone who needs to adjust basal on a night by night basis and needs very little basal at night.

For me Levemir's flexibility means I can fine tune my basal enough with it, not to need a pump. I need quite a large dose in the morning of 20units but anywhere between 0 and 5units at night and that is adjusted on a day to day basis depending upon how much exercise/activity I have done. I am very prone to nocturnal hypos so the short activity of Levemir really suits me and enables me to make those adjustments night by night that I need.

 

[Robin]

But if a person is on an insulin pump, is it not the case that long-lasting insulins are irrelevant for them?

True, but a lot of us Type 1s in the U.K. don’t qualify for a pump, because we don’t meet the criteria.(usually because our control is deemed good enough using basal and bolus insulins in pens).
I think in the US, people with health insurance tend to get put onto pumps more readily, and people who don’t have insurance end up having to use whatever’s cheapest from Walmart, (usually an old fashioned out of patent medium acting insulin).

 

[helli]

True, but a lot of us Type 1s in the U.K. don’t qualify for a pump, because we don’t meet the criteria.(usually because our control is deemed good enough using basal and bolus insulins in pens).

That has triggered a thought.
How many of those people who don’t qualify because their control is too good use Levemir? And how many of them will have worse control once Levemir is discontinued?
I doubt it would be possible to prove the cause (rather than correlation) but it is possible that this could end up costing the NHS more.

(Sorry, just mindless rhetorical speculation.)

 

[Robin]

That has triggered a thought.
How many of those people who don’t qualify because their control is too good use Levemir? And how many of them will have worse control once Levemir is discontinued?
I doubt it would be possible to prove the cause (rather than correlation) but it is possible that this could end up coding the NHS more.

(Sorry, just mindless rhetorical speculation.)

That thought was flitting around at the back of my brain, too, but hadn't quite crystallised.

 

[JJay]

That has triggered a thought.
How many of those people who don’t qualify because their control is too good use Levemir? And how many of them will have worse control once Levemir is discontinued?
I doubt it would be possible to prove the cause (rather than correlation) but it is possible that this could end up coding the NHS more.

(Sorry, just mindless rhetorical speculation.)

I am a non-qualifier on these grounds. I had an HbA1c of 49, followed 6 weeks later by a result of 59 before my annual review at the GP surgery. I jokingly suggested this might qualify me for a pump and to my surprise the nurse referred me! Unfortunately the actual referral made by the GP mentioned the lower result, and despite my pointing this out, the DSN I saw reckoned I didn’t qualify, as my TIR was 80%+ at this time.

Nevertheless I was able to take advantage of my first consultation with a proper DSN in many years, and she gave me a lot of good advice. She also said the clinic were moving all Levemir users onto another basal, mostly Toujeo. I didn’t particularly want to go back to glargine and only pre-filled pens were on offer, so Tresiba was suggested, which I agreed to with some trepidation, it being firmly fixed in my brain that Tresiba was “inflexible”.

After 3 months of Tresiba, I can honestly say I wish I’d changed years ago. Things were definitely improving until 3 weeks later when my OH was diagnosed with 2 types of cancer and our lives got turned upside down. Now, what with a hospital stay, multiple appointments, the prospect of surgery and radiotherapy in weeks to come, changing meals to accommodate food he can chew and swallow easily, fitting in household tasks etc, etc - quite frankly, “inflexible” is my friend! One jab a day, only have to think about adjustments every 3 days at most. Very few disturbed nights due to 3am highs or lows. Levels variable and TIR down to low 70s, but I can put a lot of that down to the stress and unpredictability of life at present. Libre-predicted HbA1c is still 49.

Having to move from Levemir? I’d definitely recommend keeping an open mind.

 

[rebrascora]

Really interesting to hear that you are finding Tresiba is working well for you @JJay. Did you have much difference in morning and night doses of Levemir as that is my main issue. Often I need none on an evening if I have been particularly active but I need a lot in the morning and I am not sure how I could achieve that with Tresiba.

@Robin I will be interested to see how you get on with Tresiba as we have some similarities with our diabetes management. I believe you reduce your evening dose for alcohol as well as exercise, so I will be interested to hear how you manage that with Tresiba.