Lantus vs Levemir

[newbs]

I spoke to DSN this morning as I am still spending most of each night hypo and it is getting a bit much (and scary) as my warning signs are disappearing rapidly due to length of time I am spending hypo and the fact I have had 13 hypos in May so far. I was lucky to wake on a 2.1 in the early hours of the morning I feel. DSN was very surprised I have been put on to lantus as she said lantus is "very heavy duty" compared to levemir and as I am quite sensitive to insulin she doesn't think this is a good move for me. I may have to take lantus in the morning instead - will this be a problem close to taking the Novo or make no difference? At the moment I have to reduce lantus further still and see how that goes. My head just feels fuzzy all the time.

I thought that lantus was the basal most people were on, my brother and auntie are both on it with no problems, as I thought most of you were?

 

[everydayupsanddowns]

Sorry to hear your struggles newbs.

The only way I got Lantus to work was as a single dose at breakfast. That way it was 'fading' overnight rather than it's mini-peak at 4-5hrs coinciding with my body's dip in glucose output at around the same time.

No problem with injection (Lantus in buttocks, humalog in thighs at the time) but did need to work on post-breakfast levels as Lantus was in onset for the hours immediately after breakfast when my levels tend to rise anyway.

Hope you manage to get it fixed.

 

[newbs]

Thanks. I think a morning dose may have to be the way to go as my mid-morn levels are my highest of the day too so it may work in my favour. It is also the time of day I do most running around and driving though so I am a bit worried about that. Will try a few more nights and maybe switch the time at the weekend if still not better by then.

 

[novorapidboi26]

You should definitely try a morning dose first before moving insulin, if that's what you end up doing.......

I got the impression most folk were on Levemir, because of flexibility in dose changes/exercise etc.....🙂

 

[newbs]

I got the impression most folk were on Levemir, because of flexibility in dose changes/exercise etc.....🙂

It's probably just an assumption I made due to who I know. 🙂 I will definitely try mornings first before considering switching back as my other BGs have been better on lantus.

 

[Copepod]

I have been using Humalin I as my long acting insulin, very satisfactorily, since 1997, and since about 2003, as split doses, morning and bedtime. I find it very easy to change doses according to changing activity levels. Plus, I was pleased to note that it's half the cost of either Lantus or Levemir.

 

[DeusXM]

I'm surprised someone with actual medical training would describe a particular insulin as being 'heavy-duty'. What on earth does that mean?

In terms of difference between Lantus and Levemir, there really isn't a lot in it, for most people. Some people find Levemir doesn't last quite as long and so do split doses, others don't. They're both supposed to be flat peak basals so I would say there is no real reason to pick one over the other for preventing hypos.

If you're having a lot of hypos at night I'd say you're simply on too much Lantus. Basal changes also need to be BIG to have an impact. For most people, reducing Lantus by 1 or 2u won't make any difference at all. I adjust my basal in 10% increments, give it 48 hours and then adjust again.

Not knowing exactly when you take your Lantus, it's hard to judge how much of an impact the amount has on your mid-morning rise. If you're taking in the evening, I'd suggest moving to the morning will make things worse - your Lantus will be running out and you won't get full coverage back until the early afternoon. It sounds to me like you're suffering from DP so you might want to look at ways of mitigating this first. But ultimately, if you're having hypos every night, your first step should be dramatically reduce your Lantus dose.

 

[everydayupsanddowns]

Basal changes also need to be BIG to have an impact. For most people, reducing Lantus by 1 or 2u won't make any difference at all.

I think that's quite a sweeping statement, and needs clarification. I agree much more with your concept of a 10% change being a reasonable starting point for adjustment. When I was on Lantus a 2u change was far too clumsy and was enough to move me from hypos to hypers. There are others here too who would really appreciate a half-unit delivery device for Lantus (though Sanofi seem uninterested in the T1/smaller doses market and aim their delivery device R&D at higher dose users).

 

[Northerner]

I think that's quite a sweeping statement, and needs clarification. I agree much more with your concept of a 10% change being a reasonable starting point for adjustment. When I was on Lantus a 2u change was far too clumsy and was enough to move me from hypos to hypers. There are others here too who would really appreciate a half-unit delivery device for Lantus (though Sanofi seem uninterested in the T1/smaller doses market and aim their delivery device R&D at higher dose users).

Agreed Mike - a few weeks ago a 1 unit decrease in dose would represent a 50% reduction for me, so it makes much more sense to talk of percentages than absolute units. Certainly, back when I was on 20 units and lowering at 2 units a time (on a 2-unit pen) it made a difference to me. And, of course, people respond differently - some people find they need to wait 2-3 days before they see the true effect of a lantus change, with me it would show straight away.

 

[Abi]

Agreed Mike - a few weeks ago a 1 unit decrease in dose would represent a 50% reduction for me, so it makes much more sense to talk of percentages than absolute units. Certainly, back when I was on 20 units and lowering at 2 units a time (on a 2-unit pen) it made a difference to me. And, of course, people respond differently - some people find they need to wait 2-3 days before they see the true effect of a lantus change, with me it would show straight away.

Would agree with above two posts. Anyhow a 2 unit reduction in lantus would represent 10% of a quite hefty( for a type one) 20 units.
Also, I thought it was fairly usual for people to need less lantus than levemir and I'm afraid that the original poster's consultant gave unsafe advice if he advised a switch over at the same dose.
I think an insulin that takes 48 to 72 hours to show a true effect from reducing dose is potentially quite unsafe in a person who is suffering from hypos. At least one person on this forum has had her consultent refused to sign her form for the DVLA as she had several hypos on waking up- despite no severe hypos or impaired awareness. She is not on lantus and in fact had been a little lax in reacting to the pattern but imagine how much more difficult the situation could be if she was on an insulin which took several days to respond to being adjusted.

 

[Ellie Jones]

The profile for Lantus and Levimer are pretty similar, but Levimer's profiles says it's starts to tell off sooner, the other main difference is the acidity level, Lantus is slightly more acidic than Levimer!

Problem with background insulin, designed to work over 24 hours, is that the assumption is made that our liver will dribble glucose into our blood stream at an even rate over that time spam... In most case this doesn't happen and our basal profile resembles a roller coaster! With the biggest dips and raises being at the beginning of the ride (the morning)..

So most people find that they have to spilt their background, so that they get better cover in the morning, and the afternoon..

For splitting purposes, Levimer actually splits better..

Newbs

Perhaps splitting would give you more advantage.. Then if that doesn't work then I would seriously start to push for a Pump..

 

[everydayupsanddowns]

I've always liked this graph http://www.diabetesdaily.com/wiki/Levemir_Speed_Versus_Dose

Which backs up what I've read elsewhere that Levemir *tends* to have a shorter duration, especially on smaller doses. For me (last MDI basal was around 12u) it looks like it would have been 16-18 hours for a 'full' dose and probably quite a bit less than that for split doses.

I never got to test the theory, of course, cos I moved to a pump rather than switching to Levemir.

All the duration/activity stuff they publish are just averages after all. You can use them as a starting point for your own understanding, but in reality we are all different and I've gone long past "Insulin X lasts Y hours" statements.

They all need 'can', 'might', 'could' and 'in some people' added to them