Differences in Insulin

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Alan221

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Type 1
Hi again folks. I've not been on the site for a long while, so forgive me if this has been asked & answered before;

Does anyone know what the different characteristics are between insulins? I'm thinking specifically 'background' insulins and the differences between Lantus and Levemir. A friend of mine is on Novorapid & Lantus I'm on Novorapid & Levemir - i was wondering why one would be preferred to another? The cynic in me says it's due to cost and/or kick-backs from the drug companies - but i'd like to believe that each has different properties that better suits the patients particular requirements. Any ideas?
 
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Lantus action times

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Levemir action times


Basically its just different engineering...........the two are similar and hold you steady, however changing a dose of lantus, usually once a day can take a few days to see effect, where as levemir effects can be seen immediately, it can also be split........

I am on neither of them, I am on Humulin I in my feeble attempt to beat dawn phenomonon...........



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Hi Alan, nice to hear from you again! 🙂 This is a very good article that explains the different ways that lantus and levemir work:

http://www.diabeteshealth.com/read/...nd-levemir--whats-the-difference/?section=200

There have been many experiences related here of great success when moving from one to the other. Levemir seems to suit best when split into two doses, which may not be equal, to spread the effect better over the day and to help with things like Dawn Phenomenon or when resistance may be highest, like in the morning. I've only ever used lantus and find it works very well for me. I don't think it's a cost issue, as I believe they are very similarly priced. Lantus is supposed to have a 24 hour action, but levemir tends to be more like 18 hours, hence why so many people split doses.
 
Good question Allan, basically they are both insulin analogues and act as a background insulin to stabilise bg throughout a 24 hour period. Lantus is made with glargine, and Levemir is made with detemir, both of which are genetically modified forms of human insulin. Why people are put on different types, the answer may well be cost, consultants and dsn's preference or patients experiences on one or the other insulin. In general both do the same job, but as lantus can cover a 24 hout period in a single dose, more than likely you will find levemir has to be given in a split does to cover the same period. Toby.
 
novorapidboi26 said:
How do they manage over there?????
Click to expand...

A lot of them don't. I've heard of people turning up at A&E because they've run out and have no insurance or money to buy more - this, in one of the richest countries in the world! Even if you have insurance they will only fund so much, as there is usually a 'co-pay' system where you pay part of the cost. A lot of people buy it mail order from Canada where it can be cheaper, or end up going to Walmart (!!!) for some over the counter cheap insulin that is out of patent and would no longer be prescribed because it's so poor in relation to the modern stuff!
 
When I was doing DAFNE we asked the consultant the difference...

He said, basically it was really down to consultance preferance more than any thing as both work basically the same..

He explained that in theory that the lantus profile is flatter than levimer, so should lend it self to splitting a lot better than Levimer..

But in his experience he found that in practice this didn't happen, they weren't as flat has expected, and Levimer actually split a lot better in most cases than Lantus hence his personally preferance for Levimer to Lantus..

He then added, that profile is just a starting point, as when the insulin was injected, the body tended to make it's own profile with it, so you had to work this out on individual bases..
 
Thanks for the info, i've passed on your replies.

The issue is that my friend is finding he has a low sugar level when waking which rises steadily during the morning. I was wondering if this could be addressed by a switch to a different insulin.
 
Alan221 said:
Thanks for the info, i've passed on your replies.

The issue is that my friend is finding he has a low sugar level when waking which rises steadily during the morning. I was wondering if this could be addressed by a switch to a different insulin.
Click to expand...

That happens to me too Alan. As I said, I'm on lantus and it may be linked to increased insulin resistance in the mornings. This is where a split dose (of either insulins), or maybe just switching to taking lantus in the morning, might help. For me, it's not really bad enough to consider changing from a nighttime injection to a morning one as things work pretty well most of the time.
 
A switch could benefit him............splitting the dose and giving him a lower dose before bed may stop him waking low......then the remainder in the morning..........time of dose can effect sugars also.........the diabetic team could explain it all better..........
 
My daughters specialist told me only last week that Levemir lasts between 20 and 24 hours and that was probably why she has a higher reading in the evening (as she takes her one dose at bed time). She may have meant only in young children tho'
I think I read in my Ragnar Hanas book that a bigger dose lasts longer, but Katies specialist just gave me 'a look' when i said this 😱
 
What I don't understand is why an older and cheaper long / intermediate acting insulin, Humulin I, is not offered instead of the more expensive Lantus and Levemir, both over ?40 for 5 x 3ml cartridges. 5 x 3ml cartridges Humulin I for ?26.71 according to BNF issue number 60 (Sept 2010). I've been using this for over 10 years, for the last 6 or so, twice a day, but several users of Lantus or Levemir have to split their doses, too.
 
As of yesterday, I'm adding in a 2nd dose of Lantus as a top-up, rather than a split dose. The main basal is in the morning and the top-up is after tea with a much smaller dose to cover the tail-off that Lantus has, especially at smaller doses.

Nothing to report as far as effects go because I've only been doing it for less than 24 hours but it makes sense.

When I was put on Lantus, with humalog, I didn't realise there were other basals available.

Rob
 
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