Humulin I

[Ann wainwright]

Hi
I am newly diagnosed type 1 who’s currently on lantus 6 units (my Novorapid was stopped as I had a low which panicked me too much). I have now met the endocrinologist who is changing my lantus to humulin I - 4 units morning and 2 units evening ? I am worried about taking the 2 units at evening and it causing me to be low in the night .
Is anyone else taking Humulin I which is intermediate acting and how has your experience been please. Thanks for any help

 

[everydayupsanddowns]

I think it’s possible that using a split dose of Humulin I might even reduce your risk of overnight hypoglycaemia. Taking 2 doses of a slightly shorter acting basal can allow you to tailor your basal so that you have less acting overnight and more during the day. Lots of members on the forum use this technique with Levemir (eg @rebrascora). Lantus lasts longer (24 hours or even longer) and has a little bump of action around 5 hrs after injecting, so a single dose would potentially be releasing more overnight than a large and small split dose?

 

[rebrascora]

I use a split dose with Levemir and I love it. I need much more in the morning (currently 20u) and I vary my evening dose depending upon what I have done that day. If I have been very active or done lots of exercise, then I reduce the evening dose down to 0 and if I have been more sedentary then I might need 2 or 3 or even 3.5u if I have been lazy for a few days.
The big advantage of these shorter acting insulins is that you can adjust them on a day by day basis and get real time results. Understanding when you need to adjust them and gaining confidence in doing so, is key to good diabetes management and that takes time and careful experimentation.

If you are really anxious about the evening dose then make sure you go to bed with your levels a bit higher, so if you normally go to bed with your levels at 8mmols, push them up to nearer 10 and see what happens overnight. Your CGM graph will show what happens overnight and if your levels drop by a couple of mmols with the 2units then you should be safe to go to bed on 8. Presumably you have alarms set on your CGM to alert you if you are dropping low? What level is your low alarm set at?

When I was first diagnosed I used to really worry about nocturnal hypos and I would wake up several times a night and finger prick to check (before CGM). It wasn't until I started reintroducing exercise and had a week of nocturnal hypos that I realised I could manage them and my body would wake me up and since then I have stopped fearing them. The fear was far more debilitating than an actual hypo is, now that I have learned to trust my body and my hypo treatments to work well and have mostly stopped panicking when I am hypo. Obviously I adjust my insulin to try to prevent especially now that I know to reduce my evening basal after exercise.
I hope you will find Humulin I works better for you. I may well be changing to it in the near future as Levemir is being discontinued (which I am gutted about) but Humulin I will probably be my first choice to replace it.

 

[Ann wainwright]

I think it’s possible that using a split dose of Humulin I might even reduce your risk of overnight hypoglycaemia. Taking 2 doses of a slightly shorter acting basal can allow you to tailor your basal so that you have less acting overnight and more during the day. Lots of members on the forum use this technique with Levemir (eg @rebrascora). Lantus lasts longer (24 hours or even longer) and has a little bump of action around 5 hrs after injecting, so a single dose would potentially be releasing more overnight than a large and small split dose?

Thank you that’s really helpful and reassuring

 

[Ann wainwright]

I use a split dose with Levemir and I love it. I need much more in the morning (currently 20u) and I vary my evening dose depending upon what I have done that day. If I have been very active or done lots of exercise, then I reduce the evening dose down to 0 and if I have been more sedentary then I might need 2 or 3 or even 3.5u if I have been lazy for a few days.
The big advantage of these shorter acting insulins is that you can adjust them on a day by day basis and get real time results. Understanding when you need to adjust them and gaining confidence in doing so, is key to good diabetes management and that takes time and careful experimentation.

If you are really anxious about the evening dose then make sure you go to bed with your levels a bit higher, so if you normally go to bed with your levels at 8mmols, push them up to nearer 10 and see what happens overnight. Your CGM graph will show what happens overnight and if your levels drop by a couple of mmols with the 2units then you should be safe to go to bed on 8. Presumably you have alarms set on your CGM to alert you if you are dropping low? What level is your low alarm set at?

When I was first diagnosed I used to really worry about nocturnal hypos and I would wake up several times a night and finger prick to check (before CGM). It wasn't until I started reintroducing exercise and had a week of nocturnal hypos that I realised I could manage them and my body would wake me up and since then I have stopped fearing them. The fear was far more debilitating than an actual hypo is, now that I have learned to trust my body and my hypo treatments to work well and have mostly stopped panicking when I am hypo. Obviously I adjust my insulin to try to prevent especially now that I know to reduce my evening basal after exercise.
I hope you will find Humulin I works better for you. I may well be changing to it in the near future as Levemir is being discontinued (which I am gutted about) but Humulin I will probably be my first choice to replace it.

Thank you so much
You are right about the fear of hypos - I’ve been reading very scary information and need to reduce my fear of them and know they can be treated. I have my CGM set at the highest low setting which is 5.6 but I worry at night if it is 7 as my fear is making me want to run at 9-10 . That’s good also that I can adjust as I’ve noticed even walking only moderately makes my blood sugar arrow go downward. I am currently setting my alarm 1-2 hourly to check my blood sugar as I can’t bear it being lower than 6 currently. I’ve just started with a counsellor to help me with my hypo anxiety but need to first speak with diabetic team to learn more about what to do at different times and recordings .
Again your response is very reassuring and I need to reduce my preoccupation with going low and constantly staring at my CGM readings

 

[everydayupsanddowns]

as I can’t bear it being lower than 6 currently.

It can take a while for the body’s internal ‘glucose thermostat’ to reset after it has been running at high BG levels for a while.

Genuine hypoglycaemia (where the brain has insufficient glucose to function properly) would occur below around 3.5mmol/L, so we aim to make “4 the floor”. But you may be getting fairly strong hypo warning signs at higher levels if your body has become used to running above range. Hopefully as you spend more time in the recommended range your false hypo signals will reduce, and hopefully your anxiety too. 🙂

 

[rebrascora]

I think, in some respects, CGMs don't help people when they have this fear. I think being able to see the arrows showing your levels dropping can instill panic and I am pleased that I got used to managing hypos before I got CGM because it taught me to have faith in my hypo treatment (usually 2 jelly babies). The other thing is that CGM will usually show your levels continuing to drop for a further 20-30 mins after you have taken your hypo treatment, causing further panic, whereas a finger prick will usually show your levels rising again after 15 mins, which is why you should always retest with a finger prick after a hypo treatment and act on that and ignore CGM until it catches up.
I now know that if my Libre shows my levels as 4.3 with a vertical downward arrow and I have 2 jelly babies, it will turn it around and my graph will later show that I never dropped below 4. I see my Libre as being a bit of a drama queen. It is incredibly useful when things are ticking along nicely in range, but if it says I am very high or very low, I have learned to take it more with a pinch of salt. Of course I treat lows but I don't let the LIbre panic me because usually I am not as low as it says I am and I know that my hypo heroes (AKA jelly babies) will rescue me.

I think it helps me to know that 2 jelly babies are 10g carbs and those 10g carbs will raise my levels by about 3mmols, so even if I am on 3.0 those 2 jelly babies should get me back up to 6mmols unless I have very seriously over calculated my bolus insulin, which I very rarely do and even if I have miscalculated those jelly babies will stop the drop and if I need some more then my 15 min finger prick will show me that I need more.

An important tip is to chew any solid hypo treatment well rather than chew a couple of times and swallow. The glucose will absorb quicker in your mouth than it will in your stomach, especially if there is other food in your stomach digesting, so chew and/or swill that sweetness around in your mouth rather than gulping it down. The cells inside your mouth will absorb it quickly and your mouth is closer to your brain so that glucose will get to your brain faster than through your stomach.
It is also useful to remember this when you have an illness which involves vomiting. Even if you can't hold anything down, just swilling something sweet around in your mouth (a spoon of honey or syrup can be good) can help you recover from a hypo.

 

[JJay]

I may well be changing to it in the near future as Levemir is being discontinued (which I am gutted about) but Humulin I will probably be my first choice to replace it.

Do you have a link to a reliable source for this information? I know
Levemir is being discontinued in the US and that there is a phasing out of certain pre-filled devices in the UK, but can’t find a definitive confirmation that it is being discontinued altogether.

 

[Inka]

I use an isophane insulin when I take a pump break @Ann wainwright and I much prefer it to Lantus. Having it twice daily means you can adjust each dose separately. I take less at night than in the morning and that works really well. I think you’ll find it’s a positive move.

 

[Robin]

Do you have a link to a reliable source for this information? I know
Levemir is being discontinued in the US and that there is a phasing out of certain pre-filled devices in the UK, but can’t find a definitive confirmation that it is being discontinued altogether.

Yes, I found a reliable source, after one member had been told by their DSN that it was being discontinued in 2026. I now can’t find where I posted it, but will have a Google and see if I can repost it here.
Edit. Couldn’t find my original source, but found this, from one of the regional formularies.

netFormulary

 

[JJay]

Thank you for that, @Robin.

Oh, bother! Didn’t want to have to be changing again at my age! Was on Lantus for years but never completely comfortable with it. Before that it was Humulin I, but I wasn’t even on basal/bolus then. Fingers crossed I may get a pump before Dec 26

 

[Robin]

Thank you for that, @Robin.

Oh, bother! Didn’t want to have to be changing again at my age! Was on Lantus for years but never completely comfortable with it. Before that it was Humulin I, but I wasn’t even on basal/bolus then. Fingers crossed I may get a pump before Dec 26

Exactly! I’m not relishing a change. I swapped to Levemir from Lantus too, because I could never get lantus to work well with me.

 

[Ann wainwright]

I think, in some respects, CGMs don't help people when they have this fear. I think being able to see the arrows showing your levels dropping can instill panic and I am pleased that I got used to managing hypos before I got CGM because it taught me to have faith in my hypo treatment (usually 2 jelly babies). The other thing is that CGM will usually show your levels continuing to drop for a further 20-30 mins after you have taken your hypo treatment, causing further panic, whereas a finger prick will usually show your levels rising again after 15 mins, which is why you should always retest with a finger prick after a hypo treatment and act on that and ignore CGM until it catches up.
I now know that if my Libre shows my levels as 4.3 with a vertical downward arrow and I have 2 jelly babies, it will turn it around and my graph will later show that I never dropped below 4. I see my Libre as being a bit of a drama queen. It is incredibly useful when things are ticking along nicely in range, but if it says I am very high or very low, I have learned to take it more with a pinch of salt. Of course I treat lows but I don't let the LIbre panic me because usually I am not as low as it says I am and I know that my hypo heroes (AKA jelly babies) will rescue me.

I think it helps me to know that 2 jelly babies are 10g carbs and those 10g carbs will raise my levels by about 3mmols, so even if I am on 3.0 those 2 jelly babies should get me back up to 6mmols unless I have very seriously over calculated my bolus insulin, which I very rarely do and even if I have miscalculated those jelly babies will stop the drop and if I need some more then my 15 min finger prick will show me that I need more.

An important tip is to chew any solid hypo treatment well rather than chew a couple of times and swallow. The glucose will absorb quicker in your mouth than it will in your stomach, especially if there is other food in your stomach digesting, so chew and/or swill that sweetness around in your mouth rather than gulping it down. The cells inside your mouth will absorb it quickly and your mouth is closer to your brain so that glucose will get to your brain faster than through your stomach.
It is also useful to remember this when you have an illness which involves vomiting. Even if you can't hold anything down, just swilling something sweet around in your mouth (a spoon of honey or syrup can be good) can help you recover from a hypo.

Thank you again. That's also good advice about the chewing.

 

[rebrascora]

@JJay My Consultant confirmed it at my appointment on Christmas Eve and most of the appointment was spent discussing alternatives, so it is genuine information. I believe there is info about it on the main Diabetes UK website. It comes into effect 2026 so I am going to order Levemir every month from now on as my prescription allows rather than just 4 times a year which is what I need, so I can build up a little surplus to tide me probably well into 2027. My consultant was happy for me to continue to use it as long as possible and whilst the 3 main alternatives offered were Glargine standard strength, Glargine triple strength ie. Toujeo or Tresiba, he was open to me moving to Humulin I or even Porcine if I felt those older options would give me close to the flexibility I have with Levemir.

 

[JJay]

@JJay My Consultant confirmed it at my appointment on Christmas Eve and most of the appointment was spent discussing alternatives, so it is genuine information. I believe there is info about it on the main Diabetes UK website. It comes into effect 2026 so I am going to order Levemir every month from now on as my prescription allows rather than just 4 times a year which is what I need, so I can build up a little surplus to tide me probably well into 2027. My consultant was happy for me to continue to use it as long as possible and whilst the 3 main alternatives offered were Glargine standard strength, Glargine triple strength ie. Toujeo or Tresiba, he was open to me moving to Humulin I or even Porcine if I felt those older options would give me close to the flexibility I have with Levemir.

Thanks. Good plan re the “stockpiling”.

 

[dannybgoode]

When I spoke to the DSN the other day I mentioned it and she confirmed that was the current plan.

Interestingly though I have signed up to the Glooko app so the hospital can see my data and Novo asked a couple of questions about my Levemir use so perhaps they are gathering data for some reason.

It's a way off yet. I seem to get on well with Levemir and it holds my BG very flat but I wouldn't go to the lengths of stockpiling it. If I need to change I'd rather do that under the guidance of the diabetes team rather than them change my prx and then me to continue with something else for a number of months when they think I've switched.