Insulin profile comparison chart?

[CALSHOT]

Hello,

Could anyone point me in the direction of an insulin comparison chart you've found useful. A few are online but not what i'm after.
My consultant has recommended a trial of Novo's Tresiba aka Degludec to replace my current Levemir. Has anyone seen these two on a comparison chart? I'm having trouble finding Tresiba's profile.

Many thanks,

 

[rebrascora]

Hi
I believe the Tresiba works over 42hrs so it may be difficult to find a comparable profile graph and obviously there is significant overlap of doses which means looking at a profile doesn't really help because they become overlaid onto the previous injection's profile. I believe it is generally considered to be much flatter and there is more flexibility as regards when you inject it. The down side is that it is slower to adjust because any changes in basal take 3 days to show their effect.
For me, split dose Levemir gives me more flexibility to adjust my daytime and night time basal insulin to suit my needs during those different periods and being able to vary it to get a reasonably instant result is something I like.

Are you having particular problems with Levemir that the consultant has suggested this change?

There are a some posts from people who changed from Levemir to Tresiba which might be worth reading as not everyone finds that change beneficial.

 

[rebrascora]

Here is one of the posts I was referring to

Levemir to Tresiba?

Hi all. Hope you are well. I saw my consultant last week, who has now said he wants to switch me from levemir insulin to tresiba. I have only been diagnosed a year so this is my first big change in my diabetes management. Does anyone have any experience of this switch? Has it been...

forum.diabetes.org.uk

 

[trophywench]

JJust been back to that thread @rebrascora and suddenly noticed that someone kept on referring to Levemir as being 'a 24 hr insulin' - it isn't and never has been unless you need a really high dose per kg of your body weight - it was always intended to be given twice a day, but not equal doses, nor 12 hours apart necessarily - you need whatever you need at whatever times you need it - cos we are all different.

Basal testing is essential to get to just the right place for you.

Why on earth does a diabetes consultant believe a flatter profile of a basal insulin is such a good idea, in this day and age? There's not all that many 2 consecutive hours in my own pump basal profile where I need the same amount of basal! - and I am not whatsoever uncommon in that.

 

[rebrascora]

I agree. Flat basal wouldn't suit me. I take 16units of Levemir in the morning about 8am and 7 or 8 units on a night about 11pm and that balance seems to work reasonably well for me now although I usually get a slight dip in BG between 6pm and 8pm if I don't have dinner.... which is quite often.... but easily dealt with by having a 10g carb snack and I know to look out for it.
I also wonder if Tresiba is necessarily a good choice in the current climate because if you need to adjust basal insulin due to illness it is not as quick to respond as Levemir would be and from what I have read, basal needs can rocket with C19.

 

[DaveB]

Levemir is considered a good Basal with a more predictable behaviour compared with Lantus, for example, (not that Lantus is a bad insulin). It only works for around 12-18 hrs. You can Google the web for a 3D profile and the time varies depending on the dose. I was started at a single dose but have recently split the dose guessing the split ratio (there are no rules). I agree with Trophywrench.

 

[SB2015]

Hello,

Could anyone point me in the direction of an insulin comparison chart you've found useful. A few are online but not what i'm after.
My consultant has recommended a trial of Novo's Tresiba aka Degludec to replace my current Levemir. Has anyone seen these two on a comparison chart? I'm having trouble finding Tresiba's profile.

Many thanks,

Hi Calshot

What are the issues that your consultant is trying to address? As others have said the most flexible basal insulin I found was a split dose of Levemir. I was advised I could take the two doses at whatever time I wanted but needed to be consistent. I then needed to do basal tests to get the correct dose. The change to this made life a lot more flexible as I could change the daytime dose, to match what I was doing that day, without impacting my night time dose.

For any that go onto a pump here they are required to switch to Levemir as their basal in preparation.

 

[Amity Island]

JJust been back to that thread @rebrascora and suddenly noticed that @Amity Island kept on referring to Levemir as being 'a 24 hr insulin' - it isn't and never has been unless you need a really high dose per kg of your body weight - it was always intended to be given twice a day, but not equal doses, nor 12 hours apart necessarily - you need whatever you need at whatever times you need it - cos we are all different.

Basal testing is essential to get to just the right place for you.

Why on earth does a diabetes consultant believe a flatter profile of a basal insulin is such a good idea, in this day and age? There's not all that many 2 consecutive hours in my own pump basal profile where I need the same amount of basal! - and I am not whatsoever uncommon in that.

Hi Jenny,
I've never discussed Levimer, I know nothing about it and have never used it.

 

[Amity Island]

Hello,

Could anyone point me in the direction of an insulin comparison chart you've found useful. A few are online but not what i'm after.
My consultant has recommended a trial of Novo's Tresiba aka Degludec to replace my current Levemir. Has anyone seen these two on a comparison chart? I'm having trouble finding Tresiba's profile.

Many thanks,

Hi Calshot,

Please see link below for Tresiba profile. I can't comment on Levimer as I have never used it, but I was on Lantus previously and changed to Tresiba Degludec a couple of years ago. Degludec has given me very flat results on basal blood glucose readings. Whether that is because my basal needs are flat or degludec is able to smooth out any peeks and troughs in basal needs I don't know. Tresiba Degludec wouldn't be the best option for anyone with a variable lifestyle, e.g one day running, next day rest, one day swimming another day resting. It can't be adjusted any closer than a few days apart.

Any other questions just ask.

You consultant may have recommended the change based on the trials undertaken by NOVO.

"Adult patients treated with TRESIBA® achieved levels of glycemic control similar to those achieved with LANTUS® (insulin glargine 100 units/mL) and LEVEMIR® (insulin detemir) and achieved statistically significant improvements compared to sitagliptin."

Tresiba® (insulin degludec) injection 100 U/mL, 200 U/mL Product Profile

Once-daily Tresiba® (insulin degludec) may be the right option for your patients over 1 year of age starting on or switching to basal insulin. Read Important Safety & Prescribing Info.

www.tresibapro.com

 

[CALSHOT]

Hi All,

Thanks for the comments.
I was on Lantus previously for about 2 years then swapped to Levemir.
I take Levemir at 10pm with the intent to be more of use whilst i sleep. The fading of potency mid afternoon the next day suits me and i do not have a second Levemir jab in the 24 hour period.

During the day take Novorapid and one shot of HumalinS at 11pm (usually to bed). This is also to have a slightly longer potency whilst i sleep vs Novorapid.

However, despite this setup dawn highs are an issue for me. I go from approx 5 to 15+ most mornings in the period of 1 hour. Peaking 5am. Its an aggressive increase. I avoid carbs after 5pm (most days), pasta rice etc to avoid the delayed sugar increase they give.
My consultant recommended the option of Tresiba with the overlap of potency occuring at my DP peak around 5am

I guess if Tresiba is up to 48 hours i would have to be more rigid on the injection time to meet the crossover, whereas my Levemir and HumalinS times are currently flexible slightly.

Thanks

 

[trophywench]

Well Amity there were folk on that thread, either already on Lantus or already on Levemir and wondering about changing back so I assumed you were talking to all/both.

(Anyway - some Medics seem to think it's supposed to last 24 hours, so spose it shouldn't surprise me if anyone on the forum had been led to believe that, should it!)

 

[Inka]

Hi All,

Thanks for the comments.
I was on Lantus previously for about 2 years then swapped to Levemir.
I take Levemir at 10pm with the intent to be more of use whilst i sleep. The fading of potency mid afternoon the next day suits me and i do not have a second Levemir jab in the 24 hour period.

During the day take Novorapid and one shot of HumalinS at 11pm (usually to bed). This is also to have a slightly longer potency whilst i sleep vs Novorapid.

However, despite this setup dawn highs are an issue for me. I go from approx 5 to 15+ most mornings in the period of 1 hour. Peaking 5am. Its an aggressive increase. I avoid carbs after 5pm (most days), pasta rice etc to avoid the delayed sugar increase they give.
My consultant recommended the option of Tresiba with the overlap of potency occuring at my DP peak around 5am

I guess if Tresiba is up to 48 hours i would have to be more rigid on the injection time to meet the crossover, whereas my Levemir and HumalinS times are currently flexible slightly.

Thanks

I’m probably being dim here, but why are you taking the Humulin S at bedtime (if I’ve read that correctly)? Have you previously tried taking the Levemir slightly later? Could it be running out (if you take a small dose)?

There’s a chart showing insulin profiles here, including Tresiba:

https://www.diabetes.org.uk/resourc...0of%20Leicester%20-%20Insulin%20Profiles.pdf?

Would you qualify for a pump? Mine keeps my rise right down without giving me hypos in the night as the insulin amount increases to squash my Dawn Phenomenon.

 

[billyblue]

Hello,

Could anyone point me in the direction of an insulin comparison chart you've found useful. A few are online but not what i'm after.
My consultant has recommended a trial of Novo's Tresiba aka Degludec to replace my current Levemir. Has anyone seen these two on a comparison chart? I'm having trouble finding Tresiba's profile.

Many thanks,

people react differently to insulin, I know few people didn't react well with Tresiba but i can tell you about my experience i switched from levemir 3 months ago and tresiba is working very well i was on 14 units of levmir bedtime once i switched to tresiba i started with lower dose 7 units and after a month of the lower dose I went up to 10 bedtime and its working perfectly well it kept my all day reading at 4.7 mmol/L.
now my HBA1C went down from 7.6 to 5.5 in just 3 months.
your GP should explain the difference between both and give you the right dosage, probably you will start with a less dose as it takes some time for your body to react to it.
stay safe

 

[Amity Island]

Hi Calshot,

Hi All,

Thanks for the comments.
I was on Lantus previously for about 2 years then swapped to Levemir.
I take Levemir at 10pm with the intent to be more of use whilst i sleep. The fading of potency mid afternoon the next day suits me and i do not have a second Levemir jab in the 24 hour period.

During the day take Novorapid and one shot of HumalinS at 11pm (usually to bed). This is also to have a slightly longer potency whilst i sleep vs Novorapid.

However, despite this setup dawn highs are an issue for me. I go from approx 5 to 15+ most mornings in the period of 1 hour. Peaking 5am. Its an aggressive increase. I avoid carbs after 5pm (most days), pasta rice etc to avoid the delayed sugar increase they give.
My consultant recommended the option of Tresiba with the overlap of potency occuring at my DP peak around 5am

I guess if Tresiba is up to 48 hours i would have to be more rigid on the injection time to meet the crossover, whereas my Levemir and HumalinS times are currently flexible slightly.

Thanks

Hi Calshot,
Regarding the crossover you mention on the degludec, I couldn't be certain without trying it. I do normally take the Tresiba in the morning everyday. But sometimes I may take it several hours later. The official testing has shown that doses can be taken as close as 8hrs apart one day and then 40hrs apart another day and still run smoothly, it's VERY flexible in terms of dose timings.

 

[DaveB]

Well Amity there were folk on that thread, either already on Lantus or already on Levemir and wondering about changing back so I assumed you were talking to all/both.

(Anyway - some Medics seem to think it's supposed to last 24 hours, so spose it shouldn't surprise me if anyone on the forum had been led to believe that, should it!)

I remember my otherwise great DN showing me a big chart from Novo showing Levemir as a 24 hr insulin. The sad thing is she actually believed it and said I shouldn't split it. I'm not impressed that Novo should put out that bad information.

 

[DaveB]

What on earth has Sitagliptin got to do with insulin and can't be compared with insulins? It's a DPP-4 inhibitor and inhibits and enzyme that in turn switches off insulin after a meal and has a completely different mechanism to injected insulin.

Hi Calshot,

You consultant may have recommended the change based on the trials undertaken by NOVO.

"Adult patients treated with TRESIBA® achieved levels of glycemic control similar to those achieved with LANTUS® (insulin glargine 100 units/mL) and LEVEMIR® (insulin detemir) and achieved statistically significant improvements compared to sitagliptin."

Tresiba® (insulin degludec) injection 100 U/mL, 200 U/mL Product Profile

Once-daily Tresiba® (insulin degludec) may be the right option for your patients over 1 year of age starting on or switching to basal insulin. Read Important Safety & Prescribing Info.

www.tresibapro.com

 

[Amity Island]

I remember my otherwise great DN showing me a big chart from Novo showing Levemir as a 24 hr insulin. The sad thing is she actually believed it and said I shouldn't split it. I'm not impressed that Novo should put out that bad information.

Hi Dave, from what I can find on that (Levimer once or twice a day), it does appear that this is the advice given by pharmacists too. Same goes for lantus and probably other insulins. Perhaps many insulins can be taken once a day or split?

 

[Amity Island]

What on earth has Sitagliptin got to do with insulin and can't be compared with insulins? It's a DPP-4 inhibitor and inhibits and enzyme that in turn switches off insulin after a meal and has a completely different mechanism to injected insulin.

Hi Dave,
I was also wondering that, but I think what they are trying to say is that taking insulin deguldec is more effective than taking Sitagliptin (Januvia) for type 2's to reduce blood sugars, which works by increasing the production of insulin and decreasing the production of glucagon by the pancreas?

 

[Amity Island]

basal needs can "rocket" with C19.

Sounds like a headline from the express! Lol.

If you are ill or catch any virus/cold sick day rules apply. How often does one expect to catch covid19? I don't think it would be advised by any doctor to select a basal insulin based on catching Covid19.

 

[everydayupsanddowns]

Diabetes UK’s “Meds and Kit” supplement always used to give a basic idea of onset/peak/duration if that helps @CALSHOT