Preferred basal insulin for twice daily injections advice pls

Status
Not open for further replies.
M

mitchsi

Well-Known Member
Relationship to Diabetes
Type 1
Hi,

Would really appreciate advice on this one. I moved from abasaglar to tresiba due to rising BG over night on abasaglar and this has worked quite well and generally tresiba is fine, however, I found I had too much IOB during sports with increasing durations like running > 30mins.
Advice previously given with higher BG overnight was to split dose but I didn’t like the idea of twice daily injections but now I’ve come around to the idea .
I read that Levemir will be discontinued this year from Novo which I understand people use to split dose.
Can anyone help with alternatives or other ideas/experiences?
I do find with sport I’m pretty sensitive, I can even eat a large spag bol with a lot of pasta with no bolus and do 1.5hrs of sport and be fine so I guess my basal at that time day is pretty high. I don’t fancy eating that much to go running every other day though and would rather reduce basal for that part of the day.
There is the option of running with sweetened water but I do eat carbs to run and take no bolus also in general it makes sense to have different basals for am and pm. I’m open to ideas here and others experiences.
Thanks
 
Robin said:
That sent me galloping to Google, I use Levemir! I could only find stuff about it being phased out in the US, nothing about discontinuing in the U.K., unless anyone knows different?
Click to expand...
Even though I don't use Levemir, I did the same thing and, like you, only found articles about it being phased out in the US.
I did find it worrying that they referenced Tresiba and the new one injection a week basal as alternatives. As has been discussed on here previously, many of us find the flexibility of shorter active basals far outweigh the downsides of extra injections when you are jabbing for food anyway.
A small part of me pictures this decision being made by a sedentary man ignoring the women explaining how insulin sensitivity is affected by our monthly hormones as well as the differing needs when exercising.

As for an alternative for @mitchsi all I can think of is going back to Abalgasar as that can be split which may help with the overnight lows if it wasn't tried previously. When I was on Lantus, I would change my dose almost daily due to exercise and hormones and I believe Abalgasar is equivalent.

The other alternative is a pump. The justification for my pump was the number of hypos I was having when exercising. I think I was lucky but it is a possibility and the ability to suspend my basal has made a huge difference.
 
Last edited:
I'm also pretty sensitive to basal insulin and used Abasaglar until I moved to a pump about a year ago.

I found it worked well for me to split my Abasaglar into two unequal doses - one with dinner and one with breakfast.

My reason for splitting was different than yours: a single dose in the morning seemed to wear off by the end of the day. Splitting the doses seemed to help with that. A pump, with variable basal rates throughout the day, and looping to avoid extreme highs and lows day and night, fixes the problem even more.
 
helli said:
A small part of me pictures this decision being made by a sedentary man ignoring the women explaining how insulin sensitivity is affected by our monthly hormones as well as the differing needs when exercising.
Click to expand...
I don't know why the decision is being made, but I can imagine it might be just that Levemir is a lot less popular in the US. Pumps are quite a bit more common so it might just be that those on MDI are mostly those who get on OK with longer lasting basals. (I don't know that Levemir is less used in the US. I'm speculating that that might be the case.)
 
Ah sorry for the scare, I saw it online and then specifically googled discontinuation in the uk and it came up from a decent source not specifying any country which made it look like in general, another link states USA.
 
Finn said:
My reason for splitting was different than yours: a single dose in the morning seemed to wear off by the end of the day.
Click to expand...
That was the main reason for me to change to tresiba actually.
Still figuring it out but from past discussions on here it looks like Levemir is quite popular with the split dose.
Relieved to understand the discontinuation is only in the states even if that is a bit odd. I thought I might had to do with supply issues/manufacturing/profits
 
Levemir is one twice daily insulin @mitchsi There are also the isophane insulins. I use one of those as a twice daily basal when I take a pump break. I find it’s not so affected by heat as Levemir. The isophanes are Hypurin Isophane and Humulin i.
 
Robin said:
That sent me galloping to Google, I use Levemir! I could only find stuff about it being phased out in the US, nothing about discontinuing in the U.K., unless anyone knows different?
Click to expand...
My stomach lurched too. Hopefully it’s only over the water.
 
I absolutely love my Levemir. Would be gutted if it was discontinued so I hope you guys are correct that this relates to the USA only. I also love my NovoPen Echo so changing to an Isophane or a Glargine insulin wouldn't be ideal for that either.
I feel like I need to start a petition, just in case they think about phasing it out here too. I blame all these consultants for moving people onto Tresiba!
 
As abasaglar is a 24 hrs insulin, i can't see the point in splitting the dose...there is no way you can get less of a dose, for example at night, than during the day. Unless it lasts less than 24hrs in you as an individual
I was recently on daphne and they were putting people onto levemir...i think if it were being discontinued they would have been using a diffrent basal
 
The thing with Glargine is that it has a peak of activity so by splitting it you can potentially benefit from two peaks of activity if you get the dose timing right and the higher dose will have a bigger peak and a smaller dose likely a negligible peak and tail off quicker, plus it only lasts 24hrs if you believe the bumf. Human bodies are all different and it will last less for some and longer for others.
 
rebrascora said:
I absolutely love my Levemir. Would be gutted if it was discontinued so I hope you guys are correct that this relates to the USA only. I also love my NovoPen Echo so changing to an Isophane or a Glargine insulin wouldn't be ideal for that either.
I feel like I need to start a petition, just in case they think about phasing it out here too. I blame all these consultants for moving people onto Tresiba!
Click to expand...
Tell me more about your 'love' of levemir.

I discussed switching to Levemir from Lantus just because I wanted to use a Novopen Echo for basal. No medical reason, I just prefer the engineering 'feel' of Novopen verses the crap Solostar with its total lack of mechanical feel.

My consultant talked me out of it purely because it was 2 jabs a day. It does seem a drag, But tell me the benefits. I can see it opens up opportunities to vary loads during the day, but how real is that? How do you anticipate changing doses, rather than retrospective adjustment for tomorrow?

The one-a-week jab seems ideal IMHO.
 
Tdm said:
As abasaglar is a 24 hrs insulin, i can't see the point in splitting the dose...there is no way you can get less of a dose, for example at night, than during the day. Unless it lasts less than 24hrs in you as an individual
I was recently on daphne and they were putting people onto levemir...i think if it were being discontinued they would have been using a diffrent basal
Click to expand...
It is known to have a peak as @rebrascora mentioned AND does not last a full 24 hours.
Combining these two characteristics with careful timing and overlap, it has been shown to be very useful to split the dosed by quite a few people.
However, I agree that Levemir is a better option for twice daily basal dose. My suggestion was only as an alternative if Levemir was discontinued.
 
If your consultant considers an extra jab a day a drawback then to my mind they clearly have very little understanding of managing diabetes.

Firstly I love Levemir because I have a big differential between may daytime and nighttime basal insulin needs. My standard doses are usually 22 units as soon as I wake up and anywhere from 0 to 6 units at night. I am very susceptible to nocturnal hypos so being able to adjust that evening dose after exercise is really important for me and if I have had a very active day, I need to reduce the night time dose. If I have 2 active days in a row, I need to reduce it each night. If I have a more sedentary day I need to increase it again afterwards. I am not big on planning, so my Levemir allows me to be reactive and that suits the way my body works. I can also adjust the time I take the doses to take advantage of the slight peak of activity, again particularly the night time dose although I did mess around with waking up an hour before I intended to get up on a morning to inject the morning Levemir, but the novelty soon wore off and I can just inject a couple of units of Fiasp as soon as I wake up to overcome my strong FOTF. However sometimes I get spells of my levels rising on an evening about 8pm. Normally I take my evening Levemir at bdtime (11pmish) but when I get these spells when levels start rising earlier in the evening, I can bring my evening dose forward to deal with it. The pattern seems to be that this happens more at this time of year when the nights are longer and I am less active into the evening. Being able to make these adjustments to match my body gives me better "control" and keep things on more of an even keel. I hate it when my levels are turbulent and I get really frustrated so being able to balance my basal needs with these adjustments makes a huge difference to my mental well being as well as my diabetes management. Otherwise I imagine I would need a pump and I really do not want to go down that route or think it would suit me mentally for that matter. I cannot imagine how I would manage my diabetes with Tresiba because my needs vary a lot. I change my evening basal doses several times a week and daytime dose needs a tweak every couple of months.
 
mitchsi said:
Hi,

Would really appreciate advice on this one. I moved from abasaglar to tresiba due to rising BG over night on abasaglar and this has worked quite well and generally tresiba is fine, however, I found I had too much IOB during sports with increasing durations like running > 30mins.
Advice previously given with higher BG overnight was to split dose but I didn’t like the idea of twice daily injections but now I’ve come around to the idea .
I read that Levemir will be discontinued this year from Novo which I understand people use to split dose.
Can anyone help with alternatives or other ideas/experiences?
I do find with sport I’m pretty sensitive, I can even eat a large spag bol with a lot of pasta with no bolus and do 1.5hrs of sport and be fine so I guess my basal at that time day is pretty high. I don’t fancy eating that much to go running every other day though and would rather reduce basal for that part of the day.
There is the option of running with sweetened water but I do eat carbs to run and take no bolus also in general it makes sense to have different basals for am and pm. I’m open to ideas here and others experiences.
Thanks
Click to expand...

Seriously a pump is your best option, you can reduce or put a temporary hold on your basal insulin prior to & after exercising, so suggest you speak with your team as a pump can be really life changing.
 
nonethewiser said:
Seriously a pump is your best option,
Click to expand...
Thanks I appreciate the benefits you mention but I’ve had hell of a job keeping my Libre2 on while practicing karate with the Gi on let alone hit so the pump makes me nervous as hell. Also I’m only almost 5 months in since diagnosis, although my Cpep results were low I think they want me to wait anyway.
The pump is in my mind but I’d like to give it more time.
 
Inka said:
Levemir is one twice daily insulin @mitchsi There are also the isophane insulins.
Click to expand...
Thanks @Inka
I’ve asked my DSN’s about the 3 options and asked them what they recommend. I’m trying to find the profile charts for all these insulins is a good site for that (acknowledging I haven’t checked the diabetes.org knowledge base yet ).
You mention about heat stability, is that in terms of body heat/weather or transporting/storage?
 
mitchsi said:
Thanks I appreciate the benefits you mention but I’ve had hell of a job keeping my Libre2 on while practicing karate with the Gi on let alone hit so the pump makes me nervous as hell. Also I’m only almost 5 months in since diagnosis, although my Cpep results were low I think they want me to wait anyway.
The pump is in my mind but I’d like to give it more time.
Click to expand...

There's different options with pumps, example tubed pump or tubeless pump which might be option for people who enjoy contact sports.

No harm in asking & put your name forward for one, it can take several months before starting on one by which time you'll be a year into your diagnosis.
 
nonethewiser said:
There's different options with pumps, example tubed pump or tubeless pump which might be option for people who enjoy contact sports.

No harm in asking & put your name forward for one, it can take several months before starting on one by which time you'll be a year into your diagnosis.
Click to expand...
You’re absolutely right, I did show interest with the consultant and they didn’t object but no feedback on when. I’m waiting for the pasty or Daphne course invite, so I think that to be done.
 
Status
Not open for further replies.
Back
Top