Preferred basal insulin for twice daily injections advice pls

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mitchsi said:
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?
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There is a profile chart - let me see if I can find it. For heat stability, I meant external temperature affecting absorption by the body, ie in the heatwave we had, the Levemir can be absorbed more quickly.

I know you don’t want a pump now, which is wise (best to get a solid knowledge of injections first IMO) but for contact sports, I’d recommend a tubed pump as you can simply take it off and put it back on again after, both of which take literally seconds.
 
rebrascora said:
I am not big on planning, so my Levemir allows me to be reactive and that suits the way my body works
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@rebrascora yeah that’s an attractive benefit, my classes are fixed but running or active days can be ad hoc.
Tresiba is a nice easy one to take but inflexible for me.
 
mitchsi said:
Relieved to understand the discontinuation is only in the states even if that is a bit odd.
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I'm guessing there's some particular reasons (maybe insurance companies want to remove it for some reason (for example they can get a much better deal on one of the other basal insulins)) that don't apply so much elsewhere.
 
Inka said:
Here we are @mitchsi There’s a slightly newer chart but you can see here for now:


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Thanks a lot @Inka very useful, I’ll look deeper later. I should be working but this is more interesting
It does seem the isophanes profile would suit more in terms of the peak response time.
Did you ever use Levemir just to be able to compare between the two in terms of the active times rather than the heat response?
 
I think it is important to be aware that all of this data is just a rough guide to what you might expect each insulin to do. As with all things diabetes related, your body may respond typically or it may respond slightly differently or even very differently.
Changing insulin can be quite disruptive so not to be undertaken lightly and probably not if you are going through a really hectic or stressful period.
I found the change from NovoRapid to Fiasp incredibly challenging and frustrating and it took me 2 x 3 month trials of it (both instigated my me) before I managed to find a way to make it work for me and to be honest if I hadn't promised myself I would give the second trial a full year, I would have given up at the 3 month mark again and gone back to NR. I made the breakthrough between 3 and 4 months the second time. I don't love Fiasp like I do Levemir but it is an improvement on Novo(not so)Rapid and worth the frustration of changing in the end!
 
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mitchsi said:
Thanks a lot @Inka very useful, I’ll look deeper later. I should be working but this is more interesting
It does seem the isophanes profile would suit more in terms of the peak response time.
Did you ever use Levemir just to be able to compare between the two in terms of the active times rather than the heat response?
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I did but I didn’t do a scientific comparison because I was taking a pump break rather than choosing a new basal for MDI. I tried the Levemir first, then the isophane, which I preferred so I stuck with the isophane on that and subsequent pump breaks.
 
rebrascora said:
took me 2 x 3 month trials of it (both instigated my me) before I managed to find a way to make it work
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Thanks @rebrascora ill keep that in mind, good advice. It was mentioned to me before to split doses and I wasn’t keen but in hindsight perhaps I should have or it might have been the wrong time too early. But what I’ve witnessed I’m motivated to make the change even though I’m not a morning person and I’ll have to be quite aware of how I’m reacting to this change, which I think could be quite significant.
Curious to hear back from my DSN’s now
 
Thanks for all your advice, all really good info and discussions. I’ve learnt a lot in a short space of time - you wouldn’t get the advice this succinct in a book !
 
rebrascora said:
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.
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That's extremely interesting. Thanks.

Firstly I must clarify my consultants comments. Firstly she knows me!

I do run reasonably tight control; 90%+ in range of 3.9-10. That control is through obsessive behaviour as most of us do I'm sure. But I find it so difficult to get repeatable outcomes. To recognise different highs/lows and attribute it to action is OK, but to anticipate what will happen with what I'm intending is difficult. I can do this with meal by meal FIASP quite successfully but far from perfectly.

I suspect my consultant considered it would be yet another variable for me to juggle. God knows this disease is already all consuming without more balls (to juggle).

I must say, I am in awe of you and others here who demonstrate such complete understanding of how their body works.

If only we weren't all different eh?
 
No, definitely not complete understanding and I get it wrong often enough but I am more relaxed about it than I was in the early days and more keen to experiment and the more I experiment the more I learn.
Having a whole week of nocturnal hypos after exercise early on helped me realise that I needed to take control myself and do some adjusting of basal as clearly it wasn't a bolus issue. Interestingly up until that point I had feared nocturnal hypos to the point that I woke up several times a night to check (pre Libre) but having so many in a week, even whilst reducing my Levemir doses gave me confidence in my body and that I could deal with them and I would wake up and I wasn't going to die in my sleep from them. I rang the diabetes helpline and their advice was nothing more than I was doing myself, so I decided that I needed to become the expert in my diabetes and the only way to learn is to experiment and not be frightened of making mistakes. It has taken time but it has really improved my confidence enormously, particularly that I can manage any mistakes I make.

I still get nocturnal hypos occasionally, sometimes even when I have dialed my evening Levemir down to 0 but they are mild and easy to manage but if I could not adjust my evening basal I would be in serious trouble, because the difference between 1 and 2 units at night is so significant let alone between 0 and 5. I find it very challenging to balance my levels overnight and I rarely achieve any sort of consistency with my waking readings but it would be far more challenging with a long acting or once a day basal.
 
helli said:
I would be surprised if anyone have “complete” understanding. But I am sure whoever you are referring to would be hugely complimented.
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Obviously I should have said in comparison to me! ;-)

Edit:

Anyway these discussions have persuaded me to have a go at Levemir, maybe just for the better quality pens, and I can have a RED one - Yippee.
 
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You've got to love those NovoPen Echoes. They are the business!
 
Good luck getting a red one, I’ve got two blue ones despite asking for a red. Then GP surgery made a mistake in my prescription and sent me two new novo pens and guess what both blue!!
If you end up with two red I can swap for a blue!
 
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