Semglee shortage

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pistolpete

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Type 1
Hi all,

I recently had my Semglee switched to Abasaglar due to the shortage and its been a bit of a nightmare. I'm awake all night with hunger pains and feeding hypos more often, also running lower levels at night. I normally aim for 6 overnight but lately I've been around 4.5 which is a little low. I have halved the Abasaglar dose but this has messed up my carb to insulin ratio and like I said my back ground levels.

I am low carb and low GI diet so my levels are still ok but I really am struggling at night with hunger/sleep and really do not want to start putting weight on.

Luckily I have one Smglee pen left so I am back to normal for the next 4 weeks but I really am not looking forward to going back on Abasaglar. I am told its going to be mid 2024 before Semglee will be back to normal stock levels.

Is it worth me trying to ask for another slow release like Lantus? or maybe a good excuse to push for a pump??

Any advice would be great as I have already lost a little interest in keeping an eye on things and when things do go wrong its easy to just ignore or walk away and I dont want that to happen.

Thanks
 
As Semglee is supposed to be very similar to Lantus, you could try Lantus. Or, you could try a twice-daily insulin like Levemir or an isophane insulin, which would allow you to adjust the morning and night doses separately, helping to avoid overnight hypos.

You say you halved the Abasaglar because you were going low overnight. Did you do a basal test with it? How did it mess up your meal ratios? Were you going too high on the halves dose?
 
@pistolpete you say "I normally aim for 6 overnight but lately I've been around 4.5 which is a little low."
A basal insulin like Abasaglar or Semglee or Lantus should keep your levels stable in the absence of food, etc. This isi usually easy to see overnight.
So, are you falling to 4.5 or staying there?
If your levels are staying around 4.5, then the problem is not your basal insulin: you are going to bed too low.
If your levels are falling during the night, they you have too much insulin.
This could be the change in insulin but it could be something else (there are something like 42 things which can affect our BG). For example, have you been doing more exercise? Have you been drinking more alcohol? Both of these things will lower our BG.

Reaction to a change in basal insulin, is not likely to be a justification for an insulin pump. You still have to manage your basal insulin (it is just micro-doses of fast acting insulin) and, unless you are very lucky and get a closed loop solution, you will have to set this and manage it and tweak it yourself.
 
Inka said:
As Semglee is supposed to be very similar to Lantus, you could try Lantus. Or, you could try a twice-daily insulin like Levemir or an isophane insulin, which would allow you to adjust the morning and night doses separately, helping to avoid overnight hypos.

You say you halved the Abasaglar because you were going low overnight. Did you do a basal test with it? How did it mess up your meal ratios? Were you going too high on the halves dose?
Click to expand...
No specific basal test, yes was going high on the half dose and not dropping significantly enough after 2 hours, I was also dropping low when exercising. I can deal with the highs and lows, I can not cope with the hunger pains in the middle of the night, I have to eat at 2-3am to stop the pain (its like a hypo hunger only Im not hypo) and Im starting to put weight on.

Im back on my last Semglee pen today and things are getting back to pre Abasaglar times, hopefully tonight will be peaceful.
 
Inka said:
As Semglee is supposed to be very similar to Lantus, you could try Lantus. Or, you could try a twice-daily insulin like Levemir or an isophane insulin, which would allow you to adjust the morning and night doses separately, helping to avoid overnight hypos.
Click to expand...
Abasaglar is biosimilar to lantus 😉

info on basal testing https://www.mysugr.com/en/blog/basal-rate-testing/
 
helli said:
@pistolpete you say "I normally aim for 6 overnight but lately I've been around 4.5 which is a little low."
A basal insulin like Abasaglar or Semglee or Lantus should keep your levels stable in the absence of food, etc. This isi usually easy to see overnight.
So, are you falling to 4.5 or staying there?
If your levels are staying around 4.5, then the problem is not your basal insulin: you are going to bed too low.
If your levels are falling during the night, they you have too much insulin.
This could be the change in insulin but it could be something else (there are something like 42 things which can affect our BG). For example, have you been doing more exercise? Have you been drinking more alcohol? Both of these things will lower our BG.

Reaction to a change in basal insulin, is not likely to be a justification for an insulin pump. You still have to manage your basal insulin (it is just micro-doses of fast acting insulin) and, unless you are very lucky and get a closed loop solution, you will have to set this and manage it and tweak it yourself.
Click to expand...
Hi helli,
I understand how basal insulin works, if i go to bed at 6 I should wake up at 6 (in theory) so yes I am dropping during the night, ie my basal is dropping due to insulin, I dont drink alcohol and I exercise regularly. Yes I reduce my bolus accordingly when I exercise. I have been sailing along happily for a year until now.

Sorry I was joking about the pump, I definitely dont want a pump I have enough stuff to cart around already.

I have been off Abasaglar for 36 hours now and already things are getting back to normal, the main problem is the incredible hungar in the middle of the night, originally I put it down to hypos but when I reduced the Abasaglar I was still getting hunger pains and needed to eat!!
 
Yes I thought Absalgar was a biosimilar, but I seem to remember @Flower had a very different experience with it than with actual Lantus?

It does sound like emotionally and psychologically it would be better to try something else?

There are several new kids on the block too - like Toujeo (another glargine), and Tresiba
 
Really fascinating that you have had such a dramatic reaction when these two insulins are both Insulin Glargine although I can understand your frustration. Really weird waking up in the night with hunger pains. Can I ask how much Semglee you were talking? Halving your basal dose is a very significant reduction when the basal you have been changed to should be "like for like", dose wise and action wise. Normally a 10% adjustment is advised with basal and see how that goes. If you have then had to adjust your meal ratios, then it suggests that you have adjusted it too much and possibly knocked everything out of kilter and I imagine eating through the night is also throwing your levels out.

It sounds like you are a keen cyclist so I wonder if a change to Levemir might be worth considering. I love Levemir for it's flexibility as you can adjust day and nighttime doses separately and reduce doses before or after exercise according to how your body responds and you can reduce or increase on a daily basis and you get more or less real time results. It does take more thought because if you have a variable lifestyle, you end up adjusting it regularly, but you develop an intuition for what you need when. My daytime needs are pretty stable but my nighttime needs vary quite a lot with exercise, so my evening dose gets tweaked a lot. I have certainly never had any issues with hunger but then I have not heard of anyone else reporting that problem with their basal.

Do you have reusable pens or are you on disposable pens? Just wondering if cartridges for Semglee are available but just not the disposable pens and that getting a reusable pen and cartridges would resolve your problem if you are happy with Semglee? It is also worth shopping around with your Semglee prescription as a lot of the issues with medication being unavailable is not a shortage but a logistical problem within certain pharmaceutical wholesalers or pharmacy franchises, so ringing around all the pharmacies in your area and particularly any independents may well turn up a supply of Semglee. You would then get your current pharmacy to release your prescription so that you can take it elsewhere to be dispensed.
 
Just had a look and it doesn't appear that Semglee is available as cartridges for reusable pens from a very quick internet search, so discard that idea, but definitely worth shopping around other local pharmacies for Semglee pens if you are happy with that particular basal.
Have you been diagnosed long?
 
rebrascora said:
Just had a look and it doesn't appear that Semglee is available as cartridges for reusable pens from a very quick internet search, so discard that idea, but definitely worth shopping around other local pharmacies for Semglee pens if you are happy with that particular basal.
Have you been diagnosed long?
Click to expand...

Hi Barbara,

Thanks for that and the kind reply. I wouldnt say its dramatic but more anoying. Diagnosed 18 months ago and the bottom fell out of my world. I have since attended many courses and with help I have been sailing along flawlessly for the last 12 months. I pretty much knew my numbers without my CGM, through diet and counting carbs I keep my numbers probably better than most non diabetics do. I do drive and need to keep within the law so I have always done my utmost to avoid hypos and any hypo situation. My basal rate is 9 units and I bolus 1:12 cho for breakfast and 1:10 cho the rest of the day. I am on a low cho diet and low GI and avoid proscessed foods as much as I can. My dietician is happy with my diet but my doctor always pulls a face, but never says anything.

I have tried other pharmacies but no one can get Semglee, I had a appointment with my DSN the day after I got my Abasaglar perscription and they told me it will be mid 2024 until normal stock levels resume. I will look into Levemir, I dont like to trouble my DSN as they are so busy hence why I asked here for any ideas first.

I really dont want a pump, I did enquire about the Omnipod Dash around a year ago after watching a demonstration, obviously I would have to self-fund but if I remember it was just over £3k and they would do a 12 month contract, maybe worth considering.

To be honest I am surprised Semglee is in short supply as far as I am aware it is the cheapest insulin available, you would of thought our cash strapped NHS would do there best to save a few quid and keep the supply going.

Does anyone think my low carb diet could be the cause? some days I only have 36g cho for breakfast.

Thanks again Barbara
 
I manage fine on a low carb diet but I do need to inject for protein release.
I think it is likely that you will still be within the honeymoon period and therefore your own insulin production may still be able to deal with the protein release or your muscles are utilizing that during exercise and therefore dealing with it. Protein release can be quite good for stabilizing levels during exercise in my experience because it is a long, slow, steady release. Low GI rarely works for me in the sense that my digestive system sees it as a challenge and apparently it is rather competitive 🙄, whereas with protein release it has no option. It takes 2+ hours for protein to start digesting and slowly releasing glucose. If you eat enough carbs, the body doesn't break down protein for glucose, but you need to be aware of it if you do eat low carb.
 
@pistolpete
I found this thread as I've just made the switch, but fortunately without issue. But I thought it would be useful for others if you could update where you ended up.
 
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Glad you haven’t had problems getting hold of your meds @RBZ5416 - there do seem to be some significant supply issue challenges with all sorts of medications at the moment :(

Last week the Dept of Health and Social Care issied a supply notification for Lantus Solostar from thenend of Jan. Vials and cartridges are unaffected, but cannot support uplifts in demand.

Absaglar Kwikpen seems to be the suggested switch. Bit any change of medication requires increased monitoring.
 
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