Switching from Lantus to Levemir

[Jon-Manchester]

Hi
My nurse have switched me from Lantus to Levemir, I am still waiting on ‘Pharmacy2U’ to get it sent out but in the mean time I wanted to ask for some tips & tricks when switching.
My nurse said it ‘should ‘ be roughly 1:1 between the two so I guess I start there?
anyone with experience who can share their experiences?

many thanks
Jon

 

[trophywench]

Well that's he starting point Jon - but it isn't likely to land up as an equal split, nor 12 hrs apart.

All you can do is test test test. It's just hit and miss anyway for the first 3 days, cos the effects of Lantus won't disappear until 72 hrs have passed since the change - hence just firefight as it were for the first 3 days. Then get round to structured basal testing to work out where you need more less or just different - after the first half a week I found that Levemir was just more 'biddable' - ie if I observed I needed less or more of it, I'd know if it had worked by the BG results I got on my meter that same day I enacted the change! If the change was disastrous then I'd change it back the next day - but then leave a couple of days before I attempted any other change. It's like the tortoise and the hare - you get to the finish quicker by taking it at more of a plodding pace than a sprint and collapsing half way through it.

Best of luck!

 

[Jon-Manchester]

Well that's he starting point Jon - but it isn't likely to land up as an equal split, nor 12 hrs apart.

Thank you Jenny. I was thinking of starting 1 or 2 units lower than i am on the lantus and then increase as required. I rather fight slighly higher at the switch than constantly going low. Does that sound like a reasonable approach?

nor 12 hrs apart.

Now, I can kind of manage that it wont be 1:1 match to lantus in terms of # units but how do I work out what the right timings are? How do I do that in a "controlled environment" as for the #units, i was thinking of just skipping carbs for the morning as an example and see if BS rise or fall for the next 5-6 hours.. and do that a few times over the next few weeks but what is the best way of finding out what the split should be in terms of the day (so 10 h / 14 h or what ever)?

Best of luck!

Thank you! 🙂

 

[Jon-Manchester]

Oh and i forgot to ask, i guess this mean I need to be much stricter when i take the Levemir?
For the Lantus I take it before breakfast and in the evening, and though i try to do it at the same time every day, it does vary quite wildly (certainly in the evening)

 

[mikeyB]

Splitting Levemir doses is very different to splitting Lantus, for the very good reason that splitting Lantus is pointless - it’s action is too long for that to make a difference, apart from adding insulin to insulin.

The advantage of changing to Levemir, I found, was by splitting the dose so that the morning dose was approximately double that of the evening dose after some basal testing research. The effect of Levemir starts running down after 12 hours or so, I found on basal testing. That’s not a hard rule, everyone is different and will find different ratios, but this game is a marathon, not a sprint. Experiment away🙂

 

[trophywench]

Think you need to heed the original basal testing instructions Jon - see
https://www.diabetes-support.org.uk/info/?page_id=120

I agree with the approach of letting BG be a bit higher temporarily and just firefighting with correction doses of fast acting as necessary and for what it's worth whereas I was on 18u Lantus I finished up on 14u Levemir in the morning on rising (at work then so approx. 07.30) with a further 4u at approx. 9.30pm! If I didn't do the latter my BG soared into the stratosphere before I went to bed (about 11-ish) so taking it 'at bedtime' was too late.

Exactly as @mikeyB says - we're all different and the only way to find out is test, test, test ad infinitum until you can get it as right as you can. Obviously it'll never be perfect - we are using a sledgehammer, after all, since our precision instruments popped their clogs! LOL

 

[Jon-Manchester]

Thank you both! I think i will just have to take the plunge, I now realise that is has been quite comforting getting the basal right so a bit nervous to have to start all over again. But if it is one thing I do a lot of, its testing. I checked and over the last 3 months I have an average of 17 checks per day, of course that is with the Libre, so it is easy

 

[trophywench]

Ah - you'll be quids in with basal testing - I wanted the ruddy thing more for that than anything but the results I got bore so little resemblance to fingerprick testing and no reliable comparison with them (should that be 'to them' ?) I gave up once the trial was over.

 

[Jon-Manchester]

Ah - you'll be quids in with basal testing - I wanted the ruddy thing more for that than anything but the results I got bore so little resemblance to fingerprick testing and no reliable comparison with them (should that be 'to them' ?) I gave up once the trial was over.

It seems like Libre users have very different experiences. I am usually +|- 0.3 on the first day with a new sensor but after that I quite often get exactly the same result finger pricking as I do with the Libre (apart from when things changes quickly). I am only finger prick now when I am low or high apart from that my fingers are safe 😉

 

[trophywench]

Yeah, well I use a Roche pump, for which the bolus calculator is contained within the remote control, which also contains the BG monitor - hence if I get my BG from another device I would need to enter that BG into the meter/remote, for it to calculate the bolus. For pumps without a remote, you have to enter the BG into the pump itself so it can again, calculate the dose required and then, deliver it. I just don't want to have to carry round multiple devices either, because that defeats the object of trying to make treatment 'better'. The way it is yes I have to carry the pump cos it's attached to me, and yes, I have to carry the meter.

On MDI yes I had to carry a pen and a meter.

It's enough thanks.

 

[Jon-Manchester]

No I can completely understand that with pump etc it doesn’t suit. And the last thing that any of us need is another thing to carry around that’s for sure.