Switching from Levemir to Humulin - is dosage the same?

[Hobbit]

I've been forced to switch from Levemir to Humulin because apparently it's being discontinued. I'm down to my last few days dose of Levemir and wondered if I'm supposed to use the Humulin exactly like Levemir? I'm currently taking 12 units of Levemir at night.

Also I did a test squirt of it in the air because I wasn't sure if my needles would fit on it. When I pressed down there was no click, it just went down silently. Is it supposed to do that?

 

[Inka]

Presumably it’s Humulin i you’ve been given @Hobbit ? That’s an isophane basal insulin and a perfectly good one 🙂 I use an isophane basal insulin when I take a break from my pump but I take it twice a day. Your nurse should have told you how often to take it. Are you also taking a bolus/fast/meal insulin?

What pen have you been given for your Humulin?

ETA if it’s the Savvio pen, then that doesn’t click when you depress the button. It just goes down like pressing the end of a syringe. You still need to do airshots the same and dial your dose, but when you inject you won’t hear any clicks.

 

[rebrascora]

Quite surprised that you just injected Levemir once a day and that you have been switched to Humulin I. If you were injecting Levemir twice a day, then I could understand moving to Humulin, but if you can manage your diabetes well with just a single dose then I would have thought you would be switched to one of the newer basal insulins like Tresiba.

I will be interested to hear how you get on as I currently use Levemir and my consultant has agreed I can stay on it until supplies run out next year as I absolutely love the flexibility of it in taking it twice a day and being able to adjust day and night doses independently of each other and get more or less real time results, but if you don't do that then I suppose your experience with Humulin will be different.

Sorry I can't answer your question. In your situation I would either clarify with my clinic via the helpline where I can ring and leave a message and they ring me back within a couple of days or go with the same dose but make sure to set my low alarm a bit higher in case it is slightly more potent. Unfortunately some clinics don't have a helpline but the hospital switchboard should be able to tell you if they do or put you through.

There is always a question of how any individual body will respond to a change, so it is a bit of try it and see, but making sure to keep yourself safe by taking extra precautions to prevent possible hypos.

I personally couldn't get away with taking such a large dose of Levemir at night. I need a large dose in the morning but just a small one or sometimes none at all at bedtime, but we are all different.

Do let us know how you get on with Humulin I as there are a few of us here who will be hoping to get that option when Levemir runs out.

 

[helli]

Quite surprised that you just injected Levemir once a day and that you have been switched to Humulin I. If you were injecting Levemir twice a day, then I could understand moving to Humulin, but if you can manage your diabetes well with just a single dose then I would have thought you would be switched to one of the newer basal insulins like Tresiba.

When I was on MDI, I used Lantus which is a once a day basal and the idea of Tresiba, an insulin that takes 3 to 4 days for a change of dose to take effect, scares the bejeebers out of me.
My day-night basal needs are not that different. However, the flexibility of Levemir (or even Lantus) is not just the ability to have different doses night and day but also to have different doses today, tomorrow and the next day. As someone who exercises regularly but not every day, this is very important.
There are many other reasons for day to day basal flexibility such as periods and illness and shift work or different basal workdays and non-workdays.

I really hope the default replacement for Levemir is not Tresiba with no discussion.

 

[Hobbit]

Presumably it’s Humulin i you’ve been given @Hobbit ? That’s an isophane basal insulin and a perfectly good one 🙂 I use an isophane basal insulin when I take a break from my pump but I take it twice a day. Your nurse should have told you how often to take it. Are you also taking a bolus/fast/meal insulin?

What pen have you been given for your Humulin?

ETA if it’s the Savvio pen, then that doesn’t click when you depress the button. It just goes down like pressing the end of a syringe. You still need to do airshots the same and dial your dose, but when you inject you won’t hear any clicks.

I have Novorapid with my meals. The label on the pen says it's a Lilly Humulin Kwikpen.

 

[Hobbit]

Quite surprised that you just injected Levemir once a day and that you have been switched to Humulin I. If you were injecting Levemir twice a day, then I could understand moving to Humulin, but if you can manage your diabetes well with just a single dose then I would have thought you would be switched to one of the newer basal insulins like Tresiba.

I will be interested to hear how you get on as I currently use Levemir and my consultant has agreed I can stay on it until supplies run out next year as I absolutely love the flexibility of it in taking it twice a day and being able to adjust day and night doses independently of each other and get more or less real time results, but if you don't do that then I suppose your experience with Humulin will be different.

Sorry I can't answer your question. In your situation I would either clarify with my clinic via the helpline where I can ring and leave a message and they ring me back within a couple of days or go with the same dose but make sure to set my low alarm a bit higher in case it is slightly more potent. Unfortunately some clinics don't have a helpline but the hospital switchboard should be able to tell you if they do or put you through.

There is always a question of how any individual body will respond to a change, so it is a bit of try it and see, but making sure to keep yourself safe by taking extra precautions to prevent possible hypos.

I personally couldn't get away with taking such a large dose of Levemir at night. I need a large dose in the morning but just a small one or sometimes none at all at bedtime, but we are all different.

Do let us know how you get on with Humulin I as there are a few of us here who will be hoping to get that option when Levemir runs out.

I only take it once at night because that's how the nurse told me I should take it when I first had to start using insulin in 2007. I suppose it must be doing ok as they've never suggested taking it differently. My diabetes is generally well controlled but I do have to be careful to avoid hypos in my sleep, which is annoying because I have to go to bed with blood sugar readings a bit higher than I'd like but if I don't I'll wake up with a hypo.

What do you mean by setting your low alarm?

I called my GP this morning to speak to a diabetic nurse but nobody called me back. I'll ring them again tomorrow. I'll have to start taking the Humulin in a few days so I need to know what to do.

 

[mashedupmatt]

What do you mean by setting your low alarm?

Do you have a CGM? It's an alarm that lets you know if you are going low on your phone (or reader) so you can act to treat it (if necessary) - you can change the alarm to suit - I am on Levemir too and am concerned about the the upcoming discontinuation so am also very interested how the change to Humulin I goes - I take my Levemir twice daily and often change my night time dose depending on what I've been up to (have only done 2 units tonight instead of my usual 4 due to exercising tonight) - please let us know how you get on, but sorry I can't answer your question directly - and you shouldn't have been forced to change your insulin now if it is working for you as it hasn't been discontinued yet (that is in the guidelines) so if it doesn't work, get them to change it back

 

[Hobbit]

Do you have a CGM? It's an alarm that lets you know if you are going low on your phone (or reader) so you can act to treat it (if necessary) - you can change the alarm to suit - I am on Levemir too and am concerned about the the upcoming discontinuation so am also very interested how the change to Humulin I goes - I take my Levemir twice daily and often change my night time dose depending on what I've been up to (have only done 2 units tonight instead of my usual 4 due to exercising tonight) - please let us know how you get on, but sorry I can't answer your question

Never heard of a CGM before! Doesn't it feel uncomfortable having something stuck in you all the time? It would be nice not to have to keep pricking my fingers, the whole process of doing that gets tiresome.

 

[mashedupmatt]

Never heard of a CGM before! Doesn't it feel uncomfortable having something stuck in you all the time

Not at all, it's much nicer than finger-pricking, although you still need to do that from time to time - if you are on insulin (basal/bolus regime) you should definitely ask about one, particularly if you are worried about having nocturnal hypos, and are waking up low

 

[Bruce Stephens]

Doesn't it feel uncomfortable having something stuck in you all the time?

No. The first Libre sensors (at least, the first ones most of us had) needed to be scanned using a reader each time you wanted a reading. All of us occasionally scanned the wrong arm (normally you apply the next sensor on the opposite arm), proving that not only is it not uncomfortable, we don't notice it at all (generally, anyway).

 

[Inka]

I have Novorapid with my meals. The label on the pen says it's a Lilly Humulin Kwikpen.

Ah, that’s a disposable pen. If you’re happy with that, stick with it. The Savvio is a re-useable pen but not as good as the re-useable pen it replaced. I’ve never used a Kwikpen so can’t comment on its clicking.

 

[rebrascora]

Your single dose in the evening is almost certainly the reason why you were having nocturnal hypos and it should have been addressed by your Health Care Professional (HCP) who supports you with your diabetes management. Like Matt, if I have done lots of exercise, I have to reduce my evening dose of Levemir and over several days this can mean I sometimes have to reduce it to zero to prevent nocturnal hypos and I only take between 0 and 5 on an evening but need a big dose (22units) in the morning to keep my levels balanced. It sounds like you haven't been advised to adjust yours at all, but your HCP should have been adjusting it to prevent you having nocturnal hypos as they are something which should be avoided and adjusting medication is key to that. Have you made them aware that you get hypos through the night?

As regards CGM (Constant Glucose Monitors) You could apply to Abbott Laboratories for a free 15 day trial of their Freestyle Libre 2 Plus sensor. There is no obligation to buy afterwards, so it is a genuine no strings offer. If you find it beneficial, you could pressure your GP to prescribe it, particularly as you have been having problems with nocturnal hypos as that is one of the criteria for prescribing I believe. Type 1s on the same insulin regime as you automatically qualify for it but unfortunately Type 2's have to make a case for themselves to be prescribed CGM and sometimes you have to be quite persistent but most of us would say CGM is a game changer. It has it's quirks and limitations so you still have to finger prick occasionally, but far less often and the extra data and high and low alarms it provides are incredibly useful. You can set the low alarm above 4 (which is what I was referring to) so that you can catch a hypo before it happens and prevent it by having a jelly baby of two to push your levels back up a bit.
I will see if I can post a link to the Freestyle Libre free trial...

 

[rebrascora]

Here we go ....

Sampling | Diabetes Care | Abbott

Claim your 15 day free sensor if you have diabetes and have not tried the FreeStyle Libre 2 plus sensor before

www.freestyle.abbott