Toujeo insulin

[jan@glandart]

Switched over to Toujeo from Levermer, 3 months ago. Having difficulty to balance blood sugars at night. Am going lower before bedtime so topping up on sugar. Confidence to be able to sleep safely has been affected. I am now having this injection at tea time - 5pm... anyone else having the same problem ??

 

[everydayupsanddowns]

Welcome to the forum @jan@glandart

Sorry to hear you’ve been having difficulties after the switch away from Levemir (lots of members here are gutted that it is being discontinued).

Were you taking your Levemir once or twice a day? And when did you take it?

Toujeo has a much longer / flatter profile, and each dose sort of ‘tops up’ the last. So it’s less important that you take it at exactly the same time each day, but you may need to adjust your dose. Have you been going low overnight while sleeping? Do you usually adjust your own doses through the year?

The warmer summer weather may also be making you more sensitive to insulin. Quite a few members have to adjust their doses downwards in the warmer months, and up again over the Autumn/Winter.

 

[jan@glandart]

Not going low as topping up before bed... have changed the time and am doing the Toujeo at 5pm. Doses for both insulins are always adjusted according to pre eating blood sugar readings. Been doing this successfully for over 63 years. Now have a Dexcom G6 which has helped keep blood sugars far more stable and helps avoid the really low/high readings... it would be good to just have more information as the diabetic clinic /doctor had very little advice as its a new insulin.

 

[Inka]

If the Toujeo isn’t suiting you, then there are other basal insulins you could try @jan@glandart eg Tresiba (once a day) or Hypurin Isophane or Humulin i (both twice a day basals). If you were taking the Levemir twice a day, then one of those last two insulins might suit you better. Don’t be afraid to push for the insulin that you want. I’ve had to do that a number of times.

 

[rebrascora]

Toujeo is a triple strength Glargine insulin but it seems to last longer (up to 36hrs) than normal strength glargine insulins like Lantus (up to 24 hours) typically would.To me it is more suited to people with Type 2 diabetes who are more insulin resistant and it is a bit of a numb tool (sledgehammer to crack a walnut scenario) for many Type 1s I think, especially if you were using quite small doses of Levemir. I would definitely want a half unit pen with Toujeo to be able to adjust it more finely but even then it is still likely to be fairly inflexible and heavy handed in it's action.

I have discussed my Levemir replacement with my consultant and he agrees with me that one of the older NPH insulins like Hypurin or Humulin i as @Inka has mentioned would be a best fit for me, because I need to be able to adjust my basal doses to prevent nocturnal hypos after exercise etc. My initial choice was Toujeo, Lantus or Tresiba and of those 3, the Lantus would be the most flexible but I really feel that Humulin i would be a much better equivalent to Levemir which I love and my consultant has agreed that I can stay on Levemir until stocks run out next year.

If we know more about your previous Levemir doses, then we could perhaps advise you better on which other basal insulins to try but for me Toujeo would be the least best option to replace Levemir because it is so "numb" to adjustment and it isn't right that people have to load up on carbs before bed in order to prevent hypos. In this day and age we should be able to adjust the medication but if it doesn't allow that, then it is the wrong insulin.

 

[littlevoice359]

After diagnosis in 2018 I was prescribed Lantus. But I found that its activity profile (20hrs in my experience) was making it difficult to stay in range, especially late in the evening. Eventually my consultant switched me to Toujeo.

I quickly realised it was not like-for-like in terms of doses. But, after some experimentation I found a dosage that worked (I had been taking 18 units of Lantus but I only needed 15 units of Toujeo).

Personally I have found the switch to Toujeo to have been a big improvement, but clearly my experience is not universal…

 

[Lucyr]

I would definitely want a half unit pen with Toujeo to be able to adjust it more finely

I thought toujeo only came in prefilled pens, because it’s more concentrated so isn’t safe to give cartridges. I might have missed something though, are you saying there’s a u100 version of toujeo available in cartridges?

 

[rebrascora]

I thought toujeo only came in prefilled pens, because it’s more concentrated so isn’t safe to give cartridges. I might have missed something though, are you saying there’s a u100 version of toujeo available in cartridges?

No, I have no idea if there is a half unit version. You are probably right that it only comes in prefilled pens but if that was the only basal insulin I had access to, I would want a half unit pen.
I don't really understand why it is routinely prescribed to Type1s who don't need high doses of basal insulin. Just seems an odd decision to me, especially to replace Levemir.

 

[Lucyr]

You are probably right that it only comes in prefilled pens but if that was the only basal insulin I had access to, I would want a half unit pen.

Putting a cartridge of u300 insulin in a half unit pen would mean every time you thought you injected 0.5u that you actually injected 1.5u though

 

[Lisa65]

I thought toujeo only came in prefilled pens, because it’s more concentrated so isn’t safe to give cartridges. I might have missed something though, are you saying there’s a u100 version of toujeo available in cartridges?

Not in the UK there isn't. I guess there's too much worry of people putting it in a normal pen and injecting three times too much. For T2 especially who might be on large amounts of basal, that could be catastrophic.