Unhappy with insulin switches (Lantus+Novo to Levemir+Fiasp) - advice appreciated!

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StephanieMLW

StephanieMLW

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Relationship to Diabetes
Type 1
Hello 🙂 looking for any advice from people on switching insulins, and whether you think it's worth persevering.

I am almost at the end of my DAFNE course, and several of us participants have been switched onto new types of insulin by the course leaders. I was only diagnosed last September, and was quite happily on Lantus and Novorapid.

I was moved onto Levemir by the course leaders before DAFNE had even started, and was then told I'd be better on Fiasp due to its quick action, as I like to eat out quite regularly.

I feel like I've taken big steps backwards since switching insulins two weeks ago. Before, my time in range was great (90%+) and my average blood glucose was 7. My HbA1C was 43 when taken in April, which I was happy with as we're thinking about conceiving soon, so I am in the safe range to do so. My time in range since switching insulins is now in the low 70s and average blood glucose 8.8. I'm also concerned that my 'line' is no longer smooth, but very mountainous!

I'm really struggling to see the advantage of this shift right now, and feel a bit like I was pushed into it, when really my numbers were perfectly fine as they were. I'm getting barely any lows, but lots of highs and am taking way more correction doses. I've read lots of posts on the forum about people who have had similar experiences with Fiasp as me.

My current plan is to try and persevere with the Levemir and ensure it's the right level by doing proper basal testing (have tested my 6am-midday twice, and start my overnight testing tonight). But tbh I really want to bin the Fiasp and go back to my Novorapid, because I don't mind waiting the 20 minutes before food and had gotten into a good routine with it (I clean my kitchen while I'm waiting for it to work, it's never looked as spotless :rofl: )

Any advice or similar experiences, or things others would recommend I would try, much appreciated as always 🙂
 
If you’re not happy just switch back. It’s your diabetes, your choice which insulin you prefer.
 
The Levemir twice daily I agree with, and I'm certain it will prove much easier to adapt during the BG demands you'll get in pregnancy than a longer acting basal like Lantus or other long acting ones. (eg Abasaglar, Toujeo) Not so sure why the Fiasp at the same time though - I've always been much in favour of absolutely ONLY ever changing ONE thing at a time myself.
 
Changing both insulins at once is a "big ask" for anyone and doing so right before your DAFNE is really not fair in my mind because it will have impacted how much you are able to get out of the course. Insulins respond very differently in different people and I do wonder if HCPs realize just how traumatic changing insulin can be.
I use Levemir and Fiasp and I can make them both work for me but the transition to Fiasp from NR was very tough and I gave up after 3 months of tearing my hair out the first time I trialed it and went back to NR, and in my situation it was me who instigated the change and I was on Levemir from the start, so only one thing changed. It then took another 3 months of frustration the second time I trialed Fiasp, before I finally made the breakthrough.

I think you are probably very wise to stick with the Levemir but ask to go back to NR. You may be like me and in a few months time, when you get the hang of Levemir, you want to try Fiasp again or it may be that you are happy with NR for life, but your HCPs should definitely be listening to you and change you back if that is what you need at this time. Fiasp is not an easy or straightforward swap for many people so yes, definitely ask to go back to NR if you are struggling. (((HUGS)))
 
StephanieMLW said:
Hello 🙂 looking for any advice from people on switching insulins, and whether you think it's worth persevering.

I am almost at the end of my DAFNE course, and several of us participants have been switched onto new types of insulin by the course leaders. I was only diagnosed last September, and was quite happily on Lantus and Novorapid.

I was moved onto Levemir by the course leaders before DAFNE had even started, and was then told I'd be better on Fiasp due to its quick action, as I like to eat out quite regularly.

I feel like I've taken big steps backwards since switching insulins two weeks ago. Before, my time in range was great (90%+) and my average blood glucose was 7. My HbA1C was 43 when taken in April, which I was happy with as we're thinking about conceiving soon, so I am in the safe range to do so. My time in range since switching insulins is now in the low 70s and average blood glucose 8.8. I'm also concerned that my 'line' is no longer smooth, but very mountainous!

I'm really struggling to see the advantage of this shift right now, and feel a bit like I was pushed into it, when really my numbers were perfectly fine as they were. I'm getting barely any lows, but lots of highs and am taking way more correction doses. I've read lots of posts on the forum about people who have had similar experiences with Fiasp as me.

My current plan is to try and persevere with the Levemir and ensure it's the right level by doing proper basal testing (have tested my 6am-midday twice, and start my overnight testing tonight). But tbh I really want to bin the Fiasp and go back to my Novorapid, because I don't mind waiting the 20 minutes before food and had gotten into a good routine with it (I clean my kitchen while I'm waiting for it to work, it's never looked as spotless :rofl: )

Any advice or similar experiences, or things others would recommend I would try, much appreciated as always 🙂
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What you had worked before so change back to lantus & NR, it's your choice which insulin you choose to use not course leader.

Use fiasp myself & think it's far better than NR in preventing spikes, plus like it as it doesn't hang around as long as NR & find it's done by 3 hours, although NR is still good insulin.

Before moving to pump was using lantus, preferred it over levemir as only injected it once daily & dose was smaller than on levemir, so would choose lantus over levemir any day.
 
It’s only been 2 weeks, so you may want to persevere, but also trust your instincts.

Your thought of swapping back to NR, but keeping the flexibility of Levemir seems a good option.

When I swapped back from Fiasp to NR after I‘d used up the initial 3 vials the difference was night and day. I went from unpredictability, a lack of trust, and multiple corrections to 90% TIR in one day.
 
thanks all, this is really what I was hoping to hear from others!

@rebrascora I actually found some of your previous posts about Fiasp, and found them really helpful when I was initially thinking 'oh god why is this not working' 🙂

I feel that as I'm only 9 months in, I had just hit my stride with my previous insulins and was finally feeling like 'I know what I'm doing, this is just a normal part of life now', so this has been a bit like I've gone back to square one.

I have messaged my DAFNE course leader today to say I've really not enjoyed the past two weeks and that this has been too much change at once, so I'm going to persevere with the Levemir and swap back onto the Novorapid. It's a bit like being in a constant science experiment isn't it, and scientists only change one variable at a time!

At least if for any reason I am encouraged to switch to Fiasp again in future, I know to make sure I discuss any changes thoroughly with the team and not just accept 'this will be better'.

Appreciate all of the advice.
 
May take you a little while (with repeated basal tests) whilst you're fine tuning it, to get your Levemir doses and timinas spot on as you can. The two doses do not have to be equal, nor 12 hours apart forever either. It's fascinating plodding along this learning curve, on the assumption you're interested enough! Not everyone is though!
 
Hi. In general it appears that Levemir has more Pros than Lantus so stick with the new Levemir with a split dose (it doesn't last 24 hours as Novo says but more like 12 to 15 hours). Only you can decide between Fiasp and Novorapid but don't change both insulins at the same time.
 
Why the hell some HCPs have got hold of the idea that Levemir lasts 24 hrs, I have absolutely no idea whatever. It was not introduced in the first place claiming that it did. Always been intended to be taken twice a day.
 
I think myself stick with what you think works I think diabeaties is the strangest thing on the planet I'm 8 months in to it now and it's been a whirl wind experience from first day of the symptoms what was burry vision to going what I'd describe clinacly blind it was terrifying a kick up the backside to make changes I was diagnosed type 2 form called mody insulin nova rapid and tressiba 10 units tressiba and 4 nova rapid and metformin tablets going back to hospital other day they have dropped my units as I have more lows than highs but I have stopped injecting at the minute as I can not keep my sugars up always going low the best thing happend to me is the libra sensor due to working on cars alot makes finger pricking hard with high risks but as I've said from day one diabeatis is horrible as it don't come with set rules and a manual as every one is diffrent I think it's a case of working what's best for you and your body's way of reacting to it personally
 
Thank you @trophywench - that's interesting to hear. I was instructed to use the same dose as I was on with my Lantus with Levemir minus one unit, and take one dose before bed and one in the morning, at least 7 hours apart. This has been interesting, as my bed time isn't always consistent, so I wasn't entirely sure I was getting the right coverage. I was thinking of perhaps just doing doses at 10pm and 10am as opposed to last thing at night and first thing in the morning. I also seem to be needing more Levemir as a total dose than I did Lantus, and was actually told to start at a lower dose on Levemir. Basal testing is telling me to up this though!

@tony1990 we must have been diagnosed at around the same time. Was a bit of a whirlwind for me too - like many people on here, I found out because I got rushed into hospital in DKA. Glad to hear you are also finding the Libre a huge help, I do feel very lucky at least to be diagnosed at a time where we have so much technology to help us from day one.
 
trophywench said:
Why the hell some HCPs have got hold of the idea that Levemir lasts 24 hrs, I have absolutely no idea whatever. It was not introduced in the first place claiming that it did. Always been intended to be taken twice a day.
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There is an interesting three dimensional graph that has been shared a few times showing the duration time of Levemir dependent on something like dose and weight.
For some it can last 24 hours. It does not always need to be taken twice a day for everyone.
Although one of the benefits of it is that it can be.
 
The graph is based exactly on dose per kg of body weight. I've always had to increase the screen resolution on the computer from the moment I first consulted it.

ISTR it's also resident somewhere on this forum now but don't know where - @everydayupsanddowns and @Pattidevans - sorry to always have to ask these days, Patti & Mike!
 
@StephanieMLW it's a fantastic little thing since diagnosis I've spoke to so many people it's crazy how people find out I'm diffrent ways as you say technology has come a long way and it helps alot to make it easier
 
Sounds like an interesting graph! I did some reading yesterday on Levemir according to body weight, and have upped my dose slightly according to the minimum amount it's recommending per kg body weight. Don't want to speak too soon, but my patterns are actually looking a bit better already.
 
StephanieMLW said:
I was thinking of perhaps just doing doses at 10pm and 10am as opposed to last thing at night and first thing in the morning
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Hi I was told initially when I switched to Levemir to do it morning and night, but later advised that I doesn’t matter what time I did the background insulin but to be consistent with chosen times, and then do basal tests to find out what the correct split was for me.

I agree with others that your decision to stick with the Levemir should give you increased flexibility, being able to change day time dose without changing evening one.

I also tried FIASP for a while. It was quicker and worked better for meals out but soon became unpredictable, switched back.
 
trophywench said:
Why the hell some HCPs have got hold of the idea that Levemir lasts 24 hrs, I have absolutely no idea whatever. It was not introduced in the first place claiming that it did. Always been intended to be taken twice a day.
Click to expand...
My earlier DN showed me a big chart provided by Novo to her that indicated it lasts for 24hours; hyped marketing by Novo?
 
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