Do I stay on Lantus or move over to Levemir?

[Gary_W]

Hi,

Since gaining educational insight on how to manage type 1, I've been doing really well. Instrumental to this was reducing my Lantus dose from its previous 35u down to 20u.

In the 2 months since doing this, I've lost 18lbs in weight and felt a whole bunch better. As I have made other changes to my diet (although not vast ones) I cannot really say how much of the weight loss is due to the reduction of Lantus which, I am told, can cause weight gain.

I am also a whole lot more cheerful nowadays. I have read the various threads on here whereby Lantus has been linked to depression. Whilst I wouldn't claim to have been depressed, I do feel much brighter now. I did get terribly unfocussed and muddled at times. Again, I cannot be sure whether this is because of reduced Lantus dose or because my control is way better than it was.

Today, I was offered the chance to go on Levemir. In its favour is that it allegedly does not cause weight gain, makes you feel less hungry but otherwise works the same as Lantus. I was told that Levemir lasts about 20 hours whereas Lantus goes for about 20.5, so no reason to split it.

Whilst the thought of further weight loss and even better mental state appeal, I have finally got myself keeping pretty well on the Lantus, and I'm a great fan of not fixing what isn't broken. However, if it is the fact that less Lantus has suited, no Lantus at all may be of benefit.

Your opinions please; should I stay or should I go?

Gary

[LancetChick]

Those I know of who have made the switch, and have better blood sugars because of it, had real problems with Lantus. The two biggest complaints seem to be uneven absorption and unhelpful peaking, which is probably caused by the absorption problems. Lantus works very well for me, on the other hand, so I have no interest in switching to Levemir (although I am curious to see how it would work!).

[BriOnH]

When I find everything in my life is running good, and I try to push it and make it that much better by adjusting meds, it usually causes the exact opposite of what I was trying to acheive. Then again no risk no reward :) . If you are doing well my opinion is to stick with what is working well for you.

[JasonJayhawk]

Hi Gary,

I was in your place a little less than 3 years ago.

Your reduction in insulin could simply mean an adjustment to your initial prescription amount. As long as your glucose range is "normal", you're doing well.

First off, as a type 1, please disregard warnings about insulin causing weight gain. Insulin allows glucose into the cells for the production of body fat. Thus, its job is indirectly related to fat storage. Of course insulin will cause you to gain weight; that's a good thing. Insulin SHOULD cause weight gain, or else, it's not insulin! I'll touch on this later...

It's common to lose weight before your Type 1 dx. Your endo will probably be concerned if you lose much weight upon your start of treatment. If you have been keeping glucose levels within normal range, then good. (Personally, I continued to lose weight upon my initial diagnosis, but that was because I hadn't yet been dx'ed at the time with hyperthyroidism).

Back to the weight gain deal. As I said, don't look at insulin as being a cause of weight gain. Food is the cause of weight gain. If you eat a lot, you need more insulin, and people end up attributing the weight gain to insulin. If you're a teenager with an eating disorder, you would simply not take your insulin to avoid allowing your body to make use of the glucose (energy) in your blood. If you are losing weight, it's likely due to not eating enough food, or not taking enough insulin.

Lantus has probably been linked to depression simply because diabetes is linked to depression. I wouldn't point at the medicaiton.

Now, as far as your points to Levemir:

-- The weight gain claims are more aimed for Type 2's.
-- Here's where the "weight gain" claims come from. Every time you go hypoglycemic, you're gaining weight because you ended up taking more insulin than you planned.
-- Thus, the manufacturers will claim they cause "less weight gain" if their study subjects had fewer hypoglycemic events, and thus, less need to "eat up" to their insulin.

A quick comparision of Lantus and Levemir might cause you to discover:

1) Levemir doesn't burn like Lantus (pH difference).
2) Like you were told, Levemir's half-life seems to be smaller than Lantus; hence, don't expect to get away with just 1 injection a day. Of course, Lantus gives better control with 2 injections a day, too.
3) Most people in the USA will find Levemir to be more expensive of a co-pay, because it is newer.

Like you said -- if you've just started Lantus, and it's working, there's no need to change. Lantus worked for me, but I hated the sting of it. I'm paying $120 extra a year to avoid the sting. It works for me. I also think that Levemir has a bit more of a "peak" -- which I use to my advantage, in this case, because that little extra action is just what I need while digesting whatever higher protein/fat food items I have left in me from dinner.

If you're still having trouble with glucose levels going all over the place, switching to something new won't exactly help you.

If you do switch, you'll hear all sorts of advice regarding the ratio of Levemir to Lantus. Many people, to be safe, will start out with a 1:1 between Levemir and Lantus. According to my endocrinologist, who teaches other doctors how to use Levemir (and hence, is employed by Novo Nordisk), you'll actually need more Levemir than what you need for Lantus.

By the way, if one were to look at the study of Levemir causing less weight gain, you'll find that the subjects took small basal doses. It's been found that the larger the dose, the more dramatic the "peak" that Levemir has about 4-10 hours after taking it.

Sure, you've seen that Lantus and Levemir are "peakless," but this is more marketing lingo. If you compare them with NPH, then you'd agree that they're peakless. But they really aren't flat-line.

If you aren't bothered by any burning sensation to change (literally), I'd stick with Lantus.

Disclaimer: I use Levemir.

[liz32]

Iswitched from lantus to levemir due to sting (always) and crazy hunger. Now, no sting and no crazy hunger. The action is the same, at least for me and I'm happy I made the change. Hope you can figure out what's best for you 'cuase that's the bottom line.
Liz:)

[DeusXM]

Lantus has probably been linked to depression simply because diabetes is linked to depression. I wouldn't point at the medicaiton.

Query this. Lantus has been linked to depression because a significant number of people have since developed depression fairly soon after going onto Lantus. I'm one of them, in case you're not aware. In fact I'm the one who brought the whole issue to light on this forum about 3 years ago. I could also put you in touch with my nurse at my old clinic, who put me straight back onto Insulatard because I was by no means the first in her clinic to go down that road.

Lantus is an excellent insulin for BG control but it does have side-effects in a very small minority of people.

Having said that...

..if your current regime is working, I see no real need for you to change it. Your better BGs will almost certainly be elevating your mood. Your weight loss will also be helping make you feel better.

Remember, Levemir is also not without its side-effects. Firstly, I'd be surprised if you could get away with just one injection of it a day. Everyone at my clinic on Levemir is on two jabs because despite the manufacturer's claims, it simply doesn't last as long as it should. Secondly, be aware that for some people, Levemir simply doesn't work. Again, I'm an example. I was one of the first people in the UK to go onto Levemir after its NICE approval (I've still got all the pharmaceutical pre-release documents, animations and articles on a CD-ROM if you really want a copy) and they discovered that for some people, Levemir seems to just die in your system without doing anything. I was taking triple my basal dose in Levemir and still having to bolus every two hours just to get my BG in the 11s and 12s. Again, it turns out that my chance of being one a million happens with the bad stuff and never with the lottery. I'm not saying that this will happen to you (in fact I'm saying it almost certainly won't) but if you've got a system that works and makes you feel pretty good, you have to ask yourself what are the benefits in changing to a system that has a very, very small chance of making things worse and no real tangible way of making things better.

If I really had the choice, I'd be on Levemir, but that's purely because the Levemir pen is much better. And I don't think that's a good reason to change insulin.

[Erin]

It may be possible that you feel less depressed and are losing weight with less lantus because you were taking too much initially.

Having lots of low blood sugars due to too high of a basil dose (which often result in lots of high blood sugars because of overshooting) can wreck havoc with your mental state and your waistline. I often loose control of my emotions during a low BG, or at least experience my emotions differently, and eating all that food to correct the lows adds pounds. You were probably feeding your insulin for quite some time.

That said, if you feel depressed, like really and truly depressed, and you think it might be linked to the Lantus, by all means try out Levimir. But, from what you said, that doesn't seem to be the case.

[Gary_W]

Thanks for all of the replies everyone; lots of food for thought there.

I think what I'll do is go see the GP with the letter the hospital gave me which says 'stop glargine, start levemir'. I'll tell her that currently I'm on a very positive improvement curve and don't want to break what is working well.

However, If she keeps hold of the letter I'll be able to change without any hassle if it feels right a few months / years down the road.

The other thing that is interesting is that the hospital nurse actually suggested Levemir in response to my question 'Is there a Lantus pen which is any good?'. Apparently there isn't. I currently use a Lilly pen to inject the Lantus which caused her great distress, and I know for a fact when that breaks down they won't give me another... Hence her suggestion to switch insulins!

Gary

[NoraWI]

Hi,

I was told that Levemir lasts about 20 hours whereas Lantus goes for about 20.5, so no reason to split it.



How long Levemir lasts is dose dependent. The larger the dose, the longer it lasts. I tried Levemir when it first became available in the U.S. last spring and found that at my dose it only lasted some 4 to 6 hours and would require several shots daily more than Lantus. I went back to using Lantus in a split dose. Yes, the action of Levemir is more even. At your dose it may just work well for you. Nothing lost if you give it a test. Good luck.

[JasonJayhawk]

How long Levemir lasts is dose dependent.

I just want to add on to what Nora said (just in case anyone else is reading in on the thread). The "peakless peak" (e.g., no insulin is peakless in its activity) is actually greater for higher doses of Levemir.

Said in another way: The "peak" that hits with Levemir is more intense (for many people) when taking larger doses.

Thus, don't think you'll get longer coverage simply by increasing yhour dose -- you'll also have a larger blood glucose drop happen later in the day (as can be expected). Thus, one must optimize between duration and insulin activity. Many people get to this optimization better by taking two doses of Levemir.

Personally, I prefer the activity peak that Levemir gives me at night -- but it's only after finding out what worked for me (it took several weeks of experimentation, just as any other self-adjusted medication).

[bon]

Hi Gary and others,
I am so curious about your reduction in Lantus. I used to take about 10 units of lantus, which was perfect. However, I have since had to increase it to 18 or 19 (10 at night and 8/9 in the morning) and, although, some days it is perfect, some it is not. I find I have some inexplicable high readings-- even though I may be eating the same thing as the day before, and some days I need more humalog per carbs. I am often sweaty and cranky and can't, no matter how little I eat, seem to lose an ounce. Part of me wants to try going back down to my original 10 units, thinking that I was feeling much better when I took less lantus, but part of me is afraid that doing so will not be enough. How did you do it when you decreased?

[JasonJayhawk]

Hi bon,

When making changes, do so slowly. You don't have to make such drastic changes.

When you modify your doses, one trick is to log everything you do. This way, you can most logically decide if your change has caused your body's response to go with the flow.

Otherwise, it's easy to just think, "Maybe I was doing worse last week...", easily forgetting that you may have eaten more ice cream, or had less exercise.

Changes should be moderate and scientific. You might decide to keep with 10 units at night, and add 5 units in the morning, and then adjust accordingly.

For anyone else reading... Don't leave it up to the doctor to titrate your insulin -- that's for you!

[Gary_W]

Hi Bon,

What Jason is saying makes sense. The way I did it was not at all scientific, and blind luck found me on the right dose.

I used to inject 35 units of Lantus in one go. That figure was got to simply to get my morning BG down to a reasonable level. But with this much, I was having to go to bed high so as not to wake up low. Which was madness...

I read on here that most peoples basal insulin works out to between 25 and 50% of their overall total. I only used to put in about another 20 or so units of Novorapid throughout the day, so I had my percentages back to front. What kind of amounts of rapid are you using?

I decided to drop my Lantus to 20 units overnight. Probably irresponsible, certainly not scientific, and very unlike me. But it worked. I have upped the Novorapid, so in all I tend to be on about 30 units of that per day.

Since the weight has started to come off, I'm needing a little less of the rapid; my morning ratio was 1 unit to 5 grams but I've had to throttle that back a little.

I must say that the Ultrasmart meter that lets you enter the carbs and insulin was very helpful in working out where things were at. As was testing at 2 and 3 hours post meal to see how I was doing.

I nearly always have an apple or orange as part of a meal now, but what I tend to do is count it in the carbs for a meal and inject for it but not eat it until the 2 hour point. I find that hitting the meal that little bit harder tends to mean that I'm back down at a 5 or 6 at the two hour point when a little insulin is still left. Eating the fruit at that point takes up the tail :)

I really don't know what to say for your current situation other than I feel for you; I have worn out that particular t-shirt and hope you feel better soon.