Levemir or Lantus?

[ngueld]

Hi guys, a little over a year ago I changed from regular NPH to Levemir and recently I've been having kind of poor control. I've started taking 2 shots of levemir instead of 1 when the whole point was only needing to take 1 shot of long acting insulin a day. I'm going to see my Endo in a few weeks and I wanna ask him about putting me on Lantus.

Just wondering if anyone else has tried both or what their thoughts on the 2 insulins are?

[RobiJo]

Hi guys, a little over a year ago I changed from regular NPH to Levemir and recently I've been having kind of poor control. I've started taking 2 shots of levemir instead of 1 when the whole point was only needing to take 1 shot of long acting insulin a day. I'm going to see my Endo in a few weeks and I wanna ask him about putting me on Lantus.

Just wondering if anyone else has tried both or what their thoughts on the 2 insulins are?

Many people have to do 2 shots of Lantus as well. I recently switched to Levemir as my backup (pumper), but only because I can get it in a pen form, which I find easier to carry. Plus, I think Lantus stings/burns when you inject it.

The purpose of two shots instead of one is to keep it as even as possible in the background. For many people it wears off before 24 hours.

[owlyn]

Levemir is not suggested for one dose in T1s. It is possible with Lantus, however. I have never felt a stinging or burning with Lantus. Try it and see what happens.

[RobiJo]

Levemir is not suggested for one dose in T1s. It is possible with Lantus, however. I have never felt a stinging or burning with Lantus. Try it and see what happens.

I'm curious where did you get this info? I know lots of T1's on one dose and two doses of both insulins.

[Gary_W]

I'm on Lantus which in me lasts around 22-24 hours. I don't split the dose. I take it at midnight each night and (if my BG is high at 9pm) I pop in a little more Apidra to cover the gap. I find it hard enough to do the Lantus at 12 on the dot each night and if I had to do a second dose I'd foul it up....

Most people seem to report Lantus as lasting a little longer than Levemir. Both are supposed to be peakless but everyone's milage varies as far as that goes and as others have said quite a few people split the Lantus dose to even out the peaks / give 24 hour coverage. Unless you try it you cannot say how long it will last in you.

Gary

[Alice]

My doctor was hesitant on splitting Lantus saying basically that Lantus had not been approved through trials for splitting...then, all of a sudden, she changed her tune. I think levemir has maybe been tested for splitting, I'm not sure.

The splitting came about really from the patient/doctor level, not the pharmaceutical recommendations. Something to think about...but splitting has been great for me. (Lantus split)

[ngueld]

Interesting, thanks guys. I started taking Levemir before it was actually "on the market". My endo told me to take one shot at night because it was supposed to last for 24 hrs. It worked at first but after about 6 months i noticed my sugars rising during the next day. I've started taking another shot in the morning and it does help..but not as much as I would like it to.

Whats the difference between taking NpH and Levemir or Lantus then? Is it just because they're supposed to last longer because it seems like it only lasts the same amount of time as my old NpH did.

It sucks...my sugars used to be so good but lately i'm having problems...and its not like i dont try! I need to figure something out though...maybe I'll still ask him about Lantus.

[Gary_W]

I never understood the difference either until I came on here...

The difference is supposed to be that Lantus / Levemir have a flat response. In other words, if you have your basal rate set correctly on one of these then your BG should neither rise nor fall in a 24 hour period in the absence of food, excercise or rapid insulin. On NPH because it has a peak there will most likely be a part of your day where your BG was going down because of the NPH. At other times when it isn't peaking, your BG will rise. If Lantus / Levemir are doing what they should then no rise or fall will happen.

My big problem with Lantus was that I had the dose wrong due to not understanding the above; from your last post it sounds like you don't currently understand it either. Basal rate fasting tests show that I now do have it right. IMO, if your basal is out you'll have a real hard job getting the rest of it right as you're always fighting the background insulin.

I personally think you should do some fasting basal tests to check you have your dose right before you go changing insulins. Doctors often don't seem to tell people how to do this, but it is such a simple thing to do and can yield huge improvements. Just search on this board if you're not sure how to do it.

This simple change was the most important factor in getting my HBA1c down to its current level and feeling pretty good most of the time (which I'd given up on even thinking possible).

Good luck

Gary

[RobiJo]

Whats the difference between taking NpH and Levemir or Lantus then? Is it just because they're supposed to last longer because it seems like it only lasts the same amount of time as my old NpH did.



NPH has a peak about 6-8 hours after taking it. It starts off slow and steady rises into a huge mountain, then tapers off. With Lantus and Levemir the "mountain" is not so high--closer (but not completely) to a even amount the entire duration. People on NPH generally have to have a meal or snack when its working at full power (6-8 hours after the shot)in order to "feed" the insulin that is now working. On the other 2, snacks are more optional and ideally you do not have to eat just to feed the insulin.

[Alice]

Agree on everything said...another way to look at Lantus/Levemir is that you don't have to feed them necessarily...if your basal is correct. Their purpose is to simply take care of the glucose that your liver is producing.

I have been through frustrating years of trying to correct bolus/Humalog...and really, it was the basal dose that was causing me to go low so much. Once I adjusted that...then covered the gaps of start up + taper off by splitting...then I have finally reached some level of "normal". But "normal" changes frequently for me...this is all about learning how to adjust the insulin to fit your changing body. You are always in a constant state of change.

By the way...I learned all this from forum's such as this...not from my very smart Endo's. They assume everyone knows this stuff right off the bat...

[owlyn]

I'm curious where did you get this info? I know lots of T1's on one dose and two doses of both insulins.

My endo and some other messages.

[ngueld]

I never understood the difference either until I came on here...

The difference is supposed to be that Lantus / Levemir have a flat response. In other words, if you have your basal rate set correctly on one of these then your BG should neither rise nor fall in a 24 hour period in the absence of food, excercise or rapid insulin. On NPH because it has a peak there will most likely be a part of your day where your BG was going down because of the NPH. At other times when it isn't peaking, your BG will rise. If Lantus / Levemir are doing what they should then no rise or fall will happen.

My big problem with Lantus was that I had the dose wrong due to not understanding the above; from your last post it sounds like you don't currently understand it either. Basal rate fasting tests show that I now do have it right. IMO, if your basal is out you'll have a real hard job getting the rest of it right as you're always fighting the background insulin.

I personally think you should do some fasting basal tests to check you have your dose right before you go changing insulins. Doctors often don't seem to tell people how to do this, but it is such a simple thing to do and can yield huge improvements. Just search on this board if you're not sure how to do it.

This simple change was the most important factor in getting my HBA1c down to its current level and feeling pretty good most of the time (which I'd given up on even thinking possible).

Good luck

Gary


wow thanks everyone! Now i get it...actually i remember my endo talking about the peaking times and such. I find that my levemir either peaks or starts kicking in at about 5 hours after injecting because thats when I notice my bg dropping.

I think you're right gary, I think my dosage is off. My body changes so freaking much its really been hard for me to get everything right. If i get it right for one week its totally different the next week. I'll try doing the fasting basal tests and see if it helps. Thanks!

[SharpTail]

I have been on Lantus for almost three years. I struggled a for quite a while with high BS through the night and a resulting high fasting BS in the morning. Eventually I figured out that the Lantus was only giving me 18-20 hours of coverage and it was running out in the early evening before I took the dosage around 11 PM. My doctor suggested splitting the dosage, so now I take a larger portion in the morning (10AM) and a smaller protion in the evening (10PM). This solved the problem immediately. My HbA1c went from 7.4 to 6.4 in a three month period. Also I find if I miss the timing of the shots by an hour or even more, it is quite forgiving since there is always some Lantus working.

[Alice]

Don't forget that Lantus takes approximately 4 hours to accelerate to it's level ground. (My endo brushes that off...which amazes me)

Add that to a few people who only get 20 hours...that's a lot less than a lot of doctors want to admit...they like to think we're getting 24 hours out of Lantus. So, some people may only be getting 16 + hours of Lantus at 100%. (Clear as mud? It took me years to figure that one out!)

I'm doing a mini-basal fast today. Just as a check. I'm definitely not getting the basal I need the first few hours of the day...that's when my larger dose starts to build. The first four hours I need either an extra bolus of Humalog (normally what I do, but then sometimes run low after breakfast) or I need to increase the 9 p.m. dose of Lantus...which I will probably do. But, I'm waiting to see what my basal looks like around noon. I don't want to increase the basal if I end up low at midnight...an exta unit or two of Humalog in the a.m. would be easier.

Just when I get it figured out...my body gets sneaky on me!

[ngueld]

Don't forget that Lantus takes approximately 4 hours to accelerate to it's level ground. (My endo brushes that off...which amazes me)

Add that to a few people who only get 20 hours...that's a lot less than a lot of doctors want to admit...they like to think we're getting 24 hours out of Lantus. So, some people may only be getting 16 + hours of Lantus at 100%. (Clear as mud? It took me years to figure that one out!)

I'm doing a mini-basal fast today. Just as a check. I'm definitely not getting the basal I need the first few hours of the day...that's when my larger dose starts to build. The first four hours I need either an extra bolus of Humalog (normally what I do, but then sometimes run low after breakfast) or I need to increase the 9 p.m. dose of Lantus...which I will probably do. But, I'm waiting to see what my basal looks like around noon. I don't want to increase the basal if I end up low at midnight...an exta unit or two of Humalog in the a.m. would be easier.

Just when I get it figured out...my body gets sneaky on me!


Yeah so true. For most of my diabetic years my pedietrician was always amazed because I had to take more long acting insulin at night than during the day. I've kept on that regime for almost 11 years, now I'm thinking I may have to take more during the day instead of at night because I find my sugars spiking throughout the day. Maybe a bigger bolus of levemir in the morning and less novorapid during the day will work? I find myself needing to take less and less levemir at night as well. I'm pretty active so I don't need a whole lot of insulin, I take about 8 units at night and 6 during the day, however I think thats going to change!

Again, thanks a lot for all the info!

[JasonJayhawk]

My endo has always suggested Levemir as twice-a-day (I started taking it before it was on the market). My personal experience has made me determine that Levemir definately wears out sooner than Lantus. On the rare occassion that I forget to take my smaller morning basal shot, I'll end up with glucose creeping up in the afternoon.

I see some other people saying that Levemir is "flatter" than Lantus, but I disagree... I think it has a bit more of a peak (in my body), which I use to my advantage at night.

I take about 70% of my basal at night and 30% in the morning. It took a few months to figure out what worked for me, and I still tweak it by a couple units at night if I've eaten a higher fat meal.

I end up having to pay $120 more per year for Levemir, but I do it because I feel like it works better, and the fact that Levemir doesn't sting me like acid (which it is). Levemir is closer to a neutral pH (Lantus is around a pH of 4.6). While some people have reported no sting with Lantus, it has always "burned" like a fire ant, despite attempts of warming it to body temperature before injecting. :mad:

[ultrafine]

I'm having the same problem as you right now...
The reason I switched from NPH to Levemir 6 months ago was to reduce the daily injections from twice a day to once a day....That one a day of Levemir didn't work for my BG at all, so now im back to 2 shots. What was the point of that?!
Theres absolutly NO point switching to Levemir!
PLUS...I pay around $140 per 5x3ml penfills....!!!! That's double the price of NPH! Once my last penfill is used up, i'm going back to NPH.

This is my own opinion...Levemir is a rip off!

Thanks for listening to my rant.

[BlueSky]

.... I take about 8 units at night and 6 during the day, ....
Bear in mind that the action duration of an insulin shot is dose dependent. The bigger the dose, the longer it lasts. The published duration figures correspond to the average dose size, which is probably 20-30 units. Most people on big doses can get by on one injection a day. I also have a small basal dose - 12 units. And I have to split it to get 24 hour coverage.