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Does Lantus or Levemir only work for the night for you?

How long does Lantus or Lev work for you at night?   24 members have voted

  1. 1. How long does Lantus or Lev work for you at night?

    • I find it lasts me 8-9 hours, ie no basal midmorning. (around 7u)
    • I find it lasts me 8-9 hours, ie no basal midmorning. (7u++)
    • and I find it lasts me 9 - 15 hours, ie early arvo. (around 7u)
    • and I find it lasts me 9 - 15 hours, ie early afternoon. (7u++)
    • I find it lasts me 15+ hours, ie early evening. (around 7u)
    • I find it lasts me 15+ hours, ie early evening. (7u++)

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29 posts in this topic

Bernstein has an "approximate action times of preferred insulins" in his book The complete diabetes solution, in which the action time for Levemir or Lantus, (put in the same category) is:

 

18 hours if injected in the morning; 8-9 hours if injected at bedtime (apparent).

 

This apparent phenomenon of Lantus or Levemir action being cut in half if at night, is quite surprising to me! I hadn't heard much about it out there, despite that if it was the case, people (especially insulin dependents) would be in a whole world of hot water with no basal action during the day. Yet have taken, and do know that people take their long acting at night, without that seeming to be a common occurrence. Maybe it shows just how little I know - educate me, please.

 

Now, he mentions in a general footnote, that variability is expected especially with dosages larger than 7 units. One has to assume, he doesn't mean THAT much variability, if it just deserves a small footnote. Maybe a couple of hours or so either way? Is the impression that gives me.

 

So I'm interested in the question, if you do or have taken Lev/Lantus at night, do you find it's completely gone by the morning? Or does it last somewhat longer? How long, do you think/is your guess?

 

I've included a very rough separation of doses in the answer, so we might get a feel if maybe those with doses nearer the stated 7u, find it common. I mean the dose at the time, a split dose is ok, as long as you ascertain how long that actual component of the split dose lasts.

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I take Lantus every night around 9 PM, my basal dose over time has ranged from 15u up to 26u and I have never conclusively observed it running out on me, even on nights when I've had no dinner and therefore no bolus insulin providing coverage during the evening hours.

 

As you can judge from A1c results, I take controlling and knowing what's going with my body, insulin and food intake seriously.

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Thanks Scratch. That was pretty similar to what I found on Lantus, in fact for me I found much more action in the afternoon, whether I took it morning or night. As my basal needs are not suited to an even basal release, I fluctuated a lot on Lantus and the end of the day was shaky, I'm not sure how long it lasted, maybe 20 hours.

 

Levemir seems to kick in at about 5 hours and peter off at about 15, whether I take it at night or in the morning or at midday.

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When I took Lantus once at night it would be gone by late afternoon/early evening the next day. It seemed to last about 18 hours. I never tried taking it only in the morning but I did end up splitting the dose, taking it both at night and the morning.

 

So for me, taking it at night only did not give me just 8-9 hours of coverage but it was closer to 18. It also gave me nasty lows overnight/early morning when I took the full dose once at night.

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Just a note, I just realised I must have ticked "public" when I was setting it up, I didn't mean that. I usually don't like answering public polls myself even if they are for something not that personal. I don't know, I feel like I'm giving my soul away or something, really silly. :)

 

Sorry about that, if it's an issue to you please let me know some way, maybe I can re-do the poll. I jus want an indication of general trends, as far as that goes in this really limited way.

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The short answer to your question is that the 16 units of Lantus I take at 10PM seems to last in my system until midafternoon the following day.

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I don't use Lantus anymore, but I used it for over two years. Lantus only lasts for me about 15 hours. I used 26u at 11:00 pm and it would last till about two pm the next day. I did better on Lantus than I did with NPH and R, but the pump gives me the ability to have multiple basal rates. My insulin needs always increase as the day goes on.

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I guess I have a kind of oddball regimen - 34 units of Levemir at 6pm. I am seriously considering splitting though (as referenced in another thread I started) but I am still a little unsure of the dosing and times to take it.

 

I seem to do fine until about 14-15 hours later (8 am-ish) when my BS starts to rise. I assumed it was DP but maybe my Levemir is just calling it quits? If that's the case, then my boluses are carrying me through the rest of the day pretty well! I can't imagine that Levemir works all day just for me..!

 

I haven't been able to/wanted to do that since I started the Levemir but I need to just take a day and not eat/bolus and see what happens.

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Doc put me on Lantus after heart surgery, BG was every where but never in the good range. Started at 20units, nothing, 30 units nothing, I now take 40units twice a day, 40 at 8:00pm, 40 more at 8:00am and I finally fell below 100 after 3 days of this regime. Getting kinda scary having to take this much insulin, when I needed none before.

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Marty, your BG will stabilize once your body recovers. I'm sure it does seem like a lot. But, remember that you are recuperating. Quad bypass is nothing for your body to sneeze at!

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I can understand that MCS! One thing to remember about insulin (and this is one reason I like to query rules and regulations) is that there are a number of reasons for needing a high dose. We directly blame things like insulin resistance, or a direct lack of insulin production, but consider this. I need 50u basal on the pump, or 50u on Lantus, to maintain control. On Levemir, I need 145u. Yet on Levemir, I feel less side effects, and I certainly don't seem to have change my weight storage mode in the month I've been using it.

 

My point: I seem to use different insulins in (what appears to us to be) an arbitrary way when it comes to dose and effectiveness, and we shouldn't draw definitive conclusions that a high exogenous dose is in fact, definitely the equivalent of a high dose of our own internal insulin, with attendant concerns. I am only one person, one example of insulin idiosyncracy: but I have seen enough exceptions to know, you should never assume you are part of the rule, that all is as it seems and conclusions are what they are stated to be, as far as the common beliefs and textbooks go. The forum, and pretty much any other diabetes forum I've seen, teaches me that the rule is we are almost all exceptions. Either that or people on DF are a very, very weird bunch.

 

It's great we have this tool to keep things in check, Marty. If we do our best with other things as much as possible, then we should rest assured we are on the right track, as much as we can.

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Lantus --- 24 hrs.

 

I know 'cause I do checks on how well basal dosage is working every 4-8 weeks. I do 12 to 24 hr checks (typically 18 hrs.) and I base any dosage changes based on several readings done over several weeks. I've had to adjust my basal once in the last 5 years. Had to up it by 3 units.

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Thanks, read a couple of articles about By pass surgery. Both state that your Islets take a time to reload for some unknown reason. Lantus ain't cheap at close to $100 bottle. So I am hoping things start to line up again so to speak.

 

 

 

 

I can understand that MCS! One thing to remember about insulin (and this is one reason I like to query rules and regulations) is that there are a number of reasons for needing a high dose. We directly blame things like insulin resistance, or a direct lack of insulin production, but consider this. I need 50u basal on the pump, or 50u on Lantus, to maintain control. On Levemir, I need 145u. Yet on Levemir, I feel less side effects, and I certainly don't seem to have change my weight storage mode in the month I've been using it.

 

My point: I seem to use different insulins in an arbitrary way when it comes to dose and effectiveness, and we shouldn't draw definitive conclusions that a high exogenous dose is in fact, definitely the equivalent of a high dose of our own internal insulin, with attendant concerns. I am only one person, one example of insulin idiosyncracy: but I have seen enough exceptions to know, you should never assume you are part of the rule, that all is as it seems and conclusions are what they are stated to be, as far as the common beliefs and textbooks go. The forum teaches me that the rule is we are almost all exceptions. Either that or people on DF are a very, very weird bunch.

 

It's great we have this tool to keep things in check, Marty. If we do our best with other things as much as possible, then we should rest assured we are on the right track, as much as we can.

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Seems to run the full 24 for me. 22 to 26 units depending on how active I am expecting to be. Taken once a day at roughly 9 PM.

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i split levemir with a slightly larger dose at night 6 and 4 u both at the 7:15ish time..so i guess my run is 12 hrs..can't say i have noticed any need to alter this except the occassional run of higher numbers be it stress or illness...hmmm

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28 units here and I can't say exactly how long it lasts but it's at least 24 hours. I've taken the shot at many different times of day and the action wasn't less than 24 hours at any time.

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I'm on 25 units of Lantus per day. Started 3 months ago with 15 units, then 20, then 22, then leveling out at 25. I started taking my Lantus at 10PM and it's slowly worked itself down to 7PM over the months. I accredit that to anticipation and the desire to "get it over with" so I can watch primetime television without it looming over my head.

 

If I take my injection at 7PM and it lasts less than 24 hours then it's not doing its job after my lunch and dinner. How does one test to see if their basil insulin lasts 24 hours?

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I take 54 units of Levemir at around 9:45 at night and find that it only lasts me until maybe 1 or 2 pm.

 

I can tell the Levemir has stopped because my BG is always running a tad higher in the afternoons even when my lunch consists of only lettuce, cucumber, some grilled chicken and blue cheese dressing.

 

My doctor suggested splitting the dose since I take more than 40 units, but I'm terrified to do that for fear that if I take LESS at night, then my dreaded Dawn Phenomenon will rear it's ugly head.....:mad:

 

I also found that when I switched from Lantus to Levemir, I needed a higher dose - I only needed 38 units of Lantus, with the Levemir I need 54 units.

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Subby said this: My point: I seem to use different insulins in (what appears to us to be) an arbitrary way when it comes to dose and effectiveness, and we shouldn't draw definitive conclusions that a high exogenous dose is in fact, definitely the equivalent of a high dose of our own internal insulin, with attendant concerns.

 

I have the perfect case in point - I take Levemir, and I also have horrible DP. For a while I tried increasing my Levemir 1-2 units ever 2-3 nights, higher and higher I went, trying to reduce my fasting numbers. I was up as far as 25u at night with NO difference in my fasting. (My normal is 5u). I do also have to take a small amount (3u) upon waking as the Levemir seems to peter out by then, but if I take 4u at morning, I go hypo EVERY night around 10-11pm... so I'm very sensative at 3u, but the 25u at night.. did nothing. BTW, I stopped going higher, just didn't seem worth it, and I take 5U of NPH now at midnight. This brought my fasting numbers down 25% or so!

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If I take my injection at 7PM and it lasts less than 24 hours then it's not doing its job after my lunch and dinner. How does one test to see if their basil insulin lasts 24 hours?

 

Apart from basic observation any old how, (which sure can be useful, or occasionally misleading) the only way to do this for sure, is what is termed "basal test". Essentially you pick a time period, and fast through that period, taking tests. You have stripped back the effect of food and bolus, so your basal effectiveness is revealed.

 

You could do this somewhat casually, like skip a lunch (and the bolus) test every hour or so over that time and over the next few hours, and then draw a conclusion as to if your basal is holding your BG steady or not. (I like to only fast for maybe 4 or 5 hours, after 4 hours since the last meal/bolus is up.)

 

There is also a worked protocol to do so, to be sure you are maximising the effect of your short fast, and not having other influences get in the way. The books by John Walsh or Gary Sheiner have basal testing explained in them. For now, two links: one is for the rules of basal testing, this applies to the pump but you can just ignore the bits about basal rates and adjustment, but can use the basic mechanics it suggests in order to successfully test. The other is an article on basal testing for injections.

 

Integrated Diabetes Services - Diabetes Management

 

Basal Testing for MDI - Diabetes Daily

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I take 54 units of Levemir at around 9:45 at night and find that it only lasts me until maybe 1 or 2 pm.

 

My doctor suggested splitting the dose since I take more than 40 units, but I'm terrified to do that for fear that if I take LESS at night, then my dreaded Dawn Phenomenon will rear it's ugly head.....:mad:

 

One thought here: If it runs out early, then you have an overall deficit of basal insulin. If it covers only 15 hours, then you would likely need more overall if it was being distributed better. At a guess, you might need a third more!

 

There is an issue with the word "split" - that infers take one thing and split it in half. Maybe that's a reasonable safe starting point. But if you making up a deficit, chances are the two halves will end up being more than the single dose was, in finding an effective dosage. You might end up needing a night dose getting close to what you take at the moment! And it would be the right amount to hopefully do basically what you get at the moment (but with the influence of the other dose to deal with).

 

As an example, I use 145u of Levemir in 3 shots to get coverage. Yet if I take more than 90u at any one time I will have bad hypos. Splitting for me at least, involves being able to take more insulin, than I could ever take in one shot. So I can take the right amount to stay in control through the 24 hours.

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Hi there Subby...Wasn't quite sure how to respond to your poll, but I split Levemir into 3 doses at 8-hour intervals. 10u @ 10:16, 6.5 u @ 6:15 a.m. and 3 u @ 2:15. Two injections just didn't cover the afternoon-early evening time period.

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Thanks Jen! That's good info, and you were the inspiration for my own 3 way split, which works well.

 

Another way to ask the poll question perhaps, is - does your night time dosage, only last half as long as your daytime dosage? Or is it pretty similar length of action whether you inject before bed or during the day?

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Recently when I was on MDI, I took one shot before bedtime of Lantus. I was told that it provided a steady basal with no peak. I never really noticed a huge difference whether I took it or not (I almost always remembered).

 

I did notice that it REALLY STUNG when I took shots of that. I never noticed anything like that before with other insulins. I think I read that it is very acidic and that is why that happens. Not really sure.

 

Next time I go back on MDI, I want to go back to my old Regular and NPH. I tested before a meal, counted carbs, took a shot and by the time I tested at the next mealtime, I was generally fine.

 

Now I am on the Omnipod and testing practically every 2 hours and counting grams of carbohydrates.

 

So does Lantus peak or does it stay steady like the marketing pitch says? (Yes/No?).

 

Thanks.

Jimbo205

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So does Lantus peak or does it stay steady like the marketing pitch says? (Yes/No?).

 

If you look at the Lantus site, the marketing pitch says things like: there is "no pronounced peak" and compares roughly to the likes of NPH (which has a clear, established peak). It's fuzzy language. Also says things like "the only insulin approved for 1 hour in the 24 hours" (this doesn't mean exactly it's going to WORK for the 24 hours for you, eh? Just that it is officially approved for your doc to recommend that...)

 

What I am getting at, is that they get around the fuzzy nature of the length and peak of Lantus, by some careful verbage. My experience for me, is that does Lantus peaks less than NPH and Levemir. I don't find a reason to suspect the product descriptions and marketing hype are hiding a big peak in there. You might like to take a look at this graph too, a test of different insulin actions. Lantus is Glargine, Levemir is Detemir. Action of lantus image

 

Does this thoroughly establish the peaks of the insulins as applies for everyone? I don't think so, as with most studies etc there are limited parameters, (such as how much insulin people were taking, while we know it does vary a lot) but it's another source to consider. There are more details about that test, around.

 

If you are really interested in the peak that people find with Lantus or different insulins, you could post a poll about it :)

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