Lantus to Levimer

Dear All,

I have recently changed my BI from Lantus (18 units at 19:00) to Levimer (initially as advised by consultant split at 8 units am and 10 units pm) to help with BI exercise adjustments.

Since the change I have really struggled and am getting frustrated with it. I assumed that the 18 units equivalent of my lantus would work in a fairly straightforward way - but that doesn’t seem to be the case as most mornings I have woken with blood sugars of about 15. I didn’t have an issue with highs when on lantus, or experience the dawn phenomenon.

I started increasing the levimer one unit at a time and pushing back the time I take it from 19:00, to 21:00 - but there was no change. I read a few other forums which noted that Lantus is more potent than Levimer and people reported needing 30% more Levimer compared to Lantus doses. Has anyone else experienced this? This reassured me as I was getting concerned over the increase in BI units.

Last nights fasting results (meal at 18:30; no further carbs or QA; injected 15 units Levimer at 23:00):

18:30 BG 5.9 (before meal)
20:30 BG 4.7
22:30 BG 4.4
01:00 BG 14.7
03:00 BG 12.5
05:00 BG 13.7
07:00 BG 13.2

Any advice much appreciated.
Gemma

Hi,

I am not an HCP but would like to comment......

It would seem that some time between 22:30 and 1;00 your AM dose of 8 Levemir is running out, so you may want to consider taking your evening BI dose at about 21:00pm, which you mentioned you did do. You should try to get your BI in at the same time every night.....

Overnight it looks like you have a wee dip 2:00-3:00 but nothing significant, in fact your blood sugar is held quite steady through the night. This means that your current dose of BI overnight is correct, however the timing needs to be right because your AM dose is running out.

So I would make sure you get your PM dose in at 21:00pm, test for a few days through the night and see what happens.....hopefully you should start waking up on target.....

You mentioned the Dawn Phenomenon. Your results don't suggest your experiencing it, not at least between the usual time of 3 - 7 am.

When have you observed the Dawn Phenomenon?

Thanks for your reply novorapidboi26. I am going to try your suggestion of taking BI at 21:00. Have given it a go tonight, although I have been to a zulus class so introduced another complication tonight!!

I mentioned dawn phenomena, but maybe confused things. I meant that I hadnt seemed to get it on lantus so didn't need to think about it with levier. As you said it looks like I am ok between 3-7am :-) so that's one good thing.

Thanks for the advice
Gemma

No problem.

I look forward to seeing your results.......

I'm also not a HCP but I switched about a year ago from Levimer to Lantus and I did find I needed less Lantus compared to Levimer so that fact you need to take more units of Levimer seems normal from my experience.

The reason I changed was that in addition to being more potent Lantus also tends to give a better 24 hour cycle. What I was finding with Levimer was that after about 20 hours it stopped working. The way to correct for that is to split the dose so you take 2 shots like you are but as Novorapidboi26 points out you need to take it the exact same time every day with as close to a 12 hour split as you can mange. I didn't like the idea of putting an extra shot in my daily routine so when they said Lantus offered a more balanced long lasting profile the switch made sense.

While they do both do the same basic task they are different substances and don't necessarily do it in the same way. One of the reasons that some people will take one over the other is that some people experience a burning sensation as they inject Lantus, I can't say I've experienced that myself but it could be that where they do work in slightly different ways that although one created no dawn phenomena for you it doesn't mean the other won't.

Out of curiosity what was your reason for switching? Granted we are all different but I've found Lantus to be a superior insulin, just a shame the company who make it can't design a quality injection system to save their lives.

Again - not a HCP, but I like my Lantus, but when it wasn't lasting the 24hours it claims, I just split it, I know HCP's don't advise it, but it now works really well for me. I was on 28 units at 2100hours, then split it to 14 units at 0900 and 2100, then, due to weight loss I was giving 10 at 0900 and 2100, but found that looking at the figures my BG was dropping towards the evening, so I am now on 9 at 0900 and 10 at 2100.

Lantus can be split - and if it works for you, then you should put your foot down and insist on Lantus - don't be bullied into treatment you don't like, can't get on with - you are in charge, not the doctors.

why on earth do they advise not splitting Lantus? Without going into all the theory, so long as your total dose isn't greater than you would have taken on a single shot the morning and evening profiles will just add together for the overlap period so I can't see any reason why it would cause a problem.

Just because the manufacturer market it as a one shot in 24 hours product it doesn't mean you can't portion it out if you want to.

what I mean by profile is they way in which the insulin works in your body, these are the profiles of Lantus & Levimer over a 24 hour period accoring to one diabeties website





The bottom of each graph is the time in hours and the height the line goes to shows you how hard the insulin is working at that time. As you can see the Lantus tends to peak after about 10-12 hours (which is why it's general recommended you split your dose into 2 shots 12 hours apart) while Lantus is a more constant effect.

Basically Levemir is much more effective and flexible than Lantus because any changes that you make to the dose of it can be witnessed the next day, and so is ideal for folk who exercise etc as they can cut there Levemir dose and it will accommodate the extra activity.......

So for example, someone could be going out hill walking all day, they could then drop their AM BI dose to account for this so they don't go low.....on Lantus you would not see the effect from the cut in dose till days later.........

Its also good for people who like a drink..........its wise to drop your BI dose on the night of drinking and on the next day for some, like me.........

Levemir is much more flexible that Lantus that way and so that's why the 'manufacturers' suggest not to split it.....

But as SimonC says, everyone needs something different when it comes to insulin and if Lantus works for you better whether its split or not you should use it.......

The DAFNE handbook version of onset, peak and duration of the insulins is quite useful also....................found HERE - [Only Graduates can view currently........ ]

Thanks for replies.

I switched from Lantus to Levimer for reasons mentioned in last post. Although the steady 24hr action of the Lantus was good for me, I got so frustrated that I couldn't make changes in my BI for things like exercise (as on lantus the effect of changing dose isn't immediate).

So thought id give it a go, as wasn't too worried about an extra injection! And hoping to try for a baby soon, So thought the more flexibity I have the better.

Last night went well so fingers crossed I have another night of good bloods!

A few says after changing things about and I am much happier. Thanks for the advice novorapidboi26. I have injected my evening levimer at 21:00 for the last few days and here are the results:

9/4/13 - 10/4/13

22:30 BG 6.1
01:00 BG 3.4 (likley due to zumba class in earlier in evening)
03:00 BG 6.1
07:30 BG 9.9
08:15 BG 10.3

10/4/13 - 11/4/13

20:00 BG 6.9
21:00 BG 6.3
20:25 BG 8.4
00:00 BG 7.2
03:00 BG 6.4
05:00 BG 6.9
07:10 BG 8.3

11/4/13 - 12/4/13

20:12 BG 7.3
22:16 BG 9.7 (gave up the 1,3 and 5am tests and reduced BI to 14 as had been to zumba again in evening)
07:00 BG 7.7
08:22 BG 10.3

so all in all your advice has really helped me wake up at 7am with a good number. I dont usually eat breakfast till about 8, by which time it has usually gone up to nearly 10. Not sure whether to move my BI a bit later to maybe 22:00 - but then don't want to be in the same situation as I was to begin with, where I was taking it too late (and the morning does was running out!)

thanks again