- advertisement -

Should I switch to Lantus?

Discussion in 'Parents of Children with Type 1' started by Carmen, Feb 14, 2008.

  1. Carmen

    Carmen Approved members

    Joined:
    Jan 20, 2008
    Messages:
    68
    I have this bedtime Levemir problem again! As much as I love this insulin, I think that maybe it is time to switch to Lantus because I just cannot get good numbers at night.
    Stephane takes 1.5u at 8 am and 1.5u at 5.30 pm. By morning his numbers are huge! If I increase his dose, he goes low at 3 am. The endo suggested that I lower the dinner rapid acting and let him run a bit high and wait for the basal to bring him down until morning. Now, I am not at all OK with this scenario. I firmly believe that the basal should keep him steady throughout the night.
    Anyone else having this problem?
    I must say that I reluctanlty let go of Levemir. It is very stable and predictable during the day, but what else can I do?

    Your input is much appreciated.
     
  2. Mama2H

    Mama2H Approved members

    Joined:
    Oct 19, 2006
    Messages:
    4,236
    Could you try to give the lev shot later? Could it be possible that it is wearing off by morning? We never did levimer but I thought it had a 12 hour window and if you are giving it at 5:30 I would think it would be gone by 5:30 am.
     
  3. Carmen

    Carmen Approved members

    Joined:
    Jan 20, 2008
    Messages:
    68
    I tried this, too. In this case, after the rapid acting wears off and until the Levemir starts working (approx between 10 pm 12 am) his numbers climb like crazy...Uffff!
     
  4. jendean

    jendean Approved members

    Joined:
    Aug 28, 2007
    Messages:
    1,427
    Levemir only goes 18 hours. It is advertized to be an all day insulin. The hospital I work at uses only levemir, people have to have lantus specially prescribed, so it kinda stinks. People go high all the time with the levemir because they are finding it wears off 6 hours before the next injection... it is often split up into two injections, which is just pointless IMO
    I like Lantus better.
    I would go out on a limb here and say yes. lantus is more reliable.
    :cwds:
     
  5. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    We love Levemir, but the situation you describe is a problem. Note that I respectfully disagree with your endo's suggestion.

    You arer correct that the basal should keep him steady throughout the night.

    To cover the night, he needs to get the evening Levemir at bedtime. To make sure he doesn't drift higher in the evening, you can try either giving a bigger bolus at supper OR get yourself some Regular and give it with the suppertime insulin (ideally Novolog). The Regular will nicely cover the gap in basal coverage, and we use it here for that purpose.
     
  6. cydnimom

    cydnimom Approved members

    Joined:
    Nov 8, 2005
    Messages:
    232
    We use Lantus (never tried Levemir) and split the dose 12 hrs apart.

    However, have you tried splitting the dose differently rather than increasing? So 1.0 in the a.m. and then 2.0 at night. Or... moving the timing of the night time dose to 8 p.m. If you do the swapping around you may find that your carb ratios are different during the day.

    I would start by checking blood sugar more often for a couple of days just to see how far off you really are. Whenever I find we need to do something over night - I test every 2 hrs plus before eating and 2 hrs post prandial. If I'm changing the day time dose I test before, 1 hr pp and 2 hr pp. Its a lot of finger poking, but you can generally find a trend.

    Have you read Gary Scheiner's book "Think Like a Pancreas". He has a lot of good ideas in there on figuring out and changing insulin doses.

    Just some thoughts,
     
  7. Jacob'sDad

    Jacob'sDad Approved members

    Joined:
    Nov 20, 2007
    Messages:
    3,803
    I would say that if some people find that the Levemir works for only 12 hrs, then they are probably going to have pretty good luck with it.

    If, on the other hand it appears to last 18 hours then there is probably going to be trouble. If the doses are given 12 hours apart There will be two six hour overlaps in a 24 hour period during which twice as much Levemir will be present as in the other two six hour periods.

    Jacob never had luck with either Lantus or Levemir for different reasons. He has much better numbers now that he's pumping.
     
  8. Carmen

    Carmen Approved members

    Joined:
    Jan 20, 2008
    Messages:
    68
    Thank you very much for all your thoughts.

    Wilf - could you clarify, please? If I give a bigger bolus (bigger meaning more insulin than needed for the amount of carbs he ate) for supper, he will go low before the rapid wears off, am I right?

    Cyndi - We played a lot with timing and dosage. We also test a lot (especially during the night - I wanted to make sure that he is high in the morning because the insulin wears off, not because of lows); I read Scheiner's book, I loved it, but my favorite is Walsh's "bible". This is why I am totally against using the basal to bring numbers down! The idea to decrease the AM, is worth a try, definitely...

    Dave (Jacob's dad) - I am so afraid of the fact that I will not find the perfect balance with the MDI, you have no idea. My son is just not ready for the pump, neither are we.
     
  9. Ashti

    Ashti Approved members

    Joined:
    Sep 4, 2007
    Messages:
    224
    Another option is giving the Levemir three times a day 8 hours apart. But since they recommend that it be injected on its own and not combined with other insulins that would probably be too many needles. It might make sense to switch to Lantus at this point since it lasts longer.

    The way we use Levemir we only need it to last from bedtime until breakfast (10 hours) and for that it lasts well (and gives us very steady overnight numbers (touch wood)) even though we are using it at a relatively low level (0.1U/kg). The literature says that at 0.2 U/kg it lasts for 12 hours. For the rest of the day we use NPH (with a tiny bit of regular to help get us from dinner to bedtime).

    Ashti :)
     
  10. twodoor2

    twodoor2 Approved members

    Joined:
    Oct 30, 2007
    Messages:
    6,440
    This is a very interesting article. I'm not sure how much fact is in it, but it does talk about the differences between Lantus and Levemir, and even compares them with NPH.

    http://www.diabeteshealth.com/read/2007/07/17/5316.html

    There are some interesting comments to the article as well.

    One thing that I'm intrigued with is the way that both distribute insulin. Levemir is albumin binding and Lantus uses crystallization. That may have a large bearing on how each one performs.
     
    Last edited: Feb 14, 2008
  11. wilf

    wilf Approved members

    Joined:
    Aug 27, 2007
    Messages:
    9,652
    If you give a bigger bolus (more than needed for the supper carbs), then in effect he has extra insulin working after supper. That extra insulin can play the role of the basal, and if you find the ideal amount he will not go low and he will not go high either..

    How do you find the ideal amount? Experiment. Start giving him a little more bolus insulin nightly, monitor carefully (esp. around the 2-3 hours time period), and record your results.
     

Share This Page

- advertisement -

  1. This site uses cookies to help personalise content, tailor your experience and to keep you logged in if you register.
    By continuing to use this site, you are consenting to our use of cookies.
    Dismiss Notice