My provider for pharmacy disallowed Lantus Solostar, so I chose Basaglar, and a few months later disallowed Basaglar. Both are Insulin Glargine, and for now, I’d like to stick with it, before trying Tresiba. That said, the issue for me if often the pen quality. My formulary allows several Glargine insulins, and I was wondering others’ experience with the pens of the following:
Toujeo Solostar
Semglee (YFGN)
They also allow Levemir Flextouch, but I disliked the pen - injections felt less certain, and Glargine has a gentler curve - and they also allow Tresiba I want to avoid switching for now.
I know you said you don’t want to use Tresiba, but in my experience Tresiba has a superior curve for 1x 24 hour dosing, AND the pen is really nice compared to say Humalog quikpens.
The Tresiba pen gives a real click for each unit that goes in, AND a bigger click when the full dose is in. Really nice especially when injecting into my behind.
I appreciate the positive audible feedback a lot. Occasionally a needle or site will be “blocked” for some unknown reason and having the audible feedback makes this really obvious. This might only happen to me a couple times a year at most.
Having been forced to switch to Tresiba 7 or so years ago when my insurance stopped covering Lantus, I understand not wanting to switch if you feel like you’re being forced. But for me Tresiba is genuinely superior. I found I was using about 10% lower daily dose after switching to Tresiba so they are not exactly direct substitutes.
I had no problem going from Lantus to Tresiba. Tresiba is a great insulin. The pens are good, but would be much better if they allowed 1/2 unit dosing.
If I ever abandon the pump it will be Tresiba for me too, especially after hearing what Tim says about the tactile pen clicks. I used Lantus for about 15 years prior to pump
Toujeo worked fine for me for years, only one shot per day. And relatively few “lows”, even fewer than currently on a pump with Humalog. I think the basal Toujeo was less “activated” by exercise than pumped Humalog is.
I’m considering going back to Levemir/Detemir, for weight reduction reasons. I’ve seen studies showing lower weight gain and possibly slightly better HbA1c.
That’s interesting. Tell me how a long acting insulin does that.
Is it different from lantus?
Is there some appetite suppressant action?
I’ve been gaining weight ever since I started pumping, I always assumed it’s because I’m better controlled.
Not a lot of weight but maybe a pound a year for 20 years.
I did manage to lose 5 with a change in diet.
But also I don’t really try that hard. I’ve just noticed it.
Consistently, across studies, detemir led to less weight gain than glargine, and although statistically significant, it was only a few pounds less on average. As to causality, I saw one study that offered different hypotheses:
Our analyses suggest that there is no clinically relevant difference in efficacy or safety between insulin detemir and insulin glargine for targeting hyperglycaemia. However, to achieve the same glycaemic control insulin detemir was often injected twice-daily in a higher dose but with less weight gain, while insulin glargine was injected once-daily, with somewhat fewer injection site reactions.
I feel so lucky to have discovered this post tonight, as I’m going for training in how to use Basaglar (pen) tomorrow! But also apprehensive… I don’t want to gain weight or have to restrict my exercise (which has always been my best and main med for lowering BG). I know nothing about insulin or pens after 24 years with mainly diet and exercise control, assisted in the last few years by glipizide and metformin. BG and A1c have gradually crept up, due to a number of interferences beyond my control over the last few months, BUT I am gradually getting back into my exercise routine. Insulin resistance is my main problem, not food. I eat very little, and now wonder if I’m going to have to eat more when I start taking insulin. What if I’m no good at injecting? Should I see an endo (current doc only has type 2 patients)? Have only had PCP/family doc till now, and he’s been great, but this to me at age 79 is bad news! Apprehensive to say the least. Doc renewed my metformin prescription, but not my Glipizide. Should I request staying on it until I get the hang of injecting insulin? Glad to have Freestyle Libre 14 day CGM. Thanks to James and all who responded so far; at least I know a few things more than I did before!
Injecting is simple. I imagine the biggest problem you might have is with consistency and self-management. For myself, I use two (2) injections daily, one in the AM and one at bedtime. Depending on circumstances, I might dial down or up the dosage, but it is usually consistent. Also, I do a simple back-and-forth site between my thighs, and use my arms for my short-term insulin injections, but in your case, as with many others, you might only need one injection per day, but it still pays to rotate/change injection sites.
Nurse renewed my Glipizide prescription today, gave me a new prescription to Lantus Solostar Pen, and showed me how to use it. Said to inject 10 units right before dinner.
I picked it up from Walgreens, but due to circumstances beyond my control, won’t be able to start using it until tomorrow night. So that will give me a little time to do some research…
Tips, anyone?
Tip 1: it’s not awful critical exactly when you take these nominally 24 hour insulins. If you can’t take it exactly at dinner time as prescribed, don’t skip the shot. Take the shot whenever you can even if several hours off.
Tip 2: not sure when you’ve been most intensely checking your bg’s. The 24 hour insulin will not be peaking after meals so you will still see whatever post-meal rises you already have. What you are more likely to find, is that fasting or before meal bg’s is where the biggest effect is. If you haven’t been checking bg before meals because your doc never asked you to, you may not have a baseline to compare to. Being lower before a meal will also help your after meal numbers so they aren’t entirely decoupled.
Thanks, James; I might do that, although nurse said “take 10 units” when I asked her about splitting the dose. Just opened the box today, and have to read the enclosed pamphlet later this afternoon…
Thank you, Tim! Good to know. Hoping my CGM will help keep me informed, but will also need to keep regular BG meter handy, I guess.
I was thinking I’d get the BD Ultra-Fine 4mm/32G pen needles (or the III, with no pinch-up), but local Walgreens gave me Owen Mumford 5mm/31gauge Unifine Pentips Plus, which seem cumbersome.
Another TIP; take your long acting at a time that is repeatable every day. Back before I had an insulin pump, I always took long lasting before lunch. Timing for breakfast and dinner was too variable.
Thanks, William! I took my first Lantus today right before “Brunch” (which is actually a small snack-size meal, as are my other two – dinner and evening snack) today. Took only 5 units instead of the 10 units that nurse recommended, and it has had a slight positive effect on my BG levels (and energy level!) for the last 12 hours. Will do the full 10 units tomorrow, and at dinnertime as recommended.
Used my right upper arm, and plan to go in a clockwise pattern in the same area for the next 11 days/doses. Do you or others here record your insulin units and/or injection sites in a logbook or ?
I record my units of insulin and I keep track of my glucose readings, but I just jump around to different places on my body to inject insulin. I was dx with type 1 in 1959, and have given shots for all of those years. I have never had a problem with my skin even when using longer thicker needles. I regularly take a minimum of 4 shots a day. I love insulin pens and would never go back to syringes and vials.
I am sorry that at 79 you are having to start on insulin. I am 71 and know that I wouldn’t have found it easy to start insulin at this age. I am so pleased that you have found this group.
I have never used an endocrinologist on a regular basis, but I would if I wasn’t so comfortable making insulin decisions myself or if I used a pump.
I hope you will switch doctors if you aren’t comfortable with the knowledge your GP and nurse bring to the table.
I used Lantus for several years and soon split my dose so that I was taking it morning and night for better coverage.
I was on Lantus for a year before turning to a pump. My Endo said to take it in the evening, but I found myself going low over night regularly. I read about splitting the dose and decided to try it. I first tried taking half the amount before bed, the other half in the morning after getting my coffee. It worked much better, but I found I had to increase the dosage by one unit for each injection to have the control needed. Injections were at 12 hour intervals, more like at 10PM and 7AM.
I just started Lantus last weekend, and my nurse said to take 10 units before dinner. The first two nights were such a busy time that I couldn’t get it done, so on the third day I decided to take it in the morning before breakfast (to make sure it got done), and ended up splitting the dose, taking the other 5 U before dinner. It’s been working pretty well (along with moderate exercise), improving my time in range as well as my average (according to my Freestyle Libre CGM). Today is the first day that I took all 10 units before breakfast, and it lowered my BG really well all afternoon up to dinnertime, but then it started to go back up, and I’m not going to have as low numbers before bed as I did with the split doses.
Does that mean that it’s best to split the dose? Do you think the nurse will have me increase the number of Lantus units, and/or add a mealtime insulin at the follow-up in two weeks? When will she give me the go-ahead to use my own judgement?
