Sorry … I know this topic has been addressed before, but I can’t seem to find the post(s) I’m remembering.
My pump died an unexpected death today, and I’m going to be receiving a new one tomorrow. In the meantime, I’ve taken a shot of Lantus, and I have to say that after 4 years of pumping, I love not being hooked up to that device. I’m thinking of taking a break (still using the pump to bolus because I like the calculation features and possibility of giving very precise doses, but then disconnecting after delivery Edited out … have been using a pen to bolus), and I have a few questions for anyone in the know …
•Before I started pumping, I was on one shot of Lantus per day + Humalog. I think I’d do better splitting the Lantus dose, but I’m wondering what sort of timing and percentage people use for the split. Should the doses be 12 hours apart, or would bedtime and first thing in the morning work? 50% of the total with each shot? Something else?
•I’m also wondering about the Lantus/Levemir choice. I’ve never tried Levemir. Does anyone have anything to say about its advantages or disadvantages compared to Lantus?
•Any general thoughts on the experience of returning to shots?
Sorry … I know this topic has been addressed before, but I can’t seem to find the post(s) I’m remembering.
I’ve used Lantus & Levemir. Levemir wins hands down in my book. I haven’t experienced any negatives. Levemir has been far more level. With Lantus, I had lows even after changing doses several times & also using split doses. No doubt Lantus peaks, despite what the pharm literature says. Another Levemir plus is that I’ve used a vial for 6-8 weeks. Lantus lost potency by day 26 & was dead by 28 days. Levemir also doesn’t sting.
Levemir is best taken in two doses. I take it right before bed & again in the morning. My bedtime dose is 6.5 units. Morning dose is 6 units, so almost 50-50. I take slightly more at night because of dawn phenomenon.
Thanks, Gerri! That’s very helpful info. I never had problems with Lantus stinging, but it certainly did seem to peak, which was a pain.
Definite peaks for me, though my endo shook his head that this wasn’t possible. Read here that others experienced the same & argued with him to switch me to Levemir. Best thing I did.
I started using Lantus soon after it came out in 2001. I’m still using it.
Immediately after I started using it I found that it didn’t last a full 24 hours for me, so I started splitting dose 12 hours apart - upon waking and at dinner time. I have spent many years with equal amounts for the two injections. And I believe it has been very flat and peakless for me - in fact maybe too flat. I have started experimenting with taking a larger dose with dinner to try to overcome what I believe to be dawn phenomen - increased insulin need from 3am until a couple hours after waking.
That said, I have read an article that suggests Levemir may be more predictable than Lantus (but I am always a bit skeptical of these direct comparisons since they are often funded by the drug company involved). And I just got a sample of Levemir from my CDE last week to see whether it gives a closer match to my overnight insulin needs. I have also read here on Tu that Levemir might be better for this purpose since it has a shorter action time (closer to 12 than it is to 24 hours) which makes sense (though the action curves published by the drug companies seem to contradict this).
I haven’t started testing the Levemir yet but plan to do so this week. Personally, the ability to vary basal rates is the one feature of pumping that I find really appealing, though I don’t know how useful it would really be for me since I haven’t tried a pump.
But since you’ve been on the pump you probably have a very good sense for what your basal rate is throughout a day, after exercising, etc. If it is very stable throughout the day, then an equal split dose of Lantus (or Levemir) may work very well for you. If it isn’t, and your basal rate changes throughout the day, then it may take a bit of time to adjust to either of these basal insulins.
I’m surprised you would consider using a pump for boluses - I find these pretty trivial using a syringe or pen. When you say you would disconnect from the pump after each bolus, do you mean you would remove the catheter? Or just unplug the tubing? If the former it sounds like you’de be inserting a lot of catheters. If the latter it sounds like you still wouldn’t be really free from the pump. Maybe you should consider the omnipod if it is the tubing that annoys you?
It is time for my mantra: use Levemir distributed on two shots every 12 hors. It is the better choice. Know everyone wants me to proof this claim. Unfortunatly it is impossible to do. Lantus and Levemir use very different strategies and therefore these insulins show different reactions to individuals. Statistically there are clear advantages of Levemir and some of them have already been metioned by Gerri.
Please be aware that Lantus is only that successfull in the US because convenience is the seller in this market. One shot sounds so great - why should I ever need another basal insulin? To me the problem is that Lantus will not cover more than 22 hours for most users. This does not mean there is no insulin left - it just means it is not evenly distributed in potency. This has some very unpleasant side effects:
a) many users inject Lantus before bedtime. So the gap in coverage is possibly in the time of sleep. This could lead to the need of corrections before going to bed (with the potential problem of errors) or to a rise of BG in the first period of sleeping time. Oddly this is often compensated with higher dosages of Lantus. So the BG first climbs and then it is lowered till morning comes - this takes too long and is unreliable because the gap in coverage is often cloaked by the short acting insulin of the meal before.
b) because Lantus often does not cover 24 hours its users tend to raise their dosage until the coverage is better. Combined with the slighty spiking of the Lantus this is raising the risk of lows at night - possibly undetected lows.
c) some users experiened unexpected lows when Lantus is injected into the blood stream (by hitting a blood vessel etc). In contrast Levemir will bind to human albumin in the blood stream. So it does not matter how well the injection went.
I suggest to just try it out. It will take one or two weeks to get an idea about your individual reactions to Levemir. This is just one vial so cost- and time-wise this is a good investment. Just translate the Lantus dosage to two shots of Levemir and increase your testing frequency - especially while driving. But please oppose the idea of your doctor to shoot Levemir only once per day.
I am another one that prefers Levemir over Lantus. I could never get the dosing of Lantus right and always had alot of lows or if I cut back, highs. Levemir was just alot more stable for me. I just started using a pump this summer but if I ever need to go back to MDI, it will be Levemir for me.
Thanks so much, everyone, for all of this very useful information!
Just to clarify: I’m not planning to give up the pump forever (well, unless I get cured … hallelujah!). I just want to take a break. The constant presence of the device, the tubing, all the scars I have (and seem to get no matter how often I change the infusion set), the in-the-face (or on-the-waistband) reminder of my disease … I know those things aren’t issues for everyone, but I’m just really enjoying this hiatus. I believe pump therapy is probably still the best option for me (though I can’t really say my control has changed noticeably in the four years I’ve been on it, ie. compared to when I was on shots), and I expect I’ll be back on it sooner rather than later. Jag mentioned the Omnipod, which does indeed interest me, but it’s not yet available here in Canada.
Re. using my pump for boluses, that probably isn’t the best idea — I agree. I’d been thinking of leaving the infusion set in for the usual amount of time and just unplugging the tubing (which wouldn’t of course give a break from scarring), but I hadn’t thought about the delivery interruption problems that John mentions. Also, I wasn’t aware of pens that give very small doses. My I.S. is quite high sometimes, so I like being able to give, say, .3 of a unit.
Many thanks, Holger, Kelly, and Jag for your thoughts on Lantus and Levemir. I think I’ll give the Levemir a shot (pun intended) and see how it goes.
You asked about Lantus, so I’ll simply state that Lantus does not need to be on a 12 h - 12 h dose regime, half and half.
One can take 3/4 of the Total Daily Lantus Dose for supposedly covering mostly daytime activity and 1/4 of the Total Lantus Dose for covering nighttime. This way one does not need to carry a Lantus vial around. One can take it at 6-7 am and again, the lower amount, at 9-11pm.
The only importance is that it cover round the clock evenly, and a bit of tweeking can do it. And this is despite all one reads about it. It’s whatever works for the individual who wants neither hypoglycemia nor hyperglycemia.
When you get to uneven numbers, you think broadly. Example: 7u & 2u for a 9u total.
Also, don’t forget your total dose of long-acting is probably more vs pump. So, if your total basal on pump was 18 units, you might need 20-22 on Levemir/Lantus.
This kind of split dose works for me with Levemir also. I take 5 units at bedtime and 1 1/1 u in the morning. When I go into winter hibernation, sometimes I need another small amount at 2:00 P.M. When I took Lantus, I also took a split dose, but needed more total insulin and felt distinct peaks.
I haven’t heard anyone else say this, but the Lantus gave me a slight headache all the time. Levemir works so much better for me with no headache.
Thanks very much, Leo2, Trudy, and Don for your info and suggestions!
Something that I think worth mentioning is that the literature for Levemir shows that when the doses are low, it doesn’t last a full 24 hours and many people here have mentioned/found. When you get to doses about about 20u, it does last 24 hours. So if you’re on lower doses you’ll def need to split into 2 doses. If you’re on a higher dose (more common with Type 2 than Type 1) it’s more likely to last 24 hours. Not sure what Lantus shows, but it hasn’t really been studied twice a day.
It is always better to split. The more you inject the longer it acts and the less the differences in potency. Still these differences exist and depending on your insulin sensitivity it will have an impact. At the last Diabetes fair in my hometown I asked several CDEs and Doctors about their opinion about the splitting of Levemir. All of them recommended two shots of Levemir per day. Some even thought that my question is a little odd.
Well, my first day on Levemir has been pretty successful, I think, but I’m still trying to get a full understanding of the way this stuff works. Am I right in thinking that the larger the dose is, the longer it will last and the higher the hourly basal rate it will deliver?
Knowing that my insulin sensitivity is usually higher at night, I decided to split my 20 units for the day into 8 at bedtime and 12 in the morning. It seemed to work today, but maybe that was just fluke?!
Thanks, Orchid3 and Holger, for the updates!
Yes, I knew and hoped for that outcome. Good basal coverage is the key. Pumpers often develop absorbtion problems over the years and their basal coverage can be heavily impacted by that.
Your understanding is correct: the larger the longer and the higher the hourly basal rate. It is just impossible to derive the active amount of insulin. This is because Levemir is constantly binding to albumin and then released and then it binds again. But to me this binding behaviour is the key to constant delivery. The two shots combine that well because the Levemir is directly bound after injection. The bound Levemir is constantly released into the blood stream and that is why it is working so well.
I am very sensitive too and I split 8/7. This one unit less for the night prevents me from going too low. So it is perfectly ok to seek adjustments like that. I will also reduce my night dosage after sport. For me the refill of my glucose deposits always happens at night and thus I need the flexibility of the two shot regime to adjust for that.
I bet in one month from now you will think about a second pen for bolus (the Novo Junior with half unit delivery).
Well Heather, since we discussed shots or pumping yesterday, I must tell you that I left the pump at home this morning and am going to try shots for awhile and see. I have taken Levemir in the past, and to be honest, I couldn’t tell the difference effectiveness wise between it and Lantus. I use Lantus and split the dose up to 2 x daily. One thing I know about Lantus is that it stings sometimes. But I can deal with that. It doesn’t sting for long. Now it’s a matter of getting the shots fine tuned so I don’t go too low or too sky high. I hate being low, I’m sure we all do. Let’s keep in touch!
I thought I wanted to take a break from my OmniPod this past summer. Went to see my Endo, and even though he gave me Lantus, and Novolog pens, he had a funny smile on his face. He gave me enough refills for three months. I lasted maybe three weeks on shots. Could not wait to put my pod back on!!! Guess he knows me too well. It was a pain having to remember to do all the testing, shots, etc.
Thanks for the further explanation!
As for bolusing with my pump, I haven’t bothered with that. I dug out my old pen from four years ago and have ordered a new Humapen HD, which does half units … for some reason, the Novo Junior is no longer available here.
That’s a pretty good lookin’ graph, Alan!
I’ve found the Bolus Wizard to be kind of a crap shoot, too. Much of the time, the whole business feels like a crap shoot, basal rates included!