Kaiser Dropping Levemir, Forced Switch to Lantus

Type 1 and LADA
1

as I tried to refill my Levemir, the online option said "refill unavailable." My endo. then told me (after the fact) that Kaiser was no longer covering Levemir and I have to switch to Lantus.(would have been nice to get some warning, as I could have refilled in December and got 6 more bottles to ease the transition.

Quick background before I ask for some advice:

I've just had my 30-year anniversary as Type 1 in December, been injecting all the while (Kaiser only covers the MiniMed pump, and I'm just not ready to travel down that road yet, once they perfect a CGM/pump combo, I'll consider again). It was only 3 years ago that my dinosaur Endo. finally mentioned getting off the NPH (after a 3 am seizure/jumping fit ended in a broken foot) and, after my research here and on ADA site, I chose Levemir in 2 doses (he actually recommended one until I talked him out of that). It took about a year to finally get the dose right, and A1C's back down from the low 7's to the middle 6's.

To finally counter the morning high's, we ramped up the Levemir to 28 units at night, and 24 in the am, and I'm taking about 30 units of Novolog mixed in with some Regular at meals (yes, I have my own concoction/blend of about 4 units Novolog with 1-2 units of Regular before breakfast and lunch, and 6 units Novolog/4 units Regular at dinner---for some reason I like the extended kick of the R to keep working after the Novolog dies down for the slower acting carbs)..... does this lead to some extra lows? perhaps, but that's also another conversation.

Back to the Lantus: seeing the Endo. on Friday to review the plan--and the split. He says we might have to adjust the dosage and the splits. And, if the lantus does not work, he can write a "formulary exclusion" to get Kaiser to cover the Levemir. Since I finally have it working, I'm going to plead that he does it now, but he seems to play it by the book, so I doubt he'll do it unless Lantus really fails for me.

Should I ramp down from the 28 / 24 mix when starting on Lantus? And I know some basal testing is in order, but I'm a little leary of the 3 am peak and the doubling up that Lantus will hit me with.

Any advice and feedback is greatly appreciated.

2

I personally like Lantus much better than Levemir. I had much better control on Lantus. To give you some insight. You MIGHT find you need to decrease your dose when switching to Lantus. I always had to take several more untis of Levemir than I did Lantus and still couldnt get good coverage. As far as your other insulin I do not know how to answer that, I've never heard of anyone taking insulin quite like that.

I split my Lantus into two doses, and just about everyone I've talked to has better results with splitting the Lantus. I'd take it about 12 hours apart. Around 18 units at night and about 20 during the day.

3

Lantus is claimed to last 24 hours, but many people find it actually does not last that long. Some of that may have to do with dosing sizes, if you only take 5-10 units then it is absorbed faster than a dose of 20-30 units. I found a good reference on pharmacist guidlines on switching insulins. It says three things about switch from Levemir to Lantus:

  1. Convert unit-per-unit
  2. Give once daily, or divided twice daily if necessary for control
  3. Do not mix Lantus with other insulins (duh)

Even if you wanted to take a single injection, that would be more than 50 units, so it would be best to split the Lantus anyway. So I would just replace the Levemir with Lantus with the same dosing and timing and adjust from there. And given that you are switching to a presumably longer acting insulin, the transition will likely tend to leave you high rather than low.

ps. I also am on a split Levemir regime, but my evening dose is nearly 4 times my morning dose. I have trouble in the morning as well.

4

I found that I had to split my Lantus dose. Before changing to the OMNI system I was on 40 a day of Lantus. I would take 25 at 9pm and the other 15 at 1pm. I found that taking all 40 in one dose that it would wear off around 5pm and I would need to take more Novo to cover my food.

Good luck!

5

I have Kaiser NW & they cover the Animas pump as well as Minimed. so you could ask again. I think this is a country wide contract for Kaiser.

They also informed me that from Jan 1st they are switching from Novolog to Humolog for fast acting insulins. I'm not worried as when they switched the other way in the 90s I didn't notice any difference.

Pre-pump days when I took Lantus I used to split the dose with a larger amount in the evenings.

6

Thanks, that's interesting. I've been on Novolog for years, so perhaps different regions have different deals (??>
The bigger issue is in our new future of health care, with costs and premiums soaring, we are stuck with whatever formulary deals these companies work out, and have to switch on a moment's notice without regard for how long it takes to adjust. I just got my lowest A1C since 2006, and now have to change to an insulin that is chemically quite different--that my bloodstream has never known before.

7

I was on Lantus soon after it was first released (2000 or so?) until I changed to Levemir a few years ago. Both with two injections a day. If you are having good control with Levemir, it is likely you'll see the same with Lantus. If you are doing an uneven day/night mix that will likely continue. Lantus has an even longer action time than Levemir, so I don't think you'll see a 3 am peak (unlike NPH which does have an AM peak).

I do use more of the Levemir than I did of Lantus, but as always with diabetes, this could be because I did a better or worse job of adjusting my basal needs or a thousand other reasons. In any case, dialing down the amount of both your morning and evening injections for at least the first few days would be smart, until you've seen how it works for you.

I found Humalog and Novolog to be readily interchangeable, unit for unit and observed timing.

8

I hate that insurance companies are making decisions for us...and have never met us.

I have Kaiser too. And I was taking Levemir before the start of this year, and now switched back to Lantus (which i prefer).

Good luck, man!

9

My husband's company switched insurance companies in Nov (stupid time of year!). New insurance company doesn't cover Levemir. I had switched from Lantus to Levemir in Sept (?). I feel it works much better than the Lantus did. My numbers are more steady. I do have to take more units of Levemir than I did Lantus, but it's worth it to me. I ended up paying full price for a box of pens, since my new insurance won't cover it. Sucks, but it is what it is.