I just switched to a sample of Lantus 2 days ago and have been borderline-low since then, waking up around 70 and post-meals around 65-85. I had been doing well with Levemir, with fasting and post-meals consistently around 85 and 120 throughout the last week or so. However, it was leaving irritation every time I took it, so my doctor gave me Lantus samples to try out.
I remember reading in Think Like a Pancreas that detemir insulin (Levemir) “has a potency than is approximately 75% less than that of all other insulins.”. When I told the caseworker/RN from my insurance company I was switching, she also told me to make sure I asked about the dosage, because it might not be the same.
My endocrinologist initially didn’t say anything about the dosage when he handed me the Lantus. When I called him the day before switching he said to just start with the same dose that I was taking of Levemir. Based on my readings and speaking with the RN from my insurance company, I didn’t think this was a great idea. However, since I was on a very low dose - 13 units of Levemir a day, I figured it couldn’t be too dangerous to try out. I started with 13 units of Lantus 2 nights ago and had borderline-low #s all day. I took 12 units last night and it still seems like the same story (woke up with a BG of 72 and, for the first time, almost took the wrong insulin at breakfast - almost took Lantus instead of Humalog!)
On a side note, last time I saw this endocrinologist he gave me a big speech about hypoglycemia, and encouraged me to aim for an A1C of 6.5 to 7.2. Now based on his own dosing advice, which I think was kind of careless, he has me shooting for an A1C of 4.5!
Maybe someone who has switched between the two before could give me some advice on how their dosage was adjusted? I think my strategy for the next week will be to go down by 1 unit a day until I see my fasting blood glucose stabilize, but I’m very open to advice.
Thanks for the help.
I don’t have advice for you about that but I remember that when I first started Lantus I was having lows too. It’s been 5 months since I was diagnosed and I think I finally have an amount that seems to work well overall (8 units before bedtime). Others may speak more intelligently to this, but could it also be that it takes your body a bit of time to adjust? I played with the dosage I had, increasing and decreasing it depending on what was going on during the day, till it started to get more consistent.
For future reference, I put in a contact to Sanofi Aventis this morning and they had someone call me back within a few hours. The rep said that there is no set equivalency ratio, and that in clinical trials the dosage equivalents varied from person to person. In some cases, a 1:1 ratio was ok. However, on average for the study, Levemir users took 0.52 units a day per kilogram, and Lantus users took 0.44 units a day per kilogram. Using these #s, on average, dosage requirements were 15% less for Lantus than Levemir.
Dear Dan,
There is tweeking to be done. Usually it takes tweeking down 2 units every 3 days when a dose is two digits to get to the right dose for an individual. Only YOU can hit it right. It takes 3 days for Lantus to show how much you finally need when lowering dose.
Using myself as an example, I was at 118 lbs, so the initial TDD was 118/4 or 38 units. That divided 40-60 was 15 for long acting and 23 for meal bolusing. For more safety, I took 14 the first day. Hypo, hypo, hypo. Second day (no waiting for 3 days, obviously) gave 12. Hypo hypo hypo. Third day, no waiting, down to 10, hypo hypo hypo. Fourth day, down to 8 units - getting there. Now I waited a couple days and inched up a unit. Waited a couple days, inched up a half unit and divided the dose between morning (larger dose) and 9 pm (small dose). Waited 3 days before evaluating around the clock. I like being at 95-110, and that’s where I stopped tweeking.
It takes time and no Endo can do it for you.
95 - 110 feels perfect for me too!
I started out on 10 units of Lantus late August injecting at night, woke up at 3 am feeling like I was low, tested and was at 48-50, knocked down to 8 the next day, woke up at 5 am that night and tested and was in 50’s, cut back to 6. Usually in the 70-100 range now in the am, which I’m comfortable with. If you are uncomfortable where you are waking up adjust your dose and advise your doctors of the change, I don’t require a doctors approval to adjust a dose if I feel my health is at risk, I will let them know so I can get their opinion and update them on my current dosing levels out of courtesy though.
In my case I think lantus is a bit more effective maybe.
I’m not making any sense of this determining of dosage by weight! First of all, Dan seems to be giving an equivalency just for the basal dose and Leo is giving it for a TDD. Second of all, Leo, what do you mean by 118/4-25%? Either of these ways of figuring come out to significantly more than I take if I were to base it on weight. It just doesn’t make sense to me, though. I’m a Type 1 with little insulin resistance. I take about 23 units TDD. I have a Type 2 friend who takes about 4 times that. He weighs more than me, but not 4 times more! Our sensitivity to insulin has to do with many factors including insulin resistance, so how can you determine dosage simply by weight??
yeah, my total dosage is way less than those guidelines as well. i take around 20 units a day, plus or minus a few depending on what i eat. i think it’s probably because i still make some insulin on my own and because i’m t1 and i don’t think i have an insulin resistance problem. i’m guessing in the levemir/lantus clinical trials the rep mentioned, most if not all the people were t2, and needed to take more due to resistance.
t. same thoughts here. no need to wait around and pay for a dr. visit when i need 2 snacks between meals to prevent lows! answer seems pretty obvious to me, take less lantus. glad i got to speak with a rep and all of you today to find out that many other people need a lower dose of lantus as well.
leo - thanks for the practical advice. once i get out of constant hypo threat level 5 i’ll try a few doses for 3 days at a time and see what works.
I would not be surprised if 25 lantus = about 35 levemir
My experience with the two… Lantus works great for me. I can interchange my total pump basal and Lantus and it works fine (I switch to MDI and back fairly often). Levemir… it seems like it just doesn’t work at all! When I had tried it in the summer of '09, I had tripled my normal Lantus dosage and was still chasing highs all day long… I struggled with it for two weeks before deciding to just go back to using Lantus.
My CDE has said that in speaking with other CDE’s, they’ve had other patients where this is the case. I think that because of the specific way that Levemir works, it just doesn’t work for some people - like it didn’t work for me.
Well, In the Book> Think Like a Pancrease… chapter on Setting up a “starting” Basal…
and for Individuals who produce NO insulin…
-Basal Insulin ( BI ) accounts for 40-50% of one’s TDD. ( Total Daily Dose ) the rest , fasting insulin or if on a Pump , using all fast acting insulin of from 50-60% is for food and corrections.
- First have to figure out what your weight is in Kilo’s…Multiply your Weight x 0.454
Example per 100 lbs = 45 kg’s
- next…Per one’s age, Physical Activity level… If A Normal lifestyle with moderate physical activiy, the guide is From 0.20 - 0.50
- They start with using the Least or = 0.20 and work your way up as needed…
-or per 45 kg’s x .20 = 9 units…
-You woud take this at Bedtime and You would Set your alarm for 4 hrs and test to see how your BG’s are doing and of course when you get up some 2-4 hrs later…
-In Range = using a guide of btwn 80-110… if you are In range, then your fine w/o adding or subtracting any units from your Dose…
-here’s the tricky part… It All Depends on your Going to Bed “In Range” of that 80-110 as well… and if your not? Then you have to also take a CB-Correction Bolus , just as you would during the daytime if you were high… and Not Depend on the BI to bring it down…
the 30pt leaway rule?maybe… They say if you go to bed and get up with in 30pts of what your BG was at bdtime, your dialed in…I want to go to bed at 80-110 and get up 80-110…none of this being 30pts higher garbage… If i go to bed at 110 and get up 140? Not a happy camper…
-This is also where doing a BASAL Test comes in…Try to do one in 12 hr increments…
-For Dinner… you want to eat at least 3 hrs before Bedtime… this allows your Fast Acting Insulin to do it’s full job… Most effective in those 1st 3 hrs…
-eat whatever and take whatever you know will give you that “in range” #, I prefer btwn 80-100 myself. by that 3rd hour and by bedtime…
- then take your Basal , test 4 hrs later and again when you get up…
if your Above that 110 top # at AM? 3 days consistantly? and you’re either gone to be “inrange” or have taken a CB…if higher? Then you Increase your basal in 10% Increaments… ( in the above example, by 1 unit )
-and keep doing so until you start getting up In range and Not Going below 80’s over nite ( see why have to test 4 hrs after beddy time?)
- the next 12 hrs of doing your Basal Test… is the hardest time… during the daytime… drinking only diet drinks and eating Nothing or 0 carb foods at the most…
-If that Bedtime dose keeps you"In Range" thru out the Fasting -Basal Test? You’ve done about the best you can and then the rest of your BG control is upto your taking the Right Amt. of Fast Acting and that’s Knowing EXACLY what your I;CR or insulin-to-carb ratio is for every meal ( it may vary) and Knowing Excactly how many Total Carbs your Feeding your Face with…
And that my friend, is the hardest part of this game…that very few get it right consistantly…
The only way I have been able to do it? eating Health Choice Meals or eating Very Low Carb ( 5 carbs) per meal… and that gets really old, real quick…
Or you can carry a weigh scale around with you for Lunch and have it at home and weight every little bit of Food and you might be right 8/10 x… at best…
and Oh! Taking the Right CB… Correction Bolus so you will get your BG’s Down to 80-120 range? is another Phase of this game we have to learn and hope for the best.since 1/2 the time it doesn’t work either… since there are about a Dozen things we have to remember to do everytime we want to shoot up and eat… and if your just 1-2 units wrong? Bingo! You’re either going to be too low or To high and take hoursto get it back down… since these So called Fast Acting Insulins? Aren’t Fast acting… they take 2-3 hrs to be in full effect.
They’re only fast compared to what we used to have to use, R-Regular Insulin…
and also? Use Glucose tabs to recover from aLow… They work the fastest for a reason… and are not just reg. sugar… and use the 15/15 rule… ? I use the 10/15 rule or take 2 tabs = 10 carbs and takes about 10-15 min to get the #'s back up…
1 tab = about 5 carbs…x 5 pts =+25 pts for me… test to see how many points 1 tab does for you…
And get the book> ;Think Like a Pancrease…1st before apply any of this complicated stuff… It saved my D Life…Vs listening to a bunch of useless Nurses and Endo’s…( and they don’t want us to know more than them about our diease, since they loose control and don’t make as much $ off us…LOL but, you’d think they would tell us to get the book,wouldn’t you? the selfish SOB’s…
Thanks for the help guys - on day 4 of using 10 units, things seem to be stabilizing. It’s not THAT stable, partially because Lantus isn’t completely stable and it’s not a pump, so things aren’t matched based on different needs throughout the day. However, I can now skip a meal without eating, if I need to, and I’m waking up with just a slight decrease in BG from when I went to sleep (10-20).
So, for me, 13 units of Levemir = 10 units of Lantus.