Levemir vs. Lantus vs. Metaformin. Thoughts?

has anyone tried the different long-term insulins? Just want to know what is best (I am type 1 by teh way).

Hi Jessica. Yes, I started on Lantus, wasn’t getting smooth coverage, split my dose and then switched to Levemir which I found was better. Now I’m on the pump which is best of all because the coverage can be different levels at different times a day. But for MDI, yes, I thought Levemir was better. Not sure what Metformin has to do with it, but I do know some Type 1’s who also have insulin resistance take it in addition to (not instead of) their insulin with good results.

Thanks Zoe- think will ask my doctor about levemir. What did you like more about the levmir over the lantus? Were you splitting doses on levemir too?

I’ve tried Lantus but never Levemir. Most people I’ve heard from seem to prefer it over Lantus because it is less ‘peaky’, doesn’t sting as much when injected, and doesn’t cause the occasional crazy lows Lantus can sometimes cause. Not sure what Metformin information you are looking for, as this isn’t an insulin, though some Type 1s combine this with their insulin therapy if they have insulin resistance.

Yes, I believe most people split doses on Levemir. It was smoother, more even coverage and longer coverage, so there weren’t highs and lows in between meals. The goal is to stay as even as you can all through the days and nights. In theory you should be able to go all day without eating and not have your blood sugar rise or fall more than 30 points. Ditto through the night, not dropping or rising more than that. Levemir (which is newer) comes closer to that for many people on MDI.

I’m a Levemir fan because it’s more level. I had persistent lows with Lantus. Levemir doesn’t sting & has the added advantage of not losing potency quickly. A vial of Levemir lasts 6-8 weeks before it’s kaput. I noticed a decline in Lantus by day 26. Levemir works best in split doses.

The idea of basal insulin is that they should cover the basic insulin needs of the body. They are supposed to work against the glucose constantly released by the liver. Obviously basal insulin is still insulin but the reaction of the insulin is slowed down. In that aspect Lantus and Levemir are very different. Lantus connects to your fatty tissue and Levemir connects to albumin in the blood stream. The insulin looses the binding then it reconnects and finally it looses the substances attached to it - releasing it to finally work as the molecule that fits to the insulin receptor.

In my opinion there is no best basal insulin. What works is good for you. The problem is that the search for basal insulin is often reduced to ‘just take this’. This is often Lantus because it works for ‘24 hours’ and thus it is easier to handle. The problem is that the 24 hour figure is just a mean number for a group of individuals. Still this number does a hell of marketing for the product Lantus. In fact this marketing argument is so strong that Levemir has to be marketed as “good for 24 hours” too to have a chance.

In reality Lantus is just good for 23 hours and Levemir for 16 hours for most people. This does not mean that there is no Lantus or Levemir present on the other hours of the day. It just means that there is significantly less insulin present. Less coverage can cause problems from obvious to subtle - strange I:C factors for example. And really what is the use if Lantus covers 24 hours but with lows at night (just as an example)? So coverage it not all there is.

Bottom line: if you have picked one basal insulin its effectiveness needs to be questioned. For this you do shifted periods of fasting and test your blood glucose. On one day you do fasting for 12 hours. On the other day you do that for the other 12 hours. If your glucose profile in these times show that your blood glucose is steady and in the normal range then your basal coverage is good.

I personally prefer two shots of Levemir per day because it works best for me. It would be great if doctors would just be more willing to try different insulins in one patient. The differences in the quality of life are worth the effords. This is even true for the analog insulins. With one you will have higher post prandial number and with another it will work smoothly. Of course this will not always work out perfectly but there is a potential space to explore.

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Levemir will peak less and give you smoother coverage (at least, that was the case for me). But Levemir does burn when being injected and I also was prone to leg cramps when on lantus (not to mention some wicked lows). Personally, I like NPH insulin for my basal, but I’m old school like that. I think it’s just because it’s what I am used to and I know how to work around its peaks. But I’m on the pump so I only use a basal insulin if I am taking a pump vacation. The pump is really the best for basal purposes because you can adjust it to your basal needs throughout the day.

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What about Levemir vs. Lantus vs. NPH?

I have never tried Levemir or Lantus, but I will give you my opinion anyway.

The way I look at it, Levemir and Lantus both provide a flat basal profile, they require 1-2 injections and they are relatively expensive. Lantus and Levemir are less stable than NPH (although Levemir is considered by some, Dr. B and Gerri included to be more stable than Lantus). Levemir and Lantus cannot be mixed. If properly injected, Lantus and Levemir are considered to be less variable than NPH. NPH, while it has a markedly less flat profile, having a peak has its uses. NPH only lasts about 14 hours thus requiring 2-3 (or for some 4) injections to approximate a flat profile. NPH can be mixed and I consider it really stable, although I still keep my stock in the fridge and would never expose it to extremes of heat or light.

So why do I use NPH? Well I started on NPH, but I have actually found that the shorter duration of action and peaking works to my advantage. I am diagnosed as a T2 and I suffer from a wicked case of Darn Phenomenon (DP). In order to suppress a high morning blood sugar, I have to increase my overnight basal. The basal level required to suppress my DP would cause me to go through much of the day constantly battling hypos. So with NPH, I can take a morning injection (13-15 units at 6am) to establish my daytime fasting levels and then pile on the basal at night (25-30 units at 10pm) to combat the DP.

So deciding what is best really has to do with your situation. Do you need a flat or peaked basal profile? Is your insulin going bad often? Do you care about extra injections? Is your co-pay markedly different?

I forget the VS Metformin. Well, there is no VS for insulin dependend diabetics because it can not replace the basal insulin. But Metformin can be combined with insulin therapy. It moderates the glucose production of the liver down. Thus you will need less basal insulin to cover its glucose production. It also increases the sensitivity for insulin in general. So Metformin reduces the total daily dosage (TDD) of basal insulin. Often it is used to deal with weight problems. Sometimes the liver of diabetics has a very sensitive reaction to physical acitivty - some even release glucose when standing up. In these cases Metformin might help to reduce this unwanted reaction.

thank you all so much for your thoughts. I am trying levemir now (first time- been on lantus forever).
Does anyone feel weird after the shot- like kind of numbness throughout the body? It did burn when injected, but the numbness is freaking me out a bit… maybe allergic?

I’m curious if you are asking because Lantus wasn’t working for you. If that’s the case, you should definitely consider alternatives, but if it’s working for you, I would stay on it. From reading this website, you may get the impression that it is generally erratic, peaky, and does not last for 24 hours. This is true in some people, but for others (I’d venture to say “most”, and think that doctors generally prescribe Lantus first for a reason) it works just fine, and you shouldn’t get scared off of it because of anecdotal reports of its effectiveness in others.

The only fair comparison between Lantus and Levemir is one shot of Lantus VS two shots of Levemir per day. That is the most important advice I can give here.

Many of us, actually, took two shots of Lantus. But I agree with ultravires, that if it works for you, great. We are all different and when we find something that works better for us, we tend to tout it. I for one have found out how roughly both Lantus and Levemir approximated the basal control I get on my pump. I think most everyone would agree with that, but the pump is not for everyone based on other factors.

To put it in other words: one shot of Levemir does not help to decide whether or not this insulin is the right one. Only two shots will allow to make this decision. It is just a waste of a great opportunity to base the decision on the experience of one shot alone.

You wrote that you had lows with Levemir. This is another example that one shot is NOT the correct pattern of application for Levemir. It can not work great because it is not designed for one shot. Here is the working pattern of Levemir (the dotted lines in comparison to the solid line of NPH).

As you can see it works for 24 hours but the activity is not equally distributed over 24 hours. Now imagine you just split the dosage. This makes two shots of the lower profile (the lower dotted line). It still works for 24 hours but the two shots will overlap. When one shot starts to degrade in activity the other start to kick in. This will result in a very even activity pattern. With one shot you will have lows in the first half or highs in the second half. In contrast with two shots there will be no peaks and valleys anymore. This is what makes Levemir reliable, steady and a pleasure to use. That is my point why one shot is not the right way to use it. Of course honeymooning can maskerade this problem. But this does not change the reality that the beta cells are under more stress in the second half of the day with the one shot regime.

Thank you again so much for everyone’s thoughts. I decided to try levemir because I heard it had fewer spikes (and I was getting highs at night). I also heard it helped with weight loss. I am not heavy at all, but I do have a few stubborn pounds I can never seem to get rid of in my midsection/thighs- so thought I should try levemir.
So far, thinking it was probably best to stick to lantus. I am fluctuating like crazy- got a 42 in the middle of night last night, then ate sugar to counteract and it spiked into 200 and stood around there all night. This happened to me a few times, lots and lots of fluctuations.
I have lost 4 pounds in 3 days, but don’t think it is worth it for these crazy fluctuations. I am gonna stick it out for the rest of the week to see if I stabilize but if not, going back on lantus.
(also, did 2 shots a day of lantus and doing same 2 shots of levemir).
I also may switch from humalog to apidra (since humalog takes 2 hours to start working for me…)

I think, in retrospect, you are probably right about this. lantus did seem to work a bit better for me… a few more days of this levemir experiment, but if it does not stabilize, going back to lantus

Sorry you’re having problems, Jessica. I see you said you had a 42 in the middle of the night, then “ate sugar” to counteract and spiked into the 200s. Overtreating lows is a common problem (and also adds to weight gain!). Many people feel strong feelings of hunger and anxiety so they just keep eating. Also if you eat things that have fat as well it slows the work of the carbs which makes you more inpatient and you eat more, etc. To circumvent all this, I just use glucose tabs. I know from experience that if I’m in the 50s, 2 tabs will raise my blood sugar into normal range in about 20 minutes. If I’m lower I use 3. That way I just return to normal and never shoot up high.

Thank you so much Zoe- I think this is good advice. I do have glucose tabs, but never know how many to take. The 42 did scare me, so I think I definitely overdid it with the sugar (had small bag of gummy bears and some sweet potatoes). Next low, I will try to just have the glucose. I just bought some!
Thanks again, will let you know how it goes. Really hoping the night lows stop though! Makes me so tired when awake at 3 am!