Levemir vs. Lantus

My 12 year old son had his first follow-up with his endo yesterday after being diagnosed with type 1 in November. As she was asking him about how much of his care he did himself versus me doing it (shots, carb counting, record keepong, etc.), he mentioned that he does all his own Humalog shots, but that he likes me to do his Lantus. He prefers his Lantus in his bottom as the sting bothers him less there. It’s also a little awkward for him to handle the vial and syringe - he can do it, but it’s not comfortable for him. (We have a Solostar pen, but I prefer to use the pen for Humalog and the syringe for Lantus so I never accidentally, in a sleep-deprived state, mix them up.) If we’re out when it’s time for his Lantus or if he’s away camping or doing something with friends, he’ll do his Lantus shot himself in his leg or abdomen.

The doctor picked up on us saying the Lantus stings and suggested he try Levemir because it doesn’t sting. According to her, about 80% of people get 24 hour coverage with Levemir. It seems that everything I read, though, indicates most people take Levemir twice a day. I’m sure her thoughts are based on scientific literature, while mine are purely anecdotal.

My initial thought is that 1) yes, Lantus sometimes stings, but it isn’t something my son complains about or that is a major issue for him and 2) we’re getting good control (a1c of 6.1) with the Lantus, and 3) if it’s not broken, don’t fix it.

If we tried Levemir and my son didn’t get 24 hour coverage, we would definitely go back to Lantus as he’s not willing to trade one stinging shot for 2 non-stinging shots. My biggest concern, I guess, is that his numbers have been really good, we’re not experiencing night time lows, and I worry that if he begins running high because the Levemir doesn’t cover him well enough, we might be risking shortening his honeymoon period (5 months so far and praying for many more).

What do you think - should we give Levemir a try or stay with something we know works but that has some very minor discomfort? Our endo is fine either way but wants my son’s treatment to be as easy and painless as possible.

I also agree with the mantra if it’s not broke don’t fix it. BUT if Lantus stings you could perceive that to mean it is “broke”. I have used both. I got 24 hours of coverage from Lantus. When I tried Levemir I was using a CGMS and it was quite clear I got about 16 hours of coverage. I think how much coverage is obviously tied to individual variation in how our bodies work but also dose dependent. Those on lower doses of Levemir are less likely to get a whole 24 hours.

As far as stinging I have had all available forms of insulin sting from time to time but did notice it was far more likely to happen with Lantus. I did not perceive that one or the other made things any smoother as far as blood sugar but have read many others state there blood sugar is much smoother on Levemir.

On a side note: Gig’em Aggies :slight_smile:

I definitely have heard people have a smoother more even coverage with Levemir, and most people are glad they switched. But it seems I also hear most people take Levemir twice a day. For me, I had to switch my Lantus to twice a day and still didn’t like the coverage. Now I am on a pump, which has the best basal coverage by far because you can set it to different rates for different times of day.

Having said all that, if the only problem your son has with Lantus is the sting and if he doesn’t really mind the sting, I’m definitely with you on the “if it’s not broken, don’t fix it”. Many of us have to make multiple changes in our regimen to get good results, and if he is doing fine right now, why look for trouble? When he is out of his honeymoon period he might have to join the rest of us looking for better options. Hopefully not. Or maybe they will have the artificial pancreas (closed loop system) out by then. One can hope.

So yes, though many people like Levemir better I’d still say I agree with your thinking that if Lantus is working fine, stick with it.

I don’t think you can go wrong either way. If your son is okay dealing with the current regime - burn and all, keep it. If not, give the Levemir a whirl. If the Levemir doesn’t work, go back to the Lantus. No harm, no foul. I would give your son the facts (lantus burns and Levemir may = twice a day) and see what he wants to do, let him have control of this choice. :slight_smile:

If it really bugs him, then consider switching.

Otherwise… if it were me, I wouldn’t. At least not now, since it’s only been 5 month.

You say you’re getting good control with Lantus, so there wouldn’t be a reason for using a different insulin in the first place.

Since I just recently switched from Lantus to Levemir, I must say that it does not cover 24 hours whatsoever! However, for some people it seems to work out. But then, for most people, Lantus also covers 24 hours - which it does not for me (the reason I’m trying Levemir now). Also, according to my endo, the majority of the people takes Levemir twice a day. Who’s right, I can’t tell.
For the singing: I don’t feel any difference.

From my own experience I’d say that it might sting because you’re using syringes.

It’s quite some years since I last used one but I’d say that it sings less (if even) if you use pens. I’ve never had a Lantus shot with a syringe, though. But that’s how it was with the insulin I was using back then.

Maybe you could get a pen in a different colour than the other one?

What else… if you’re taking the Lantus directly our of the fridge, warm it in your hands before using. Cold insulin stings more than hand-warmed insulin.

I agree that the sting could mean it’s “broken”, but there are plenty of times he says he doesn’t feel it at all. I can’t figure out why it hurts sometimes and not others - could be that I’m in a more sensitive spot sometimes?

Thanks for your response - since I’m the mom and not the patient, I can only imagine how it feels but don’t know first hand. It’s nice to get input from people in his shoes.

Hook 'em!

Thanks for your reply. I’m leaning your way - if the sting is just a minor annoyance and not a big problem for him, AND I know he’s getting good coverage with Lantus, I think I’ll just stick with it. I antcipate he’ll be on a pump in a matter of months, then the Lantus sting won’t be an issue anymore.

He’s a really easy-going kid and does deal with the current regiment well, sting and all. He’s ambivalent about the change - if it would still be one shot, he’s fine with changing; if it means 2 shots, he doesn’t want to change. So, what would be in store for him is to try Levemir, then if he doesn’t get 24 hours out of it, go back to Lantus. I’m not sure messing with all that is worthwhile since the sting is not really a big deal for him. Tonight he said he didn’t feel his shot at all - not even the needle.

Thanks for your input.

Thanks for responding. I do use room temperature insulin, but I suppose I could try the pen and see if that makes any difference. I wish I could take the shots for him!

I was on Lantus for about 8 years and dealt with the sting most days. I just figured that was the way it goes :slight_smile:

Anyway, I spoke up about it to my endo who prescribed Levemir. She didn’t mention the 2 shots a day and I had HORRIBLE numbers. After searching online, I saw that many need it twice a day. But after 8 years of once a day, I could not seem to get the hang of twice a day (go figure!). So I went back to Lantus. It was actually easier to tolerate the burn because I knew it was better than Levemir for me :slight_smile:

I am now on a pump and really happy I switched. Good luck to you and your son!

I take 2 doses of Levemir per day, with the night dose being slightly smaller. It’s never stung me at all even right out of the fridge, nor have I ever experienced a night-time low while taking it. I was originally on only the one shot during the day, before being put on two, and I didn’t like having to take an extra shot per day either, but eventually I just got used to it.

I get really good numbers with Levemir, but I know that other people don’t enjoy the same results. If your son would rather have the sting than take two shots, I don’t see any reason to change it if his numbers are good.

Sometimes Lantus stings, sometimes it doesn’t. It doesn’t seem to be the site. (for me anyway). The Lantus pen is a different color and size than the Humalog pen so you might consider getting it for him. I take Lantus in the morning and always get it out separately from the Humalog. Then I put it back in the case and get out my Humalog. And yes, sometimes Humalog can sting!

Here’s my experience:

Lantus = often get stinging, but works reliably
Levemir = major itching at injection site, which started pretty much immediately and continued for HOURS, and I never did find a dosage of the stuff that did anything at all for me (basically it didn’t work).

I used to use longer needles (the older 1/2" long ones) when I first started on Lantus because I discovered that the longer needles meant it stung less no matter where I injected it… that might be something you could try.

I Germany most CDE’s would recommend two shots of Levemir per day and this is my opinion too. This way you will achieve a very high level of stability. This is the fundament for good control, for reliable I:C ratios and not the abuse of bolus insulin to cover the gaps in basal coverage.

With Lantus most users are aware that it has peaks. Most are also aware that only 23 hours of their basal needs are covered (at least they see very different I:C ratios). They live in a conflict: increase the dosage to cover the day VS decrease the dosage to prevent lows in the peak time.

With the right application of Levemir you will have more flexibility. The dosage for day and night can be different and both shots will combine nicely to cover the basal needs evenly.

Thanks for all of the input. As much as I can learn and try to educate myself, I don’t truly know what it’s like to walk in the shoes of someone with this disease. It’s very helpful to learn from people who walk this path every day. I appreciate you all sharing your perspective, so I can learn from you and use your experience in helping me make the best decisions possible in caring for my son.