Long acting insulin - need help deciding

I have my next Dr appointment coming up on Friday and we are going to be discussing changing my long acting insulin, so please can anyone help me with your experience on these long acting insulins, if you’ve used them.

I’m currently on Optisulin, which I’ve been on now for about 7 months and my sugar levels have been very unstable (there are some other contributing factors which I can’t do anything about this stage) but knowing that I used to be on Lantus and it worked so well, I have a feeling optisulin is not helping my case.
(my medical insurance doesn’t cover Lantus anymore, which is why I did the initial change)

So based on my medical insurance, the only other option I can look at, is Levemir. Has anyone used this insulin and have had good experiences with it?

Levemir is IMO better than Lantus. Lantus used to give me weird lows. Levemir in my experience needs to be taken twice a day. So, half of your dose in the morning and the other half 12 hours later.

okay great, thank you… I’ve never tried splitting the dose on any of the long acting insulins, just because I don’t like the hassle of remembering to take another injection, but it is a good point to keep in mind

In US, Levemir is being discontinued.

https://www.diabetesdaily.com/blog/levemir-a-long-acting-insulin-will-be-discontinued-717227/

ok well at least I’m not in the US anymore, so considering it’s still an option with my medical insurance, I think it’ll be a safe switch for at least another year… thank you for the info though, will keep this in mind.

Optisulin is a generic form of Lantus (both glargine). If you liked and did well on Lantus, then Optisulin should be a virtually identical replacement. You should look for other reasons for the recent changes you have experienced, since this insulin change is unlikely to be it. For example, has eating or exercise or weight changed?

Personally, I took Lantus type (glargine) for years, but prefer and take other insulins now. I took Levemir for years also, but currently take Tresiba, and prefer that. It is my favorite of the four different basal insulins I have used.

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I know :slight_smile: but if anyone else is like me, some things that should be a standard principle/ application/ glucose effect… can for some unexplainable reason just not work and optisulin is like that for me.

I do have other factors effecting my sugar levels (actually its a list so won’t bore anyone with it & Dr knows), but I had the same factors while on lantus and my sugar levels were fine. so that’s why I’m considering changing the optisulin just to make sure it’s not contributing to the problem.

I’ve heard a lot of people speak well of tresiba, but unfortunately on my medical plan that’s not an option. Would appreciate if you could give any feedback on the Levemir, based on when you were previously on it?

When the ingredients are the same and the only difference is the label on the bottle, I have to assume that something has changed for you other than the insulin label change. I am a big believer in generic medications.

Changing to Levemir is a much bigger change, though it is certainly possible you may like it better than Lantus/Optisulin. As a type 1 you will almost certainly need to take Levemir twice a day, since it does not last more than about 12 hours unless you are taking a large dose. The length of time it lasts is dose dependent: the larger the dose per body weight, the longer it lasts. What is your weight and Lantus/Optisulin daily dose currently?

Other than the need to dose twice a day, I liked Levemir insulin. Twice a day was occasionally a problem for me since it was easier for me to forget the evening dose, leading to pretty serious highs overnight when I was asleep. If you can be sure to remember to take it, it should be fine once you adjust the dose. When splitting the dose you may find you do better with more in the morning or evening, and may want to adjust other than 12 hours apart. If you like to adjust things, you should be very happy with Levemir.

I find Tresiba significantly less adjustable than Levemir, but far more reliable and the steady dose it provides works very, very well for me. Most of the long term T1s I am aware of who take basal seem to agree, including Ponder (Sugar Surfing).

I understand your reasoning, but for me I’ve seen it happen so many times when a medicine or food should work a certain way/ use a certain amount of insulin but then I try a different brand with the same ingredients and I bomb out.

But yes like I say there are multiple reasons for my lows at the moment, for me stress has always been a trigger for rapid drops in sugar level (again even though I see most people say stress makes them go high, for me it causes rapid drops) besides stress, I have been struggling with depression, PTSD & chronic anxiety (so the mental stuff causes changes in my levels aswell) and I have a brain lesion and cancer. Stress comes from being unemployed for 19 months now (although I’m praying that changes very soon as I’m waiting for a possible job offer :pray:t2:) I’ve been on a whole range of mental health meds which have caused me so much issues with my sugar levels so for now I’m just using Urbanol - but it still doesn’t stop the stress and while the extemely high levels of stress are present, I just have no way of stopping the lows… I’ve tried adjusting my insulins levels as well as other things, but it still happens. Which is why I’m considering the basal change, just to try everything possible.

Even though I understand why you asking, I’m not going to share my weight :upside_down_face: but I’m currently using 30 units of optisulin every morning in one dose. Tried a lesser dose but then I go high.

I am a bit worried about the snag of injecting levemir twice a day though, but appreciate the input about it not lasting the full 24 hours, will definitely give it some more thought

i apologize in advance if this doesn’t apply, however, in the u.s., omnipod/insulet is trying to set people up with dexcom and omnipod 5 via the pharmacy…might need to switch to u200 insulin and lots of special approval(aka prior authorisation), but it might be worth trying since you are having trouble with basal insulin… tresiba and levemir are both novo nordisk, so at least in the us, they tend to deny brands rather than individual insulins…the pumps that use the cgm to dose tend to do much better with contraindicated medicines… just have to make sure they aren’t affecting the cgm

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  • 3 for pump. I resisted for years but switched a few years ago. With Dexcom driving the pump I’ve never been better. Well in 30 previous years, anyway.

My last basal was Toujeo. It worked better than some others.

Unfortunately pump is not an option for me because I can’t afford it. My medical insurance doesn’t cover pump supplies and only a very very very small portion towards a CGM, but such a small amount that again I cannot afford to use a CGM either. I have fought my medical insurance many times about this, but here in South Africa the costs are just too astronomically high to afford it on my own.

My apologies for asking the question on the wrong category though, even after 23 years of being type 1 diabetic I still get confused with all the diabetes jargon.

But the point I’ll take away from your message (and from others) is that twice a day, seems to be the better choice in my situation, so I’ll chat to my Dr about that and maybe try that first before switching to another brand.

Thank you everyone for your help, I really appreciate all the feedback and advice

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Don’t apologize, you asked this in the right category. I don’t know what Bowler is talking about, and assume he is a T2, because it is not true that all basal insulins are the same and all give flat response. And it is not necessary to use a pump to get flat basal coverage - many T1s are successful with long acting basal insulin. I think it is a US thing to think everyone should be on a pump.

It is true that taking any basal insulin twice a day smoothes out coverage for any T1. It is absolutely necessary with Levemir due to short action time. And I took Lantus twice a day, though some people (like you) have been successful taking it once a day. Tresiba is the only modern insulin I have taken that worked well for me once a day.

I hope you can figure out a way to get a CGM. That is more important than a pump in achieving good management. I assume you have looked at Libre as well as Dexcom since it is more affordable. Although a CGM is better, a reasonable alternative to a CGM is to check BG very frequently. I did OK when testing a dozen times a day or more, but CGM helps especially overnight.

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when it comes to the CGM I really have exhausted all options, I would give you the cost so you can see what I mean but I also know from living the in the US that even when you do the currency conversion it doesn’t give a true depiction of what it really costs based on other financial information that ties in with currency coversions. But it really is massively expensive.

Dexcom is the most expensive, there are some cheaper ones but they still fall into the same category of having exorbitant costs. I even looked at the costs of Libre together with a Miao Miao device that attaches to it to make it a proper CGM… as the Libre one available at the moment is only a flash CGM.

So at the moment I’m testing manually about 14 times a day - I hate it, my poor little fingers are taking such a beating for it, but it’s all I can afford, so I make the best of it to make it work.

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John, I have had Type 1 for almost 65 yrs. I have never used a pump. I get excellent results with injections along with a CGM. I haven’t had an non diabetic Alc for the last 19 years. My A1c test results are always between 4.6 and 5.2. My TIR is excellent.

For those of us who wish to live without a pump, excellent control can still be obtained.

I know of least 3 well known type 1’s who prefer to not use a pump. They believe that a pump and a CGM can give excellent control, but like me, they prefer shots.

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Like Marilyn I have had T1 for close to 50 years in my case, and maintain an A1c and Time in Range that my endo says is better than current automated pump/cgm systems. So I have decided to wait until I am older before handing my control over to an algorithm, waiting for tech improvements while keeping my future pump sites virgin and unscarred.

JBowler, I have no idea what kind of diabetes you have since you don’t include any mention of it in your user page. If I recall correctly, the only time I have interacted with you was to ask why you delete all of your posts periodically, and you ignored me and didn’t answer. Please note that deleting all your content periodically contributes to the fact that no one has a clue who you are, what type of diabetes you have, how you manage your diabetes, etc.

I had bad experiences with lantus . I’d pick anything but that.

Tried all LT insulins. Loving Tresiba!

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