I contacted my doctor about switching to Levemir as my HMO has made Lantus cost me almost twice as much as Levemir will. In passing I mentioned that I understand that I'll need to break my current total Lantus dose into two Levemir doses, 12 hours apart (due to the shorter efficacy time of the Levemir.) This was her reply:
"I will check with pharmacy on how to convert your Lantus to the Levemir safely."
Then, the next day:
"...To follow up on our previous discussion about the Levemir, it looks like you can stay on one dose once a day. Levemir is very close to Lantus (glargine), but sometimes we need to make small adjustments after someone switches. So your dose will be a little higher from 55 to 58..."
I found this quote on-line, which more-closely matches my understanding of how to use Levemir after talking about it with dozens of diabetics who have road-tested it: "Whether Lantus is better than Levemir, or vice versa, is debatable. Levemir is generally supposed to be injected twice daily (although it's approved by the FDA for once or twice daily) and Lantus once. According to Dr. Richard Bernstein, however, Lantus also usually works better if injected twice a day..."
So on the one hand I know that I have both big dawn phenom plus a history of crashing in the wee hours (between midnight and three) and I have a pretty huge dose (compared to most T1's, certainly) which dictates that my 55-58 IU basal injection should be broken up anyway just to ensure absorption. I also have a world-class diabetes expert like Dr. Bernstein saying that breaking basal up into two injections is better for proper basal coverage.
On the other hand, I have my doctor who is calling the pharmacist to ask his advice on how to administer my medication and then telling me what he said without any kind of knowledge, experience of her own or critical thinking about MY case and MY dose informing her decision.
It's VERY frustrating/frightening to be at the mercy of this kind of incompetence -- thank you HMO model of lowest-quality/cheapest-price "health" care. I get the feeling sometimes that I'm being asked to rely on people who have about :15 minutes of education on how to manage diabetes. :0\
Thank goodness I have books and other diabetics to help me! I believe it was Gerri who first encouraged me take ownership of managing my own insulin regime. THANK YOU. I just nod at my doctor and do what I know is right after careful study and cross-referencing, because it's my body, my life and I'm not going to peak and crash, peak and crash if I can help it.
By the way, these HMO people are the same ones who wanted me to do a sliding scale based on an I:C ratio of 1:30. I'm up to an I:C ratio of 1:4! Using 1:30 was like injecting water -- it had zero effect. An I:C ratio of 1:30 is more appropriate for T1 children or insulin-sensitive adults, not adults with severe insulin resistance.
Sheesh. I'd kinda like to keep my toes, thanks!