AskNadia: Levemir vs. Lantus Dosing
Dear Nadia:
My friend takes Lantus. She recently was sent home from the hospital with a pen of Levemir. Can she use it with the same units as ordered for the Lantus?
Lala
Dear Lala:
I’m surprised that your friend’s doctor did not tell her what dose to take after switching her insulins, and then having her regular pyscisan monitor her results.
I can’t really say whether she should inject as many units of Levemir as she was injecting with Lantus. The last time this question came up, our advisory board member Jane Jeffrie Seley, DNP MSN MPH RN GNP BC-ADM CDE CDTC suggested that even though the insulins are similar, you might need a dose adjustment.
What I can tell you is that doctors and endocrinologists usually titrate* the dosage of a new insulin at or below the dosage of the prior insulin. What they are trying to determine is what volume of new Insulin B will produce the same blood sugar results as the volume of old Insulin A. This includes tracking the number of hypoglycemic events a patient may experience with the new insulin compared to the old.
Lantus (insulin glargine) and Levemir (insulin detemir) have been popular basal insulins for several years. They are longer-acting than previous basal insulins, such as NPH, a characteristic that helped them to become basal insulins of first choice for many doctors and their diabetic patients.
They are similar insulins in terms of performance that are produced by rival pharmaceutical companies. There have been several head-to-head comparisons of their duration and effectiveness, and among the conclusions from those studies is that both deliver about the same results with regard to blood sugar control and hypoglycemic events.
Toujeo and Tresiba
Levemir and Lantus have become eclipsed by two new basal drugs: Tresiba (insulin degludec from Novo Nordisk) and Toujeo (insulin glargine U300 from Sanofi). The Sanofi-Novo Nordisk basal insulin rivalry has now become even more heated in the chase for market share with these two basals.
How they differ from older basals is that both achieve a true 24-hour span of effectiveness—a span that older basals could not achieve or maintain. Users are as well protected at 24 hours as they are as soon as either insulin starts taking effect.
Tresiba can remain effective for up to 42 hours. Users who miss one daily injection can take a second injection- no sooner than 8 hours from their last injection. Novo touts Tresiba’s longevity by pointing out that its users are not held to a strict timetable regarding when to inject it.
Toujeo does not last quite as long as Tresiba, but can legitimately promise a 24-hour duration.
Toujeo is a highly concentrated form of insulin glargine, which explains its U300 designation. Glargine at that high a concentration acts differently from glargine U100—it becomes effective sooner and lasts longer while offering very good background control of blood sugar. Toujeo users have to be aware of when they inject and try to keep to a regular injection schedule.
The drawback for these insulins is that they are more expensive than many people with diabetes want to pay or can afford. People who are successfully managing their diabetes with Lantus may prefer to remain using it rather than switch to Tresiba or Toujeo.
Lantus and Levemir Compared
For type 2 readers who do not yet take insulin, here is a quick profile of Lantus and Levemir. Both are basal insulins, which means they have a long-acting effect through the day, providing steady “background” insulin. In contrast, bolus insulins are quick-acting to control blood sugar spikes that occur after meals.
Levemir (insulin detemir)
· Category: Basal insulin
· Manufacturer: Novo Nordisk
· Year Introduced: 2005 in the US
· How injected: pen (or drawn from vial)
· Standard Dosage: 100 units m/L
· Dosage Frequency: 1 or 2 daily depending on how quickly the insulin is metabolized
· Duration of Effectiveness: Up to 24 hours
· Hits peak at: 6 to 8 hours after injection; stays consistent thereafter
Lantus (insulin glargine)
· Category: Basal insulin
· Manufacturer: Sanofi
· Year Introduced: Introduced into the European Union in 2000
· How injected: pen (or drawn from vial)
· Standard Dosage: 100 units m/L
· Dosage Frequency: 1 daily
· Duration of Effectiveness: Up to 24 hours
· Hits peak at: Does not have a pronounced peak; is steady up to 24 hours
I hope this helps and make sure your friend checks in with her regular healthcare professional as a follow up to her insulin and hospital discharge.
Nadia
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Disclaimer:
Nadia’s feedback on your question is in no way intended to initiate or replace your healthcare professional’s therapy or advice. Please check in with your medical team to discuss your diabetes management concerns.
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About Nadia:
AskNadia (ranked #1 by Google), named “Best Diabetes Blog for 2017 by Healthline and with 24 nominations, Nadia Al-Samarrie’s efforts have made her stand out as a pioneer and leading patient advocate in the diabetes community.
Nadia was not only born into a family with diabetes but also married into one. She was propelled at a young age into “caretaker mode,” and with her knowledge of the scarcity of resources, support, and understanding for people with diabetes, co-founded Diabetes Interview, now Diabetes Health magazine.
Nadia has been featured on ABC, NBC, CBS, and other major cable networks. Her publications, medical supply business, and website have been cited, recognized and published in the San Francisco Chronicle, The Wall Street Journal, Ann Landers advice column, former Chrysler chairman Lee Iacocca, Entrepreneur magazine, Houston News, Phili.com, Brand Week, Drug Topics, and many other media outlets.
