AskNadia: Does Levemir Last Longer Than Lantus
Which lasts longer: Levemir or Lantus?
Although many people have asked this question, the answer depends on indirect comparisons from studies that compared insulin detemir (Levemir) from Novo Nordisk and insulin glargine (Lantus) from Sanofi.
The two are basal insulins designed to provide a constant background level of insulin throughout an extended period, in both cases, 24 hours. They are not bolus insulins designed to control blood sugar spikes after meals throughout the day.
A Levemir-Lantus comparison study in 2011 found no significant differences between the two insulins. One minor difference is the ability to inject Levemir once or twice daily (adjusting dosage) while Lantus requires only one daily injection.
Each insulin works for up to 24 hours, with its effectiveness declining toward the end of that period. Because Levemir and Lantus are so similar in their effect, the choice of one over the most often comes down to personal preference, availability, and cost.
Both insulins can produce such side effects as nausea, hunger, headache, and similar complaints. So the choice of one over the other may be best decided by choosing the one that produces the fewest side effects. Health plan coverage also may affect a user’s final decision.
Tresiba and Toujeo: Game Changers
The recent introductions of Tresiba (insulin degludec from Novo Nordisk) and Toujeo (insulin glargine from Sanofi) to the U.S. market may remake the American market for basal insulins.
Toujeo is different from Lantus in that it comes in more concentrated form, namely 300-unit doses versus Lantus’ 100-unit doses, both injected by means of insulin pens. Toujeo lasts up to 24 hours, although there is a drop-off toward the end of that period. Sanofi says that Toujeo is the next step in the evolution of insulin glargine.
Long-acting Toujeo was alone in the U.S. market among souped-up basal insulins until earlier this year when Novo Nordisk finally won FDA approval to begin marketing Tresiba® (insulin degludec). This newcomer arrived with some impressive numbers: Research shows that Tresiba can last up to 42 hours per injection, with a far shallower drop in effectiveness than any other basal insulin; it leads to fewer hypoglycemic episodes among its users; and it can be injected at any time of day (8 hours between injections).
One obvious market for Tresiba is young people who keep crazy hours and workers who are on call or have staggered work schedules. If a member of that group gets preoccupied or forgetful and misses a shot, the drug’s 42-hour span of effectiveness “covers” the user.
As good as Tresiba looks on paper and in research, it has one drawback that makes it less appealing to certain user groups: It costs more than any other basal insulin, anywhere from 18 percent to 30 percent more than any rival brands. Its initial high cost closed the German healthcare market to it, and delayed its approval in the United Kingdom. In the United States, some users will afford it on their own, but it could be awhile before major health plans fold it into their formularies and offer it—most likely at a higher deductible—as a diabetes drug option.
You might also be interested in reading these insulin related columns:
AsKNadia: Substituting Lantus Insulin For Levemir Insulin
AskNadia: Skin Reaction to Levemir Insulin
Go here to see an extended discussion of Levemir and Lantus comparisons:
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.
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 received 14 nominations for her work as a diabetes advocate. Her passion for working in the diabetes community stemmed from her personal loss of family members to diabetes. She has used her experience as a caretaker to forge a career in helping others.
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4 thoughts on “AskNadia: Does Levemir Last Longer Than Lantus”
Hi. Concentrated lantus is actually not the next step in the evolution. There have been concentrated insulins out there for a long time. Tresiba is the first new molecule in a long time. It’s AT least 42 hours duration and the benefits far outweigh everything else, including concentrated lantus. Sanofi just needed to protect their market as lantus is now off patent. Toujeo package insert says more insulin is needed when switching from lantus …huh? I do my reading and have a family member on insulin. Also, the cost for Tresiba is no more than the others – 80% mg care coverage nationwide. CVS – one of the biggest pharmacy benefit organizations- is actually kicking lantus and toujeo off their formulary in Jan 2017. – was just in the news. So in a few months, looking at the big picture, lantus and toujeo will more expensive than all the others. Just keeping everyone informed here.
You say “One minor difference is the ability to inject Levemir once or twice daily (adjusting dosage) while Lantus requires only one daily injection.”
However, I have never used Levemir, but while I was on Lantus, due to the DEFINITE PEAKING of the Lantus in my system, I HAD TO split my daily Lantus Insulin dosage into one morning, and one evening dose because if I took the full day dose all at one time in the evening, I was hit by a DEFINITE PEAK IN ACTION that would cause my BG to drop into the teens or even SINGLE-DIGIT range by the time I was supposed to be getting up for work. That caused MANY times where I woke up for work 1 – 3 hours after I was supposed to have been at work, and I woke up to one or both of my bosses pounding on the door of my house trying to get me to wake up…
And one time when I woke up to an IV in my arm, both my bosses along with the EMT Rescue Squad crew around my bed.
So YOU ARE WRONG when you imply that Lantus is strictly a ONE SHOT A DAY Insulin!!! Lantus HAS A DEFINITE PEAK at least in SOME people, and MANY users get better results with Lantus by splitting their TDD in half and taking one shot of Lantus in the morning and another shot of Lantus in the evening.
Sorry to hear about your EMT Rescue Squad experience.
The dosing information in my column comes from Sanofi-Aventis and Novo Nordisk’s dosing recommendations found in their prescription information. Physicians have the latitude to change dosing as they see fit for their patients.
Typo corrected: Paragraph 2 corrected from ” … Sanofi, Lantus and Tresiba …” to Sanofi, Lantus and Toujeo ” Sorry for the typo.
I disagree with your comments.
You seem to harbor an animus regarding Sanofi, Lantus and Toujeo while being very bullish on Levemir and Tresiba.
Read the Toujeo PI — Toujeo has physiologic activity for 36 hours. The 36-hour data is in the PI and is derived from a clamp study.
Regarding Levemir – you must also consult the PI for accurate information rather than anecdotal reports. Levemir’s duration of action is dose dependent.
You do not get a 24 hour profile at lower doses; you do get 24 activity at higher doses but not at starting dose.
Regarding Tresiba, the Tresiba PI contains 7 head to head trials of Tresiba dosed once per day versus Lantus dosed once per day.
In each of the 7 trials listed in the PI, once-per-day Lantus bought a higher proportion of patients to an A1C of less than 7.