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Which Is Better Lantus Or Levemir?

How Do You Use Basal Insulin?

How Do You Use Basal Insulin?

When the first long-lasting basal insulin analogs (insulin glargine [brand name Lantus] and insulin detemir [Levemir]) came out, they were supposed to last 24 hours. You injected once a day. That schedule clearly doesn’t work for everyone. Why is that, and what works for you? First of all, what is “basal” insulin? “Basal” insulin is that background level of insulin you need 24 hours a day. It’s not for the food you eat; it’s for everything else insulin has to do in your body. As I wrote here, insulin keeps glucose stored in the liver, fat stored in fat cells, and promotes cell reproduction, along with several other functions. People with Type 1 and many with Type 2 have very low or no basal insulin. Without basal insulin, your liver can pump out glucose all the time. Your sugars can go way up even if you don’t eat, like at night. So the invention of a 24-hour basal insulin was a great advance. It brought people’s A1C levels way down, but it doesn’t always work as advertised. Dr. Richard Bernstein, author of Diabetes Solution, says “In my opinion, there is no 24-hour basal insulin.” Larger insulin doses take longer to absorb. According to Dr. Bernstein, drug companies used larger-than-needed doses to make them last 24 hours. “The large basal doses needed to make ‘long-acting insulins’ last 24 hours,” he says, “[can cause] a number of undesirable consequences. These include hypoglycemic episodes [lows], weight gain, and possible [blood vessel] effects.” At the proper doses, basal insulin will frequently not last 24 hours. A study in Diabetes Care found a window of low insulin levels when the daily dose has worn off and the next day’s dose hasn’t yet kicked in. The authors suggested twice daily dosing would provide better coverage. O Continue reading >>

Basal Insulins

Basal Insulins

Lantus and Levemir are long-acting insulins that supply the background insulin needed to supply cells with glucose around the clock while preventing release of excess glucose from the liver and excess fat from fat cells. The waking glucose level best measures the activity of these insulins. All Type 1s and many Type 2s also require a faster insulin (Humalog, Novolog, or Apidra) to cover meals and lower any high glucose. Some Type 2s who have adequate insulin production do well with one of these long-acting insulins, plus oral medications or a daily or weekly injection of a GLP-1 agonist. Lantus® insulin (glargine) made by Sanofi-Aventis is promoted as a once a day background insulin. However, many users find that it does not last a full 24 hours for them and these users often notice a peak in activity about 6-8 hours after the injection. If once a day injection is giving you good control, there is no need to change and a bedtime injection is typically best. For others, splitting the dose and injecting twice a day (usually at breakfast and bedtime) often works better, lessens peaks and gaps in activity, and helps those who cannot inject Lantus within one hour of the same time each day. Lantus is slightly acidic and some may notice slight discomfort at the injection site. Levemir insulin (detemir) made by Novo Nordisk works for about 18 hours and may have a peak in activity 4-6 hours after the injection. It is taken twice a day. Different people react to each insulin differently. The best advice is trying the other insulin if one does not seem to be working well for you. Both insulins generally work quite well, but neither can be mixed in a syringe with fast-acting insulin, and neither should ever be used in an insulin pump. Keep in mind that an older insulin called NPH Continue reading >>

Levemir Versus Lantus

Levemir Versus Lantus

For people who are struggling to control their diabetes and require regular insulin injections, two of the most common long-lasting options are Levemir and Lantus. In the Levemir vs Lantus debate, both are intended for daily use and neither one is intended to help with an immediate spike of blood sugar should it occur. Neither one won’t treat ketoacidosis should it occur either. When both insulin options are considered, the risks of side effects and the benefits they provide are also the same. With so little between these two injections, are there any differences that can help to decide which one is better to take? Here are some answers to some common comparison questions. 1. How Often Does An Injection Need To Occur? Levemir can be taken either once or twice per day. The doses must be spread out over the course of 12 hours to prevent low blood sugar levels from forming. For those who inject Levemir just once per day, it should be taken around bedtime or at dinner so that it can provide the best results possible. Lantus is only taken once per day. It doesn’t matter what time of day that it is taken, but a routine should be established so that one dose occurs every 24 hours or so. Taking it in the morning one day and then in the evening the next day is not recommended. 2. What About Weight Gain? Levemir has been shown to lessen the risks of gaining weight while taking insulin injections. This may be beneficial to those who are working to control their Type 2 diabetes especially. Lantus provides a higher overall risk of weight gain, but people can gain weight while using either product. Lantus, on the other hand, was developed to produce fewer injection site reactions when used regularly. There is less of a risk of developing a rash or other similar skin reaction when Continue reading >>

Lantus And Levemir: What’s The Difference?

Lantus And Levemir: What’s The Difference?

Lantus and Levemir have a lot in common. Both are basal insulin formulas, which means that they last for a long time in the body and act as background insulin, with a slow feed that mimics the constant low output of insulin produced by a healthy pancreas. Both are insulin analogues, which means that their insulin molecules are analogous to human insulin, but engineered, or recombined, with slight differences that slow their absorption. Lantus is a clear formula made with glargine, a genetically modified form of human insulin, dissolved in a special solution. Levemir is also a clear formula, but it contains dissolved detemir, a different form of genetically modified insulin. Human insulin is made of two amino acid chains, called A and B, that have two disulfide bonds between them. In glargine, one amino acid has been switched out, and two extra amino acids have been added to one end of the B chain. The modifications make glargine soluble at an acidic pH, but much less soluble at the neutral pH that’s found in the body To make Lantus, first the glargine is produced by a vat of E. coli bacteria. Then it’s purified and added to a watery solution containing a little zinc and some glycerol; a dash of hydrochloric acid is also added to make it acidic, bringing its pH down to about 4. At that degree of acidity, glargine completely dissolves into the watery solution, which is why the vial is clear. After you inject it into your subcutaneous tissue, the acidic solution is neutralized by your body to a neutral pH. Because glargine is not soluble at a neutral pH, it precipitates out into a form that’s not soluble in subcutaneous fat, and there forms a relatively insoluble depot. From that pool, or depot, of precipitated glargine in the tissues, small amounts slowly move back Continue reading >>

Can I Get Insulin Over The Counter?

Can I Get Insulin Over The Counter?

Jennifer Smith of Integrated Diabetes Services answers a question about generic insulin brands available at WalMart. We receive many questions about over-the-counter insulin, so we decided to ask certified diabetes educator Jennifer Smith of Integrated Diabetes Services (IDS) about it. Here’s her answer: Today, most prescriptions for those using insulin cover the most up-to-date types of insulin – basal insulins such as Lantus and Levemir, as well as rapid-acting insulins like Novolog, Humalog and Apidra. Read “Can I Use Insulin Past Its Expiration Date?” When you buy insulin over the counter (OTC), these brand-name insulins are not available. sponsor ReliOn Brand of insulin at Walmart is available without prescription in some states. However, it includes very limited types of insulin. These are the older generation of insulins, including R insulin, also called Regular (a short-acting insulin and N insulin (an intermediate-acting insulin taken twice a day). These generic OTC insulins have a very different action profile than prescribed insulins. However, generic does not by any means indicate low quality. Having an insulin back-up plan in case you find yourself with an outdated prescription or short on funds is important. It would be beneficial to discuss with a health care provider how to go about using these generic OTC insulins before you have to use them, however. Read “Why Walmart Insulins Aren’t the Answer to High Insulin Prices.” Rapid-acting insulin works faster and clears your body faster. Basal insulin analogs typically work longer and more evenly without a peak in action, unlike the intermediate-acting insulin that has to be taken two times a day. R and N insulin types require users to have a bit more stability to their meals and daily activitie Continue reading >>

Insulin Detemir Versus Insulin Glargine For Type 2 Diabetes Mellitus.

Insulin Detemir Versus Insulin Glargine For Type 2 Diabetes Mellitus.

Abstract BACKGROUND: Chronically elevated blood glucose levels are associated with significant morbidity and mortality. Many diabetes patients will eventually require insulin treatment to maintain good glycaemic control. There are still uncertainties about the optimal insulin treatment regimens for type 2 diabetes, but the long-acting insulin analogues seem beneficial. Several reviews have compared either insulin detemir or insulin glargine to NPH insulin, but research directly comparing both insulin analogues is limited. OBJECTIVES: To assess the effects of insulin detemir and insulin glargine compared with each other in the treatment of type 2 diabetes mellitus. SEARCH STRATEGY: We searched MEDLINE, EMBASE, The Cochrane Library, online registries of ongoing trials and abstract books. Date of last search was January 2011. SELECTION CRITERIA: All randomised controlled trials comparing insulin detemir with insulin glargine with a duration of 12 weeks or longer were included. DATA COLLECTION AND ANALYSIS: Two authors independently selected the studies and extracted the data. Pooling of studies by means of random-effects meta-analysis was performed. MAIN RESULTS: This review examined four trials lasting 24 to 52 weeks involving 2250 people randomised to either insulin detemir or glargine. Overall, risk of bias of the evaluated studies was high. Insulin glargine was dosed once-daily in the evening. Insulin detemir was initiated once-daily in the evening with the option of an additional dose in the morning in three studies and initiated twice-daily in one study. Of randomised patients 13.6% to 57.2% were injecting insulin detemir twice-daily at the end of trial.Glycaemic control, measured by glycosylated haemoglobin A1c (HbA1c) and HbA1c equal to or less than 7% with or with Continue reading >>

In My Opinion: There Is No 24-hour Basal Insulin

In My Opinion: There Is No 24-hour Basal Insulin

by Richard K. Bernstein, M.D., F.A.C.E., F.A.C.N., C.W.S. Diabetes Health You can make any insulin last longer by injecting a large enough shot. In fact, about 25 years ago, Dr. John Galloway of Eli Lilly and Company performed an important experiment that demonstrated this very fact. In his experiment, Dr. Galloway injected 70 units of Regular insulin into the arm of a non-diabetic man. To prevent the patient from having serious hypoglycemia, his blood sugar was tested every half hour and glucose was infused into his bloodstream as needed. Given that the package insert for Regular stated that the insulin would work for four to twelve hours after injection, one might expect that Dr. Galloway could have stopped the glucose drip after twelve hours. As it turned out, however, the subject’s blood sugar kept dropping for a full week, and the glucose drip had to be continued for that long just to prevent him from going low. It certainly makes sense that a large volume of any liquid injected under the skin will require more time to be fully absorbed by nearby blood vessels than a small volume. When I was young and injected 120 units a day of NPH insulin to cover my high carbohydrate ADA diet, it would take about two weeks for the lump at each injection site to disappear. The message of Dr. Galloway’s work is apparently very familiar to modern insulin manufacturers who claim 24-hour action for their basal insulin analogues. Of course, several studies have been published to support their claims that both Lantus and Levemir last 24 hours. The single daily injection in these studies, however, is based upon using 0.3 to 0.4 units of insulin per 2.2 pounds (one kilogram) of body weight. For a 154-pound person, this comes to 21 to 28 units per daily injection. In my experience, a Continue reading >>

The Switch1 Trial: Proving That Lantus/basaglar Has A Higher Hypocglycaemia Rate Than Tresiba

The Switch1 Trial: Proving That Lantus/basaglar Has A Higher Hypocglycaemia Rate Than Tresiba

Let’s start with the SWITCH 1 trial. What is it? It was a Phase 3a trial to compare the hypoglycaemia benefit of the two insulins. It was a double-blind, crossover trial, which essentially means that when participating, you used both insulins and didn’t know which one you had at any point in the trial. The results were published much earlier this year, but the interesting point in the study seems not to have been picked up on by many in the diabetes world. If you want the full details of the trial design, please take a look here (you will need a login until the 17th September, after which access will be free). It’s important to note that for this trial, there were 501 initial participants and that 388 of them had factors that increased their risk of hypoglycaemia (including hypo unawareness, the experience of more than one severe event in the preceding 12 months, moderate renal failure, diabetes for longer than 15 years and a hypo in the previous 12 weeks – so what might be considered a normal Type 1!). There was a 16-week titration period followed by a 16-week maintenance period, where the basal level was considered to be correct. At the end of each 32 week period, the treatments were swapped so that all participants used both treatments. If you want to see the results, please click here. I think you’ll be unpleasantly surprised. I was. What was being compared? The hypoglycaemic effects of Degludec (Tresiba) versus those of Glargine (Lantus; Basaglar) were being compared, and one might argue that the results are disturbing. Why? Because there is a clear difference in what was determined much to the detriment of Glargine. And one that should make decisions on choice of insulin very clear. Overall Hypoglycaemic Risk What you can see here is that during the main Continue reading >>

Key Facts About Basaglar: A Less Expensive Long-acting Insulin

Key Facts About Basaglar: A Less Expensive Long-acting Insulin

If you’ve been using a long-acting insulin like Lantus, you might have heard about a friendly competitor called Basaglar which is coming soon to pharmacies. Basaglar is insulin glargine known as a biosimilar (also called a follow-on biologic). Because of the manufacturing process it isn’t considered a generic, but there are no differences from Lantus in regard to safety, purity and potency. To get to know Basaglar better, here are some details you’ll want to be aware of. What is the difference between a biosimilar and a generic? Generic drugs are copies of a brand name drug, and their manufacturing process can be replicated exactly through chemical reactions. Biologics are made using manufacturing processes and living organisms that are unique to each manufacturer. Therefore, it is not really possible to make an exact copy of a biologic. For an in-depth look at the definition of biosimilar, see here. Is Basaglar less expensive than Lantus? The cost of Basaglar is estimated to be about 20% cheaper than Lantus. It is manufactured by Eli Lilly as a KwikPen. Basaglar won’t be sold in a vial form. Will my insurance switch me to Basaglar? In some cases, yes. CVS Health has announced that Basaglar will be on formulary in place of Lantus. Is it really equivalent to Lantus? Yes, the onset, peak and duration of action are almost identical. Will my dose be the same as the insulin I’m currently taking? Your healthcare provider will tell you exactly how to make the switch. In general, Lantus and Basaglar can be interchanged unit for unit. If you were on Levemir, the conversion will also be unit for unit. If you were taking Levemir twice a day, the total number of units will likely be given as one Basaglar injection. If you are switching from Toujeo or NPH, your dose might Continue reading >>

Product Important Safety Information

Product Important Safety Information

Selected Important Safety Information WARNING: RISK OF THYROID C-CELL TUMORS Liraglutide causes dose-dependent and treatment-duration-dependent thyroid C-cell tumors at clinically relevant exposures in both genders of rats and mice. It is unknown whether Victoza® causes thyroid C-cell tumors, including medullary thyroid carcinoma (MTC), in humans, as the human relevance of liraglutide-induced rodent thyroid C-cell tumors has not been determined. Victoza® is contraindicated in patients with a personal or family history of MTC and in patients with Multiple Endocrine Neoplasia syndrome type 2 (MEN 2). Counsel patients regarding the potential risk for MTC with the use of Victoza® and inform them of symptoms of thyroid tumors (eg, a mass in the neck, dysphagia, dyspnea, persistent hoarseness). Routine monitoring of serum calcitonin or using thyroid ultrasound is of uncertain value for early detection of MTC in patients treated with Victoza®. Selected Important Safety Information Tresiba® is contraindicated during episodes of hypoglycemia and in patients with hypersensitivity to Tresiba® or one of its excipients Levemir® is contraindicated in patients with hypersensitivity to Levemir® or any of its excipients NovoLog® and NovoLog® Mix 70/30 are contraindicated during episodes of hypoglycemia and in patients hypersensitive to insulin aspart or any of the excipients Warnings and Precautions Never Share a Tresiba® FlexTouch®; Levemir® FlexTouch®, NovoLog® FlexPen, NovoLog®FlexTouch®, PenFill® Cartridge, or PenFill® Cartridge Device; or NovoLog®Mix 70/30 FlexPen® Between Patients, even if the needle is changed. Patients using vials must never share needles or syringes with another person. Sharing poses a risk for transmission of blood-borne pathogens Hypoglyc Continue reading >>

Specific Insulin Info & Dosing Scales

Specific Insulin Info & Dosing Scales

There are many kinds of insulin available to use for our FD cats. Some perform much better than others and each has its idiosyncrasies. Sometimes we will have a choice when it comes to which insulin is prescribed by our vets; sometimes we won't. Whatever insulin, all insulin types have been proven to work with TR. The insulin types addressed in this sticky are PZI (compounded, ProZinc and Hypurin), Lantus, Levemir, NPH (Humulin N), Caninsulin/Vetsulin, please scroll down to for information on the specific insulin. It is advised to start TR / Insulin when you are available to monitor your cat’s BG frequently by performing frequent testing and/or curves for the first few days until you know how your cat processes their insulin. One of the important premises TR is built on is maintaining overlap between doses – meaning that the remnants of the prior shot are still working to keep the BG from rising very high, while the next shot approaches onset (when the insulin starts to work). Different insulin types have different durations -experienced members on forum will help guide you through the process of understanding the nuances of the insulin you are using to get maximum results. Insulin should be stored in the fridge at all times, in a protected spot on a less-used shelf, in a sturdy, padded container where it will not get knocked over. Do not store insulin on the door of your fridge to avoid excess jostling. Practicing TR we handle our insulin more often than when dosing twice a day. Handling your insulin gently and with care will prolong potency considerably. Dr. Hodgkins' Tight Regulation protocol was developed for use with bovine based PZI insulin but it has been proven over time that many insulin types work very well with TR. Please scroll down this page for explana Continue reading >>

Cochrane Review – Long-acting Analogues Vs Nph Insulin In Type 2 Diabetes

Cochrane Review – Long-acting Analogues Vs Nph Insulin In Type 2 Diabetes

Reviews and reports K Horvath, K Jeitler, A Berghold, SH Ebrahim, TW Gratzer, J Plank, T Kaiser, TR Pieber, A Siebenhofer Cochrane Database of Systematic Reviews 2007 Issue 2 (Status: New) Insulin analogues are the latest form of GM synthetic insulin and this review compares long-acting analogues glargine [Lantus] and determir [Levemir] with long-acting ‘human’ isophane [NPH] insulin for Type 2 diabetes. For us to have an informed choice of treatment, it is necessary to look at evidence from high quality systematic reviews and Cochrane Reviews provide just such evidence. The authors’ conclusions are: "If at all there is only a minor clinical benefit of treatment with long-acting insulin analogues for patients with diabetes mellitus type 2 treated with "basal" insulin regarding symptomatic nocturnal hypoglycaemic events. Until long-term efficacy and safety data are available, we suggest a cautious approach to therapy with insulin glargine or detemir." Below is the ‘Plain Language Summary’ but the full review can be found on the Cochrane Database www.cochrane.org Plain language summary No unambiguous clinical benefits of treatment with long acting insulin analogues in the majority of people with type 2 diabetes mellitus demonstrated NPH (Neutral Protamine Hagedorn) insulin is the current standard for basal insulin in the blood glucose lowering therapy in people with type 2 diabetes mellitus. The mode of action of this insulin is highly variable, which may be the cause for the difficulties some people with diabetes have to achieve current goals for long-term metabolic control. Therefore, new insulins which are thought to show more favourable properties of action have been developed: insulin glargine and insulin detemir. Because of their theoretical advantages, it Continue reading >>

When You Can't Afford The Insulin That You Need To Survive | How To Use The Cheap

When You Can't Afford The Insulin That You Need To Survive | How To Use The Cheap "old-school" Insulin

Note: BootCamp for Betics is not a medical center. Anything you read on this site should not be considered medical advice, and is for educational purposes only. Always consult with a physician or a diabetes nurse educator before starting or changing insulin doses. Did you know that all type 1 diabetics and some type 2 diabetics need injectable insulin in order to live? Put another way, if a diabetic needs insulin in order to live, and the diabetic does not get insulin, the diabetic will die. Diabetic death from Diabetic Ketoacidosis is a grisly process, during which acid starts running through your bloodstream, searing your vessels and organs while your body shrivels up in dehydration as it tries to push the acid out of your body through your urine and lungs, and, left untreated, the condition shuts down your organs one by one until you are dead. If you're lucky, your brain will be the first thing to swell itself into a coma and you'll be unconscious for the remainder of the organ failures. In some cases, this grisly diabetic death can take a few days or weeks to complete its process. Or, if you're one of the luckier less-resistant insulin-dependent type 2 diabetics, you may actually get away with staying alive for quite a few years and suffer only some heart disease, stroke, kidney damage/failure, neuropathy, limb amputations and blindness. (my intent in describing how lack of insulin leads to death is not to cause fear in people with diabetes or their loved ones; rather, my intent is to make clear the reality that injectable insulin is absolutely vital to diabetics who depend on injectable insulin to live) While I'd love to go off on a political rant about how insulin should be a basic human right for all insulin-dependent diabetics (and why the hell isn't it?), that' Continue reading >>

Hit Me With Your Best Shot: Updates In Insulin Therapy

Hit Me With Your Best Shot: Updates In Insulin Therapy

C A T H Y E D I C K , P H A R M D , C D E A P R I L 9 , 2 0 1 7 Pharmacist Learning Objectives  List the onset, peak and duration of action for the various insulin preparations  Determine which insulin to use and how to adjust doses based on blood glucose values from a given patient  Assess where the newest insulin products fit into diabetes management Pharmacy Technician Learning Objectives  List the onset, peak and duration of action for the various insulin preparations  Describe the newest insulin products  Describe how blood glucose values are used to make adjustments to insulin regimens Insulin Basics  When is insulin indicated?  Type 1 = ALWAYS  Type 2 =  High baseline A1c  Poorly controlled on 3 oral/non-insulin medications  Contraindications to non-insulin medications  Pregnant women  Hospitalized patients Review Question  Which of the following appropriately orders the insulins from shortest acting to longest acting? A. NPH, Lantus, Humalog B. Humulin R, Novolog, Levemir C. Tresiba, NPH, Levemir D. Novolog, NPH, Lantus Insulin Basics Types Examples Rapid-acting Aspart (Novolog) Lispro (Humalog) Glulisine (Apidra) Short-acting Regular (Humulin R, Novolin R) Intermediate- acting NPH (Humulin N, Novolin N) Long-acting Glargine (Lantus, Basaglar, Toujeo) Detemir (Levemir) Ultra long-acting Degludec (Tresiba) 4/4/2017 2 Insulin Basics Onset Peak Duration Rapid-acting 15-30 min 30 min to 2.5 hours 3 to 6.5 hours Short-acting 30 min to 1 hour 2 to 3 hours 8 hours Intermediate- acting 1 to 2 hours 4 to 10 hours 16 to 24 hours Long-acting Glargine 1 hour Relatively flat 20 to 24 hours Detemir 1 to 2 hours Relatively flat 12 to 24 hours (dose dependent) Ultra long- Continue reading >>

What's The Best Insulin For Diabetic Cats And Dogs?

What's The Best Insulin For Diabetic Cats And Dogs?

With the reintroduction of Vetsulin (porcine insulin zinc suspension) to the U.S. market (1-3), I've received a number of questions concerning the use of this insulin in dogs and cats. Here are the major questions I've received: Is this the initial insulin of choice for dogs? How about for cats? Should this be an insulin that we turn to for our newly diagnosed feline diabetics? If we have a dog or cat that isn't responding well to the current insulin, should they be switched to Vetsulin? How will this insulin compare to NPH, glargine (Lantus), detemir (Levemir), or PZI (ProZinc) in cats or dogs? How does the cost compare to these other insulin preparations? Is this the initial insulin of choice for dogs? In my opinion, the answer to that is yes, this is the initial insulin of choice for most dogs. Because it's composed of both short and long-acting insulin components, Vetsulin helps control postprandial hyperglycemia and has a longer duration of action than NPH in most dogs (4-7). The cost is approximately the same as NPH, but less than the insulin analogues (e.g., detemir and glargine). See more below, where I do my cost-comparisons for the various insulin preparations. Is this the initial insulin of choice for cats? A number of studies have proven that Vetsulin will certainly control hyperglycemia in cats, especially if combined with a low carbohydrate diet (<10% of calories) (8-11). However, the duration of action may be too short in some diabetic cats, and most feel that the longer acting insulin preparations (glargine, detemir or ProZinc) work better to maintain better control of hyperglycemia in cats (11-13). Of course, maintaining glycemic control throughout the day is more important if diabetic remission is the goal (13,15,16)— if not, Vetsulin might be less e Continue reading >>

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