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MSN,RN,CDE
Lantus vs. Levemir
keywords: basal insulin
Section:  General Diabetes

My hospital is considering using Levemir  rather than Lantus. I have read about Levemir but have very little experience with it. Would those of you who have experience with these insulins please answer my poll questions? And please add any comments that may be helpful. Thanks in advance. Roxy

Is Levemir equivalent to Lantus?
Poll Results:
Yes, they are equivalent
25% 25% (1 votes)
No, Levemir needs to be dosed BID
25% 25% (1 votes)
No, higher doses of Levemir are needed to achieve glycemic control
0% 0% (0 votes)
Both 2 & 3
50% 50% (2 votes)
MEMBER COMMENTS
Re: Lantus vs. Levemir

Hi Roxanne
My answer does not fit into any of the categories you offered. There are, however, distinct differences between Lantus (glargine) and Levemir (detemir). The deliver of insulin action  (sometimes influenced by dose) and duration of potency assurance in an insulin pen are also to be noted.

        Lantus has a low pH of 4 (acidic), and thus differs from other insulins which are generally neutral (pH of 7). When Lantus is injected, the acidic solution is neutralized by the body, causing insulin glargine crystals to precipitate out.  From those crystals, the insulin is slowly absorbed over about 24 hours (sometimes fewer than 24 hours). In an insulin pen the potency of Lantus is assured for 29 days.

Levemir does not form a precipitate as Lantus does. Levemir binds to albumin in both the circulating and interstitial fluid. This provides a buffering effect against the impact of changes in absorption rate. If the patient has a low albumin, it is unclear what the effect that has on Levemir. It surely must have some effect, but I have not found any research to specifically determine that aspect. In an insulin pen,  the potency of Levemir is assured for 42 days.

This is a great topic. When I teach health professionals or patients, I always say that if efficacy is not achieved with either one, it is worth trying the other. The reasons for that recommendation are clear by my comments above.

Re: Lantus vs. Levemir

WOW.  Pat Linekin, you are brilliant!  I never before understood the pH relevance and the precipitating insulin crystals.  Thank you so much for that info. 

Also, I agree with Pat, Roxy, that my answer also didn't fit into the classifications available to answer.  Also like Pat, if one doesn't work I try the other.

In some patients, it seems that bid dosing on Levemir is more effective.  There are also for me concerns re the patientsd we all see with 'mega doses' of Lantus, typically, prescribed.  These larger doses definitely affect absorption and are around longer in the body so there can be dosage overlaps.  These may contribute to more erractic absorption, or hypoglycemia.

We do have educational data that tells us that a dosage greater than 30 units will not be evenly absorbed from a single injection site, and yet this is done all the time.  Perhaps it's not critical for the patient w Type 2 diabetes but for someone with Type 1 diabetes, this contributes to more erractic glucose levels.

The other problem I have with both insulins for many patients, is that there is no way to adjust for circadian differences in basal requirements.

Re: Lantus vs. Levemir

B"sd
My understanding is that head to head trials show
Levemir vs Lantus:
1. identical dosing in units
2. lower risk for hypoglycemia 
3. lower weight gain
4. weight loss when lantus replaced by levemir

On the other hand, have seen several patients with drug rashes from levemir who have been fine on Lantus.

It would seem then that Levemir is the best first choice for most patients.
Also twice daily use of basals  provides for  something like two basal rates.

Re: Lantus vs. Levemir

I haven't much use of the product as it's not within the budget or approved for use on all the formulary's that I see.

I'd be interested in what folks say...as the drug reps often sell it as a better product for weight issues.

Re: Lantus vs. Levemir

Jesse,

I agree with you re: experience with Levimir, and have actually used it to get a second basal rate.  I've also found a more favorable weight outcome as compared with Lantus, and the studies do support that it should be equal from a dosing perspecitive to Lantus.  From an experience standpoint, I have seen more folks needing twice daily dosing though, as compared to Lantus , although the data doesn't support that.

Re: Lantus vs. Levemir

Thank you for all for your input. I am more comfortable with the decision to use Levemir.
When Levemir first came on the market, I asked about persons with low albumin as it is an albumin-binding insulin. I was told that we have so much albumin in our system that even with low albumin levels, there is still plenty albumin to carry the Levemir.

Re: Lantus vs. Levemir

Roxy, also, for what it is worth, Levemir is cheaper than Lantus.  We currently have Lantus on formulary as our "workhorse" and we have Levemir as restricted. With all the cost cutting measures that are taking place in today's world we are seriously looking at the cost savings from swtiching Lantus to Levemir.  Just wanted to let you in on that little tidbit!

Re: Lantus vs. Levemir

The real current available 24 hr basal insulin is Lantus. Duration of action of levemir is dose dependent. A  study by Porcellati,in diabetes care showed that with an avarage dose of 0.35 u/kg,Lantus effect last 24hr,Levemir 16 hr.I will not switch frome Lantus to levemir,since in about 50% of cases you will need to give 2 injections.

Re: Lantus vs. Levemir

Hi Roxanne
Even if there is supposedly enough albumin to handle the insulin, what if the patient needs other albumin binding meds?

Re: Lantus vs. Levemir

Having Low Albumin,is not an issue with use of Levemir,that is binding to albumin,.Even in sever hypoalbuminemia there is enouph albumin for Levemir,and other medication that bind to albumin.

Re: Lantus vs. Levemir

Thank you for yoiur insight, Dr Sachmechi

Re: Lantus vs. Levemir

 

I switched from Lantus to Levemir last year and found that the same 7 u for a basal at bed time works super to keep the dawn phenomenon BG rise in check (the assumption for bed time use is 8 hour max effectiveness).  At breakfast 7 u of Levemir will keep me good all day to dinner (and seems I can assume 12 hour coverage for daily use) with only small 2-3 u of Novolog to cover meals.

 

I also switched from Humalog to Novolog and found that while they both are very rapid acting and peak about the same Novolog is a bit slower to start peaking, by ±30 minutes.  I would often go low with Humalog about 30-40 minutes after eating since it would start rapidly peaking before digestion has progressed and my BG levels began to rise.

 

Not an issue with Novolog as it is slower to peak, but seems to peak at the same time as Humalog and lasts the same 5 hours.

 

My experience with these has been since Aug 2009 and this coupled with low carb has dropped my A1C from 6.5% to 4.7%.  Only a few more tenths to go to stabilize at ± 4.5% A1c and have Normal healthy BG levels all the time.

Hope that helps some.

Good luck

 

Bruce

Re: Lantus vs. Levemir

Thanks for your input. Roxy