FUDiabetes

Thinking Out Loud - Toying with Going back to Lantus

I currently use:
Omnipod with Novolog for basal only
Novolog pens for food/corrections
Dexcom + Sugarmate

So my pods tend to give up the ghost on basal absorption at about the 36 hour mark. They bleed frequently. Like a lot.

I’m toying with the idea of going back to Lantus once I get back to low hormone days (low insulin resistance) to try it out for a week.

Back when I consulted with Gary Scheiner’s group (same time that I joined FUD) during my suspected Humalog allergy and non-stop podding issues and inability to gain weight…Jenny said that I might be one of the rare people who actually do better on shots.

I already can’t use my pods for anything other than basal. But…my main reservations are:
(1) how manageable are the overnight drops going to be
(2) how well will I be able to match my Lantus for my increasing insulin resistance throughout each cycle
(3) If I accidently inject Lantus into a blood vessel…what happens then? After that happened with a 5 unit Novolog injection, I never inject more than 3 units of Novolog in one place now.

I know wayyyyyy more about my body’s needs now than I did when I switched to podding. So I might have a more successful experience with it this time around bc I’d have a better idea of what to look for in trend changes.

And I absolutely hate having a pod attached to me. I would freakin’ love to only wear a Dexcom. I feel so flipping restricted by pods bc I can never clean anything with my pod arm or play sports with my pod arm or get into my car too fast bc of my butt pod bc of the effin’ thing. And I’d love to just wear what I want and not have to dress around it due to where waistbands fall.

But…I’m chicken. My days are so tightly scheduled that trying anything “new” takes up bandwidth that I don’t really have.

Okie dokie. That’s my emoting into the webiverse for now. :slight_smile:

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If you are gonna do MDI again, I suggest giving Levemir a try. It can give you much more flexibility if you don’t mind taking multiple shots.

Like if you were to do it 3x per day, you could have 3 general basal rates instead of the 1 basal rate that almost lasts for 24 hours with Lantus.

Another advantage of Levemir is that it’s not affected by absorption differences. It binds to the albumin in the blood, which means absorption is consistent and stable. Even if you inject it directly into a vein it does not change its delivery!

Exercise can affect your insulin sensitivity. It also affects the absorption of Lantus and rapids because your blood flow is increased and your blood vessels dilate. But with Levemir, the only affect of exercise is your insulin sensitivity, NOT the absorption!

Check out this reference link quoted below
(BTW, detemir is the generic name they are using for the brand name Levemir in this article.)

While albumin binding makes only a minor contribution to prolonging insulin detemir’s duration of action, it plays a much more important role in buffering against sudden changes in absorption and thus providing more consistent blood levels of this insulin preparation. In the circulation, insulin detemir is 98% bound to albumin and this has two potentially important buffering effects. First, the rate of absorption for insulin detemir is only slightly affected by variations in injection site blood flow. In addition, the high binding of insulin detemir to albumin means that the potential effect of abrupt rises in plasma concentration, should they occur, would have only minimal effects on the concentration of this insulin at its receptors in target tissues. This would be the case since only 2% of the circulating insulin detemir is unbound and available for transport across capillary walls. These two buffering mechanisms both contribute to the low within-subject pharmacokinetic and pharmacodynamic variability that has been demonstrated for insulin detemir.

So this is just another thing to throw into the mix if you are going to consider doing MDI. I can hook you up with some Levi if you want to try it.

Go for it. Why not give it a try for a few days?

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What if I said I wasn’t real into the 3 basal shots/day idea?

Does that seem ungrateful of me for the offer to help?

Bc I cannot hit shot times like that with all of the kid taxi business, sports and web meetings right now. I just know I won’t be able to sustain that long term so I don’t really see investing time into the trial of it. :grimacing::grimacing:

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I am no expert with Lantus or MDI in general but I fully validate your simultaneous frustrations and lack of bandwidth for new experimentation :heartpulse:

(And while totally respecting your lack of bandwidth for experimentation, I will just say that I have clocked some of your complaints as likely being rather Omnipod-specific rather than insulin pump-specific, but I know that swapping insulin pumps is no small change, and oftentimes made quite impossible by insurance)

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So why put an analog into the Omnipod; you are only using it for the basal and your basal program (which you have to pretty much abandon with MDI) only changes every 1/2 hour ('cause that’s all Insulet allow) so why not use something safe, like Humalin-R or any genuine, unmodified, human genome insulin?

At least as an experiment it should reveal if Novolog is the problem - the basis of all science, keep everything else the same and change one thing; “ceteris paribus”.

Lantus (glargine) is another analog; it’s been genetically modified to make it adsorp slower. Detemir, @Eric’s approach, is a chemically modified human insulin, so it’s also an analog.

I probably shouldn’t be publishing this here but it’s my religion so I will state it and you can take it or leave it, bearing in mind that it is a religious viewpoint therefore might not match up to the rigors of science, or the pestilence of law.

Some people [apocryphal] put regular insulin into an Omnipod. Some people put insane chemical concoctions into an Omnipod; people like me, in this case, I use Fiasp. The thing is (my religion), once you’ve put it in, you can’t take it out. So if I put in a drop of Fiasp I’m stuck with skin itching and minusculy lowered blood sugar for a few minutes, if I put in a drop of, well… let’s say Lantus, I’m stuck with that drop for 8 hours. But if it works, why do I need an Omnipod? My religion again; I experiment, sometimes, and I also get fed up, often. I do all sorts of things I shouldn’t - I rage bolus!

Like I said; it’s not advice, it’s a religion.

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When I took Levemir…I tried twice a day and once a day…once a day worked best, I took it not too far before bed that way it started working it’s magic in the early morning, also required a little bit of humalog in the early evening for when it would wear off, that way I could also have it dwindle as I went to bed…or have a snack to adjust things

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I went back to MDI/2x Levimir in Feb 2020 with high hopes, considering how much better my perceived control was when I was younger compared to how I do now with pumps/cgms/etc. It did not work out well for me. I went back to a sensible dose of levimir based on ancient experience and current pump basal, with a sliding scale of humolog. The basal was not as stable as I hoped (mybe didn’t take enough?) and mealtime/correction humolog didn’t respond more quickly than the pump. YMMV.

Also, I didn’t appreciate how big a pain it is to take a mealtime injection with strangers. I did MDI’s in college and its a little more acceptable to randomly inject yourself as a 22 yo, but felt strange in the middle of a work meeting.

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Might not be possible to avoid as you make the switch and fine tune the Lantus dose and timing. But if you’re willing to deal with those alerts, hopefully not too often, the switch might give you some peace of mind. Maybe look at it as an experiment for a week or so and see how it goes?

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Actually, depending on the amount you take, it might only be 2X.
(I mentioned it as 3x because that’s the worst case scenario.)

I am guessing for your basal amount, you would be somewhere between 8-12 hours. (With Levemir, the more you take, the longer it lasts.)

So if you are closer to 8 hours, you’d need 3X. But if you are closer to 12 hours, you might squeak by with 2X.

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2x daily Levemir works good for me. Even though I take a low dose, 0.2 units/kg (Total daily), it lasts longer than it should for that dosage.

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What do you mean what happens if you inject into a blood vessel? What happened when you did it before? I’ve never heard of this…

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I’ve accidentally injected a meal shot into a blood vessel and the full action came to fruition in about 15-30 minutes, I’d guess?

I’ve not accidently injected Lantus into a blood vessel. But I am still curious what would happen if that happened by chance.

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I believe it would be the same as with other insulins; i.e. the slow adsorption would not occur. The wikipedia article explains how the long-acting nature is achieved:

In the neutral subcutaneous space, higher-order aggregates form, resulting in a slow, peakless dissolution and absorption of insulin from the site of injection.[[16]](https://en.wikipedia.org/wiki/Insulin_glargine#cite_note-Bolli-16)

I’ve certainly seen adsorption problems with MDI, particularly with the extensive skin damage to the front of my thighs that was caused by injecting there in my teens. My assumption is that if there is an active venous blood supply close to the injection site then it might be possible for the insulin to flow directly from the site to the vein. I suspect hitting a vein directly, however, will probably rupture the vein and cause it to seal up; possibly resulting in delayed adsorption!

I don’t remember having had a serious hypoglycaemic reaction from this, but I might have had minor ones. Certainly one of the reasons I like the Omnipod is that I believe I get more consistent results, though that might be a side effect of maintaining closer control.

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This is terrifying!! I didn’t even know this issue existed…

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Hello T1Allison,
I too use very small amounts of insulin and I have been T1D for 50 years in 2021. I currently take 5 units of Tresiba and intermittent shot of Fiasp.
Both those insulins have been quite great for me but they also have a flaw in that their effectiveness begins to drop after 30 day.
With such low insulin requirements I try to use the Fiasp after it starts its decline.
I am now thinking of finding some other kind of insulin to replace Fiasp. Have to wait until I get an appt at our University of Alberta where Dr. Peter Senior and Dr. James Shapiro have been developing innovation solutions to curing diabetes. It’s a remarkable team who should likely will be awarded with a Nobel Prize .
So in total, I tend to use approximately 12-14 units of insulin a day. I’m not super skinny and am 5’4 and weigh around 120 lbs.
My noon highs are quite extreme, which I understand is something most diabetics experience.
Anyway, keep at it!

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Intravenous Lantus has about the same effect as intravenous regular NPH insulin.

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I checked around on other forums regarding Lantus injections into a vein. Sounds pretty not fun and I’m super risk adverse these days. And my shots bleed so frequently that I never really know if I’m going to see all the action in the next 15 minutes or the next four hours with my Novolog.

So I’m gonna do my best to sleep steadier and not roll on top of my pods as much as possible and keep podding for now. :crossed_fingers::crossed_fingers::crossed_fingers:

[If I were to try basal injections again at some point, I’d probably go with @Eric’s suggestion of Levemir bc it would not accelerate if it accidentally went straight into my bloodstream which matters to me.]

If that plan changes, I’ll update this thread.

Thanks, everyone!

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That makes a lot of sense to me; I hadn’t realized that Levemir (detemir) does the delaying action in the blood stream.

I started my a-pancreatic life on PZI (NPH), I never asked how it worked (too old to ask, too young to know, bloody 12 year olds). NPH seems to be the long-acting insulin of choice these days (and it probably was in 1972 as well :wink: The delaying action is in the subcutaneous layer, see “Mechanism of Action”; the second and third paragraph, the first is just a general description of the action of insulin. It might behave differently from Lantus in areas of high blood supply, but detemir still sounds like a better bet.

I also have bleeding, but mine is pretty much always around the G6 sensor; my pods are rare bleeders. I currently always use my pods in areas where I have never injected, but then my G6 is also in an area where I never injected, but I use one that has much less subcutaneous fat where I seem to have problems (weird adsorption) with the pod.

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