Study Says Lantus Lasts Longer Than Levemir

| Dec 4, 2007

In an Italian study to compare once-daily injections of insulin glargine (Lantus) with once-daily injections of insulin detemir (Levemir), 24 patients with type 1 diabetes were treated for two weeks with either one or the other in a randomized double-blind study.

At the study's outset, the patients were injected with 0.35 units of insulin per kilogram, which comes to about 28.6 units for a 180-pound man. (See Dr. Bernstein's article about "long-acting" insulins for his opinion about giving experimental subjects high doses of long-acting insulin, "In My Opinion: There is No 24-Hour Basal Insulin")

Plasma glucose was clamped at 100 mg/dl for the 24 hours after the insulin injections. This means that for the 24 hours after the insulin injection, to prevent hypoglycemia, the patients were infused with just enough glucose to keep their blood sugar from dropping below 100 mg/dl.

With glargine, blood sugar remained at about 103 mg/dl for up to 24 hours. With detemir, things were fine for about sixteen hours, but then blood sugar began to increase progressively.

The glucose infusion rate was similar between the two insulins for twelve hours, after which it dropped more rapidly with detemir. Only about a third of the detemir subjects completed the study with blood sugar levels below 180 mg/dl.

The researchers, led by Francesca Porcellati, MD, concluded that glargine and detemir are similar for the first twelve hours, but that detemir begins to poop out during the second twelve hours.

Source: Diabetes Care, September 2007

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Categories: Blood Sugar, Diabetes, Diabetes, Insulin, Lantus, Low Blood Sugar, Type 1 Issues


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Comments

Posted by Anonymous on 19 November 2007

Can a cost comparison be made available between Glargine and Detemir to understand the cost of treatment with both the drugs

- Chandrakant Kathote

Posted by Anonymous on 21 November 2007

As recently pointed out in a review of clamp studies by Heise et al (Diabetes, Obesity & Metabolism, 2007), the Porcellati group is the only group to have been able to demonstrate a protracted duration of action for insulin detemir. Three other studies have demonstrated 24-hour duration of action of insulin detemir in patients with type 1 and type 2 diabetes. These studies also show significantly less within-subject variability, thereby reducing the risk of hypoglycaemia and allowing clinicians and patients to more effectively titrate insulin dose.

Posted by Anonymous on 9 December 2007

As a CDE, I've seen both of these insulins last 24 hrs and "poop out" within 24 hrs. I believe there are individual differences in how the body uses meds. Another reason why someone with diabetes has to be treated individually.

Posted by Louis on 9 December 2007

As a user of both of these insulins, Lantus peaks 6-10 hours after injection and has never lasted 24 hours. Detemir lasts almost 24 hours with a much smoother action and less of a peak. Lantus always has required 2 doses a day for me to work. (12-14 units basal per24 hours)

Posted by Better-Cell on 16 December 2007

I have used both Lantus and Detemir as my Basal Insulin.
With Detemir I find that I have to take almost 35% more insulin compared to Lantus for blood glucose consistency.
In addition, I found that I had experienced more episodes of Hypoglycemia with Lantus than Detemir and both required a 2Xday injections as well.
Itching continues to occur at the site injection with Detemir while none had occurred using Lantus.

Posted by Anonymous on 19 December 2007

I have also used both Lantus and Detemir as my Basal Insulin. Detemir did not last nearly as long. I had to take it every 8 hours (3X/day), and it had a more pronounced peak. I returned to Lantus, taking it twice a day, at 11 units each shot. Lantus works best for me.

Posted by Anonymous on 24 December 2007

Levemir works very well when metformin is introduced into therapy. FBS are now

Posted by Anonymous on 31 January 2008

lantus is more effective than detemir.. It is backed up by several studies wherein it is used once daily.

Posted by Anonymous on 10 February 2008

No one need look any further than the product package inserts. Levemir is dose dependent, lasting as little as 5.7 hours at a dose of 0.1 units per kilogram vs. 23.2 hours at a dose of 1.6 units per kilogram. Do the math. For Levemir to last a full 24 hours, a 220 pound man would have to take in excess of 160 units per day. And by looking at the PK/PD profile of insulin detemir, the higher the dose, the higher the peak action, even greater than the accepted peak of NPH. The "Medical Letter" even concludes that Levemir is a BID medication, and more recent studies have shown that more Levemir is required to achieve the same glucose lowering effect as either NPH or Glargine. I'm still confused as to why some individuals see an advantage to taking an intermediate acting insulin like Detemir to a long acting insulin like Glargine.

Posted by Anonymous on 25 February 2008

Is .35 units per kilo a standard dose? I thought patients took much more than that.

Posted by Anonymous on 1 April 2008

Every study done by Sanofi-Aventis is done at a single dose level which is a typical dose range of 0.4U/kg. Their so-called peakless profile has never been reproduced in any other study than the Lepore study. If they were to actually do a study with 0.1 or 0.2U/kg they would also find that they do not last 24 hours but much less. Their PI indicates that they were not even successful at controlling the A1c as good as NPH. The variability of intrasubject sugar control is double that of Levemir leading to weight gain, greater hypoglycemia. It is simple pharmacodynamics that all medicines have a rise to a peak and a fall which makes them dose dependent. Somehow people think that Lantus goes directly to a peak level and stays there until the magical time of 24 hours and then it all completely disappears. This is simply inaccurate and misleading. The conclusion that one would require 160 units per day is completely false. The advantage to an additional 24 hour basal such as Levemir vs Lantus is more consistent sugar control, less hypoglycemia, and low to no weight gain.

Posted by Anonymous on 1 April 2008

I am confused. It says in the lantus p.i. that, "The median time between injection and the end of pharmacological effect was 14.5 hours (range: 9.5 to 19.3 hours) for NPH human insulin, and 24 hours (range: 10.8 to >24.0 hours) (24 hours was the end of the observation period) for insulin glargine." Does this mean that Lantus can only last 10 hours at a low dose like NPH and have to be taken twice a day?

Posted by Anonymous on 17 March 2009

I injected Lantus once a day and felt I had 24 hour coverage, though morning blood sugars were often high. I'm now on Levemir, twice a day, and while morning blood sugars are better, I have noticed the exact "pooping out" effect described. Worse yet, sometimes it poops out earlier, sometimes later. On the whole, trading one flat line of Lantus for two bloop singles of Levemir (plus correctional injections) hasn't been a great experience to date.

Posted by Anonymous on 26 June 2009

Lantus works perfect for me,I take one dose at bedtime and my fastings in AM are always 70-95 consistently. I also take Januvia, Metformin ER and Amaryl oral during day.
This stuff works perfect for me!


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