Lantus vs. Levemir

[turnforthenurse, MSN, NP]

Why would a prescriber prefer Lantus over Levemir or vice versa? I know that they are both long-acting insulins. I remember asking a pharmacist about it awhile ago and the only answer they provided me was that Levemir is cheaper than Lantus.

The reason I ask is because I had a patient who was on Lantus 15 units at bedtime. The MD ended up lowering the dose and changing the order to Levemir 10 units at bedtime when I came back the next night. The lowered dosage makes sense, but why change from Lantus to Levemir?

[blondy2061h, MSN, RN]

Levemir's action tends to be a bit dose dependent, ie, higher doses last longer and lower doses last short. If the patient is having lows at the 20 hour or so mark after Lantus switching to Levemir might help because the action lasts a bit less time. Sometimes one insulin just works a bit better than the other for certain people. Levemir is also thought to cause less weight gain.

[turnforthenurse, MSN, NP]

blondy2061h said:

Levemir's action tends to be a bit dose dependent, ie, higher doses last longer and lower doses last short. If the patient is having lows at the 20 hour or so mark after Lantus switching to Levemir might help because the action lasts a bit less time. Sometimes one insulin just works a bit better than the other for certain people. Levemir is also thought to cause less weight gain.

That makes sense, even though this patient had a low at less than 20 hours. This patient was admitted for hypoglycemia (along with some other admitting diagnoses). They were on Q2H blood sugar checks when I took care of them one night. Their blood sugars were fine (120-130 compared to the 34 they originally came in with!) and the patient has had a great appetite. I made the decision to give the 15 units of Lantus that evening and at 0515 their blood sugar was 61. Via the hypoglycemic management protocol, the patient's blood sugar came back up.

They were fine all day, then I came back and found out the patient's night time insulin was changed from 15 units of Lantus to 10 units of Levemir. Their HS sugar was actually high that night (220) so they received 2 units of Novolog via sliding scale + 10 units of Levemir. The patient showed no signs of hypoglycemia throughout the night, but I ended up checking the blood sugar at around 0500 at the request of the family member, even though the patient felt fine. Their sugar was 148.

Thanks for your reply!