Afrezza and Levemir

This video update covers my switch to Levemir, and its nifty pen. Scroll down for my charts comparing the two.

The high variability of Lantus prevented me from further optimising my basal dose, and the issue makes some consider it dangerous.

So I decided to switch to Levemir. My experience with Levemir mirrors that of this user in the UK, who finds “the duration of the Levemir is frustrating, as the amount taken in each of the two injections is not quite enough to get me through a twelve hour duration“. Further, I need to be cautious during its peak.

As you can see in the video, the NovoPen Echo is very cool. However my third pen has already failed once already, and I hope it’s the top display that’s wrong and not the one on the side. Novo has asked me to send in the pens to investigate.

If I can get a pen I can trust, I would like to pair the NovoPen Echo with the longer acting, flat profile Tresiba basal (not yet available in Australia).

Update: I have since changed basal insulin to Tresiba. Novo has sent two replacement pens, and I await the results of their investigation into the faults.

The goalposts have shifted a lot in a couple of weeks.

The goalposts have certainly shifted a lot in a couple of weeks.


  1. I changed to Levemir shortly after I was diagnosed with Type 1 about 7 years ago. A 40:60 am pm split usually gives me the best results. Lantus gave me unpredictable BGL. I have major problems stabilizing BGL on a daily basis. NovoRapid is used for my bolus as it is the fastest acting but still takes 30 minutes or more to kick in. I am sensitive to insulin when active and extremely so when I have run down my glycogen reserves. I would say afrezza would be a suitable alternative for me to trial. It is good to see you are willing to try afrezza and will be following your posts.


    1. Thanks for the comment. I’m also very sensitive to insulin once my reserves are run down (liver is empty), and its great not to have a 5 hour tail of bolus hanging around, which i think is why you need less basal during the day – I have an even split AM/PM.

      I have also found that while using Afrezza I am extremely sensitive to insulin when I am active but haven’t eaten in a while. However, this doesn’t happen often, so it’s not really a problem.

      It sounds like Afrezza might be a great fit for you too Paul.



  2. Have you tried Toujeo yet with Afrezza? Other people are finding this combo to be a great 1 2 punch for basal/bolus?


    1. The Australian regulator says, based on the information submitted by Sanofi, comparing once daily Lantus with Toujeo:

      [Toujeo] appears to have the same effect on glycosylated haemoglobin and frequency of adverse events as [Lantus] in the treatment of type 1 diabetes mellitus… [For Type 2 diabetes], the PBAC did not accept [Toujeo] to have superior comparative safety in terms of reduced risk of hypoglycaemia.

      Although Lantus is only approved to be taken once daily, most Type 1 diabetics use smaller doses of Lantus twice daily because of its variability. This would be already be far less variable than a once-daily dose of Toujeo. While split dosing Toujeo might offer a marginal improvement, it is unlikely to help the problem that we are seeing with Lantus. Word has spread, and that’s why people have recently been switching in droves to Levemir, a decade-old basal that seems worse on paper.

      The variability of Lantus/Toujeo is far more pronounced when using Afrezza because conventional rapid acting analogues hang around for 5-8 hours, and end up contributing to the basal insulin dose, effectively smoothing out some of its variability. This is why the few Type 1s using Lantus once-daily tend to use it in the evening. Lantus variability issues likely prevented doctors in the Afrezza trials from increasing basal insulin to the levels that were expected to make Afrezza demonstrate its superiority.

      Instead of testing Afrezza with Toujeo as others are already doing, I’m very excited to start using it with Tresiba – which brings many other quality of life improvements. In addition to those benefits, it has 310% (!!) lower variability than insulin glargine (Lantus/Toujeo). Anecdotally, the combination is amazing. My first dose will be tonight – check out


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