Converting between insulin brands and types

Rapid-acting and short-acting insulin When converting between rapid-acting and short-acting insulins, the dose typically remains the same

Rapid-acting insulins act quicker (within 10 - 30 minutes) than short-acting insulins (within 30 - 60 minutes), therefore, the timing of the dose should be adjusted

Rapid-acting insulins have a shorter duration of action than short-acting insulins (3 - 5 hours vs 6 - 8 hours). Because of this, patients switching to rapid-acting insulins from short-acting insulins may require more basal insulin to maintain blood sugar control, and vice versa.

Conversions for inhaled insulin are discussed here - inhaled insulin dosing

Lantus, Semglee, Basaglar, Levemir, and Tresiba Dose remains the same when switching between Lantus, Semglee, Basaglar, Levemir, and Tresiba

Patients at high risk for hypoglycemia may want to reduce the initial dose of the new insulin by 10 - 30%

In trials comparing Tresiba to Lantus and Levemir, the glucose-lowering effect of Tresiba was equivalent to both insulins [22]

Lantus/Basaglar/Semglee and NPH Once-daily NPH to Lantus/Semglee/Basaglar

Dose remains the same



Twice-daily NPH to Lantus/Semglee/Basaglar

Lantus/Semglee/Basaglar dose is 80% of total daily NPH dose

Example:



Patient's NPH dose is 30 units twice daily





Total daily NPH dose is 60 units





To convert to Lantus/Semglee/Basaglar: 60 units X 0.80 = 48 units





Daily Lantus/Semglee/Basaglar dose will be 48 units [19]



Lantus/Semglee/Basaglar to once-daily NPH

Dose remains the same



For patients who are at risk for hypoglycemia, consider an initial dose reduction of 20 - 30% to account for the peak effect that occurs with NPH. See converting from long-acting insulin to NPH for more.

for more.

Lantus/Semglee/Basaglar to twice-daily NPH

When switching from Lantus/Semglee/Basaglar to twice-daily NPH, it can be anticipated that a higher amount of NPH may be needed in order to achieve an equivalent effect



In most patients, leaving the dose the same and retitrating as needed will be appropriate. Patients at high risk for hypoglycemia (e.g. concomitant premeal insulin) may want to reduce their initial NPH dose by 10 - 30%.



See converting from long-acting insulin to NPH and twice-daily NPH for other considerations when changing to NPH insulin

Lantus/Semglee/Basaglar and Toujeo Lantus/Semglee/Basaglar to Toujeo

When going from Lantus/Semglee/Basaglar to Toujeo, the daily dose remains the same



Expect that a higher daily dose of Toujeo will be needed to maintain the same level of glycemic control as an equivalent dose of Lantus/Semglee/Basaglar



In a multidose study, the glucose-lowering effect of Toujeo was about 27% lower than that of an equivalent dose of Lantus [21]



Toujeo to Lantus/Semglee/Basaglar

When going from Toujeo to Lantus/Semglee/Basaglar, the Lantus/Semglee/Basaglar dose should be started at 80% of the Toujeo dose in order to avoid hypoglycemia



Lantus/Semglee/Basaglar is more potent than Toujeo; therefore, an equally effective Lantus/Semglee/Basaglar dose will likely be lower [19,23]

Example:



Patient's Toujeo dose is 60 units a day





To convert to Lantus/Semglee/Basaglar: 60 units X 0.80 = 48 units





Daily Lantus/Semglee/Basaglar dose will be 48 units

Levemir and NPH NPH to Levemir

Daily dose remains the same



Levemir to once-daily NPH

Dose remains the same



For patients who are at risk for hypoglycemia, consider an initial dose reduction of 20 - 30% to account for the peak effect that occurs with NPH. See converting from long-acting insulin to NPH for more.

for more.

Levemir to twice-daily NPH

When converting from Levemir to twice-daily NPH, an initial dose reduction of 20 - 30% may be appropriate in some type 2 diabetics. In a study where twice-daily Levemir was compared to twice-daily NPH, NPH doses of 0.52 units/kg had the same effect as Levemir doses of 0.77 units/kg. [20]



See converting from long-acting insulin to NPH and twice-daily NPH for other considerations when changing to NPH insulin

Toujeo and NPH Once-daily NPH to Toujeo Dose remains the same



Twice-daily NPH to Toujeo

Toujeo dose is 80% of total daily NPH dose

Example:



Patient's NPH dose is 30 units twice daily





Total daily NPH dose is 60 units





To convert to Toujeo: 60 units X 0.80 = 48 units





Daily Toujeo dose will be 48 units [19]



Toujeo to once-daily NPH

Dose remains the same



For patients who are at risk for hypoglycemia, consider an initial dose reduction of 20 - 30% to account for the peak effect that occurs with NPH. See converting from long-acting insulin to NPH for more.

for more.

Toujeo to twice-daily NPH

Daily dose remains the same. Patients at high risk for hypoglycemia (e.g. concomitant premeal insulin) may want to reduce the initial NPH dose by 10 - 30%.



See converting from long-acting insulin to NPH and twice-daily NPH for other considerations when changing to NPH insulin

Toujeo and Levemir Once-daily Levemir to Toujeo

Daily dose remains the same [21]



Twice-daily Levemir to Toujeo

Toujeo dose is 80% of total daily Levemir dose

Example:



Patient's Levemir dose is 30 units twice daily





Total daily Levemir dose is 60 units





To convert to Toujeo: 60 units X 0.80 = 48 units





Daily Toujeo dose will be 48 units [21]



Toujeo to once-daily Levemir

Daily dose remains the same [21]



Toujeo to twice-daily Levemir

Daily dose remains the same. Patients at high risk for hypoglycemia (e.g. concomitant premeal insulin) may want to reduce their initial Levemir dose by 10 - 30%.

Tresiba and Toujeo Tresiba to Toujeo

Dose remains the same when switching from Tresiba to Toujeo



Expect that a higher daily dose of Toujeo will be needed to maintain the same level of glycemic control as an equivalent dose of Tresiba



In a multidose study, the glucose-lowering effect of Toujeo was about 27% lower than that of an equivalent dose of Lantus. Lantus and Tresiba have similar glucose-lowering effects. [21]



Toujeo to Tresiba

Reduce initial Tresiba dose by 20 - 30% to avoid hypoglycemia. In trials, the glucose-lowering effect of Toujeo was about 27% lower than that of Lantus. Lantus has a similar effect to Tresiba.