Question about dosage of Toujeo
 

Hi all.

I have been on Levimir for years. No problem. My doctor gave me samples of Toujeo saying "Take the same amount that you take of the Levimir". I ran this by the pharmacist who agreed.

I have two pens of Levimir left. I can either try the Toujeo or pay for a months worth of Levimir instead of using the new Toujeo that my doctor gave me.

I have read that this Toujeo is concentrated and that you can use less. If this is the case, why am I being told that I can use the same dosage that I use with Levimir.

My doctor also told me he has two new samples of a brand new insulin (different than Toujeo) when he sees me.

So how does this concentration thing work. I mean if my doctor and my pharmacist agree on the same dosage plan, why does it indicate that people who use Toujeo can use less because it's concentrated?

I'm interested in hearing from anyone who is using Toujeo and did you have to use less or did you indeed you the same amount as either Levimir or Lantus.

Thanks very much

Melody

Hi Melody,

Interesting question. I was under the impression that it is 3x the amount of insulin per unit, ..... concentrated as you mentioned.

I would have thought that if one takes 30 units of Levimir, they would only need 10 units of Toujeo. I am only going by the advertisements on television.

My GUESS is that each pen of Levimir contains 100 ml and each pen of Toujeo contains 300ml. In that case, the number of units would be the same. I really don't know.

It will be interesting to know the answer to your question. Why didn't you ask the pharmacist or your doc to explain it better? I see my endocrinologist next week, so I may ask him about it just out of curiosity.

I heard the patent is about to expire on Lantus and that is why they came out with Toujeo. (Lantus being equivalent to Levimir -- just different mgf.)

Good question and hope one of us gets an answer and will share it.

HI. Just checked. Levimir is 100 ml and Toujeo is 300.

I'm going to call the makers of toujeo and ask all my question.

And with the patent on Lantus going to expire, might this not mean that someone can invent a generic insulin? That would really be something.

Will update after I speak to the Toujeo people

Thanks so much for replying by the way

Melody

Let's get something clear here.

Toujeo is 3x more concentrated in UNITS... 300units/milliliter.
Toujeo(R) (insulin glargine injection) 3 Units/mL

No pen is 300ml....that is almost 12 ounces in volume.

I don't understand how a doctor and pharmacist said to use
the same amount. 10 units of Lantus or Levimir would not correspond the the same volume of Toujeo which is 3x stronger per ml.

I don't have a Toujeo pen here to examine, but strenuously suggest you straighten this advice from your doctor out! It is possible that the pen calibration has been adjusted to make conversion easier for patients. But I cannot confirm that at this time. You need a live person on your end to
sit down with you and explain this product and its administration to you.

You must be very sure of your dosing before you try using this new version of insulin.

Please disregard the above quote from my prior response. I wasn't engaging my brain at the time. My insulin pens contain 300 ml each, 5 pens per box, for a total of 1500 units. What was I thinking when I wrote the above???

I totally agree with mrsD and clarification is needed before proceeding with the Toujeo.

To mrsD,

MANY thanks for your input and for responding to this thread.

I sure would not want someone to put themselves into a diabetic coma or worse by injecting triple the amount of a long-acting insulin.

I think I will see if the mfg. has some info online regarding Toujeo.

http://products.sanofi.us/toujeo/toujeo.pdf

Above is the link for dosing of Toujeo.

It states that there are 300 units per ml in a 1.5 ml prefilled pen.

It also states that the dosing for a patient already having used insulin would be the same as that for their long-acting insulin, like Lantus or Levemir.

Another mention is that patients may need a higher dosage of Toujeo than with Lantus. Titration to be utilized. In one of the studies, patients basal insulin need with Toujeo was 11% more than with LANTUS.

So, bottom line, personally, I am still confused but it appears that what you were told by both your pharmacist and your physician is the same as what is stated in the dosing information provided by the mfg.

When it comes to "measurements", I am a total idiot. I don't know a unit from a ml so maybe that is why it is still confusing to me.

My doctor tells me what to dial up on my pens and that is all I know. How that translates is a mystery to me as far as ml so I am sorry I am not much help. He also said NOT to go by any markings on the side of the pen, just use the amount dialed up prior to injection.

This is the reason I went with pens and not with a vial and syringes. Well, that and my BAD eyesight. The pens are just so easy and convenient. No calculating involved. Glad I don't have to administer any injectable medications to others like nurses have to do. Much too easy to make a mistake and move a decimal or add a zero and you have overdosed someone.

Sorry I am of no help here. Thank goodness my doc has brains and figures this out for me.

A few excerpts from the link I provided regarding dosing on page 2.

Patients should be informed that the dose counter of the TOUJEO SoloStar disposable prefilled pen shows the number of units of TOUJEO to be injected. The TOUJEO SoloStar prefilled pen has been specifically designed for TOUJEO, therefore no dose conversion is required.

To minimize the risk of hypoglycemia when changing patients from a once daily long-acting or intermediate acting insulin product to TOUJEO, the starting dose of TOUJEO can be the same as the once daily long-acting dose. For patients controlled on LANTUS (insulin glargine, 100 units/ml) expect that a higher dose of TOUJEO will be needed to maintain the same level of glycemic control.

I hope the above excerpts help.

I am STILL wrong
 

My pharmacy records show 5 x 3ml meaning 5 pens with 3ml each. So my info above saying 300 ml is STILL probably NOT accurate. See why I am not a pharmacist??? I would have to get this stuff straight or I would be responsible for a lot of deaths due to medication errors.

Hi all.

I am so confused I can't tell you. I went on the internet. Some postings say you need to take more of the Toujeo, some people say you might need less, and then we have my doctor, the pharmacist, and other people saying "same amount as you have been taking using Levimir".

I'm not doing ANYTHING until I go back to the pharmacy and sort this stuff out. I will also be calling the manufacturer.

I will be using my Levemir until I know what I am doing.

Will update when I hear of anything.

And much thanks to Mrs. D.

Love you all

Melody

Okay!!!! I returned to Walgreens and told my story about Toujeo. I then told her to go on the internet so she could be as confused as we all were.

She did. She came back and said "I can see why everyone is confused, let me do some phone work and some digging and I'll get back to you".

I continued my shopping at Walgreens, I was summoned to the front desk and the pharmacist said and I quote"

"Okay, we have some answers. The dosage is 1 to 1 that meaning, if you took 20 units of Lantus, you take 20 units of Toujeo".

I then said "But it's concentrated, right?"

She replied "Yes, it's concentrated but it's all in the delivery" "When you press down and deliver the dosage, the pen gives you the equivalent of the 20 units"

I said 'The pen knows how to do that?"

She replied "that's how the pen was designed, to re-configure the amount, when you press down the plunger and give yourself the insulin. Because it's concentrated, they configured the pen that way"

So again....I said to her. "So if I give myself 20 units and night and 20 units in the morning with the insulin I am presently using, I do the same thing with the Toujeo (what is exactly what the other pharmacist and my doctor said)>

She said "Exactly".

I looked her in the face and said "IF YOU THINK I'M GOING TO TAKE YOUR WORD AND GIVE MYSELF THE SAME AMOUNT, YOU ARE CRAZY, I'LL START WITH 10 AND WE'LL SEE".

She burst out laughing.

So when Melody is ready to be a guinea pig, Melody will update all of you.

Presently I am using Levimir

lol

Melody

Hi Melody,

A picture is worth a thousand words is true. Basically, the pen itself has been designed to make all conversions necessary and YES, you DO use the same dialed up number with TOUJEO as with your Levemir.

The DROP of one unit of Levemir is different than a drop of Toujeo in volume. See the picture in the link provided by mrs D.

You may try to think of it as you would a pill. For example, a pill containing 150 mg of a drug is about the same SIZE as the pill containing 300 mg of the same drug.

It boils down to (from the picture) that the amount of insulin can be delivered in smaller drops.

I noticed that when I prime my needle with two units of my FAST-acting insulin, there is MORE liquid coming out than when I prime my needle for my LONG-acting once a day insulin. NOW, I understand why.

It has more to do with how much "liquid" is used to deliver X amount of insulin.

Sort of like it takes some people only an ounce of water to swallow a pill and others may need 4 ounces of water to get it down.

THAT's what they mean by concentrated. They pack more insulin in the same amount of fluid that is in the pen to deliver the insulin.

All the conversions are already done and calculated so that you can just dial your usual number and get the right amount of insulin. You are just going to be using less fluid to get the same amount of insulin into your system.

OK, that is MY way of understanding it.

If you dial up the same number on your Levemir and put it in a measuring glass, then dial up the same number on the Toujeo and put IT in a measuring glass, the volume of liquid in the two glasses will be different but the amount of insulin packed into that volume of liquid would be the same. Does that make any sense to you?

I could be all wrong but that is the way I understand it after having done some research.

I don't know how often you test each day but if you use less than the same amount of Toujeo than you use with your Levemir, your blood sugar numbers will show it. They will go up because you would not be getting the full dose.

The amount of "liquid" is NOT the same as the amount of insulin.

That is obvious with my fast-acting vs long-acting insulins.

The only advantage to using this new insulin (besides keeping big bucks rolling in to the drug manufacturer) is that for people using a large # of units of the older types, this concentrated one would inject less liquid into the skin. This may help with skin reactions etc, and in general be more cost effective since the pen machine itself is very expensive-- costs probably more than the insulin inside of it.

What really bothers my brain, is the statement that people may need higher units than before. This tells me that lower doses may not be very accurately delivered by the pen.

Think of this: 10 units per injection of the old types would be
.1ml injected. 10 units of Toujeo would be .033 ml. That may not be really an accurate amount for the pen. Hence that person may need MORE Toujeo to get any insulin at all. And that explains that qualifying statement we have all read.

1ml of water is about 20 drops. So one drop is .05ml. So 10 units from the Toujeo pen is less than one drop in volume!

I don't see this pen lasting long for sale. It is going to mess up alot of therapies and confuse too many people, and result in using higher doses of units, for those who only use low dosing like 10 or 20 units at a time. (because the pen can't be really accurate in those low ranges.)

The new oral insulins are doing very well in the later trials. Could be available in only a couple of years!
http://www.neurotalk.org/health-news...ial-yahoo.html

Hi mrsD,

Was I on the right track about volume of the delivery fluid?

I agree that the new TOUJEO would not be of much benefit to someone using lower amounts of once a day insulin. I think it would benefit a select group of people that use a higher volume, like 60 units and more as there would be less fluid being injected using TOUJEO than Lantus.

Again, I appreciate your continued efforts to help us with this discussion.

Yes, you are right.
Alot depends on if the pen is good enough to deliver small
doses.

Some medications never catch on or don't last for various reasons. Remember the nasal delivery system for insulin that Pfizer had?
It didn't last 2 years and was discontinued.

My doctor says he has two NEW (different than Toujeo and the others) to give me if I stop by. I haven't been brave enough to try the Toujeo yet.

I did however ask the pharmacist the following question.

"Since the patent on Lantus is soon to expire, does this mean that other companies might be coming out with generic insulin that is equal to Levemir and Lantus?"

She nodded and said "Yes".

Really??? Anyone!!!!

I would imagine some company would make an insulin calling it 'Insulin Glargine (or however it's spelled).

So confusing.

Melody