4/9 Leo PMPS 295, +4 160, +5.5 164

Leo's 1 Year Annifursary Condo

Hi LL Long time no chat.

So i've just gotten off the phone with Dr. Andrea, she has finally agreed to switch us to Levemir flip_cat flip_cat flip_cat She has spoken to the diabetic cat guru over at the veterinary college and they both agreed to let us try Lev, they did have some concerns about the switch, Dr. Andrea told me a few times that its a much longer lasting insulin than Lantus and that i need to extra careful and do extra monitoring..........well of course i will!!! They both figure Leo has begun to metabolize Lantus much faster than normal, it might have to do with his weight gain but they aren't 100% sure. So hopefully with the switch to Lev it will give him that extra boost and he won't bounce up to 300+ by pre-shot. I did ask about acro and it turns out they both spoke about that as well, Leo just doesn't fit the acro profile and she said that i'd be seeing an almost insulin resistance as opposed to what we are seeing now......you'll notice that he is green :mrgreen: today ;-) ;-) I told her that i'd like an acro test done on Leo just to put my mind at ease..........and for everyone else out there who also thinks Leo is an acro-cat. So she was going to phone around and find out for me where the tests can be sent, in Canada, i know they can be done in Michigan. She was also going to phone in a script for Lev for us today or tomorrow morning (she's pretty busy at the moment) she wasn't sure if it could be purchased at a human pharmacy or if she would have to order it in (i kept my mouth shut, i didn't want to seem like a know-it-all) So i guess i need dosing help with Lev, should we start a little lower than what we're at now, which is 6.75 units? Or stay at the same dose?

Leo is doing well, we just came in from outside, i turned my head for a few minutes and the last i saw him he was turning the corner around the house, i walked over to see where he was just in time to see a car driving by slowly, i called his name and he came sauntering from the street where the car had just been!!!! OMG i just about had heart failure........Leo couldn't care less :roll: :roll: :roll:

Re: 4/9 Leo AMPS 358, +3 194, +5 99, +6 83 need Lev dosing h

Hi guys .. oh yay on the new lev script! I know that's what you been wanting for leo and Im going to keep my fingers crossed you see the results you are looking for .. no dosing advice from me of course, but I am sure someone will be here to guide you along .. Good luck!!

Re: 4/9 Leo AMPS 358, +3 194, +5 99, +6 83 need Lev dosing h

Thanks Devon ;-)

Just spoke to Dr. Andrea again, she's phoned in our new Lev script and i can go and pick it up today. I think i'll start Leo on it tomorrow. She wants us to start at 0.50 units I don't know about that.............

Re: 4/9 Leo AMPS 358, +3 194, +5 99, +6 83 need Lev dosing h

Hi Tracy,
I don't think Lev. is necessarily longer lasting than Lantus, it just has a longer onset (about 4 hours instead of 2) and a later nadir; and with some cats (e.g., Gracie) there can be overlap of cycles (a surf on the later nadir continuing while the next cycle is starting; this is supposed to be ideal and is the reason why Lev. is good for bouncers). (Rusty doesn't get this overlap, and I don't think Tess does either.)
Check out the "Levemir 101" sticky in the Levemir forum. It has some good info. I don't know anything about the starting dose for Lev. when switching from Lantus (Rusty was already on Lev. when we adopted him), but I seem to remember reading that it should be a little lower than the Lantus dose. The people in the Lev. forum do a lot of micro dosing (e.g., 1.3 Units, 1.8 units).

You don't need a script for Lev. in Canada. And, you can buy a pack of 5 cartridges--just the cartridges. (In the US you can only buy the vial and the Flexpens.)

Leo is coming down nicely today. Good luck with the switch. I'm sure that Marje and Ann can give you tips on how they went about switching. Barb (Checkers) can, too. And Lisa (Do Lou) switched from Lantus to Lev, back to Lantus, and back to Lev (where Do Lou is now).

Ella & Rusty

Re: 4/9 Leo AMPS 358, +3 194, +5 99, +6 83 need Lev dosing h

Hi again,

I just saw your vet's recommendation that you start on 0.5 units!!! And Leo's Lantus dose is 6.75 units?? That's insane!!

Ella

Re: 4/9 Leo AMPS 358, +3 194, +5 99, +6 83 need Lev dosing h

Thanks Ella, i try my hardest to keep my mouth shut whenever i talk to Dr. Andrea, i think at this point i/we (FDMB) know more about Lev than she does. There is 1 cat at the clinic that's on Lev and Leo is about to be the 2nd. She really is a wonderful vet and always has Leo's best interests at heart. So i think i'll listen to FDMB about dosing and just not tell her.......what she doesn't know won't hurt her.

The pharmacy just called as well to ask a few questions and i asked a few questions as well. Turns out vials aren't available here, just the flex pens that have 5 pens in a package. The price is $115 a package, about $40 more than what i pay for Lantus at the moment. Oh well, i didn't call around for the best prices and just told Dr. Andrea to call the script into the closest pharmacy to me. I had no idea you didn't need a script for Lev here!!!!

Re: 4/9 Leo AMPS 358, +3 194, +5 99, +6 83 need Lev dosing h

Tracy, yay for your Vet coming thru for you with Lev. You will have lots of great help here from those mentioned. I bet your heart stopped with the car. Leo, please be carefull little buddy. Have a nice day, Tracy.

Re: 4/9 Leo AMPS 358, +3 194, +5 99, +6 83 need Lev dosing h

Tracy, I will be following your posts because I am wondering if Simon might do better on Lev since he has been so bouncy lately. I sure hope Leo does well and it is the answer to his bouncing.

Re: 4/9 Leo AMPS 358, +3 194, +5 99, +6 83 need Lev dosing h

Hi Tracy

So glad you finally convinced them!! And that $115 is a deal! I pay $184 for a pack of 5 flex pens.

I agree 100% with Ella....levemir is not longer lasting than lantus; it's still a 12-hour insulin with onset and nadir as she mentioned. And yes, Gracie is a lucky girl who often gets really great overlap between cycles because she nadirs so late. Sometimes she comes up a tad in between them but nothing like she did on lantus.

I'm not sure where the idea came up that you should start lev at a lower dose than lantus. I did start Gracie at a lower dose but only because she is so sensitive to everything; I also started her really low on lantus, too. In hindsight, I wish I had started her at 1u; she was on .75u of lantus and I had to take her up to 1.25u lev before we saw any green. I know that Jill also had to take Alex up higher than what would have been her "calculated" starting point using the units/ideal weight formula. When Libby switched Jazzy, she barely reduced and Jazzy was an acro cat. And we had Barb start Checks at the same dose he was getting on lantus.

I would suggest you start him out pretty close to his lantus dose; if you are a little nervous about it, start him at 6.5u instead of 6.75u. The Tilly protocol allows for pretty quick increases at first when switching insulins but if you start him at 6.75u, you probably won't need to do that. Remember that numbers "may" go higher at first as you empty one shed and fill another.

Tess went way low on lev at first but it was because she was on A/B for a UTI and was just finishing it at the switch so as her infection cleared, her numbers came down fast. I think that was atypical from what you would expect when changing insulins.

Let us know if you have questions. I think you will really like levemir!

Re: 4/9 Leo PMPS 295 need Lev dosing help

There's that lovely pre-shot bounce i was talking about......sheesh!!

I'm scared to switch to Lev!!! I think we'll start at 6.5u, is there a nice outline for Lev like there is for Lantus? You know the one that says:
+1 food influenced
+2
+3 onset begins
+6 nadir
etc, etc.

I hope Lev doesn't bubble as badly as the Lantus pens did, otherwise my father is going to have one heck of a time drawing a dose. I'm glad we're switching, tonight was a very owie shot and Leo kept flinching, i poked him 3 times before i finally got his full dose in......poor kitty.

Re: 4/9 Leo PMPS 295 need Lev dosing help

I think there was urban legend at one point that Lev had longer duration. Jill finally realized that it didn't have a longer duration. Rather, it has a later nadir which can give the impression that it's longer lasting.

There may be some limited wisdom to starting the dose a little lower than Leo's current Lantus dose. Some cats to have a marked initial reaction to an insulin change. It usually isn't long lasting, though.

If you are going to get the acro testing (IGF) done, they can do insulin resistance (insulin autoantibodies or IAA) testing done at the same time. The IAA test runs about $15 at Michigan State.

Re: 4/9 Leo PMPS 295, +4 160

Tracy

There used to be somewhat of a little "scale" in the Levemir ISG that was similar to the lantus one indicating what you might expect at what times.....but it's gone. I was trying to find it as I know I posted it on
someone's condo recently....I think Barb ...but I can't. It wasn't anywhere near as good as the lantus one.

Basically what you need to know is that onset is about +4 and nadir anywhere between +8 and +12. Since Gracie never read the lantus "scale", she also ignored the levemir one. As an example, her nadir from her AM shot is at +16; then her PM shot onsets at about +7. Figuring out their pattern on lev takes time and patience and as you know, can change, just like on lantus. Also remember, it can take weeks or months for them to get where they were on lantus. It took Gracie about three months to start stringing together cycles and about five months to where she is now which I am not sayin' nuttin' about so if you want to know...you'lll just have to look at her SS :lol: :lol: :lol:

Re: 4/9 Leo PMPS 295, +4 160

Ok picked up the Lev from the pharmacy and had to go to a different pharmacy to pick up the NovoPen. I am terrified! :shock: :shock: I will give Leo 6.0 units just to be on the safe-ish side. Lev smells exactly like Lantus does, which kinda surprised me, i don't know what i was expecting.

Promise someone will be here for me tomorrow to hold my hand.................PLEASE!!! :lol:

Re: 4/9 Leo PMPS 295, +4 160

Tracy.....where are your big girl pants? ;-) ;-) :lol:

Don't be scared.....I bet you will love it once you get used to the different cycle. It's a little confusing at first but once he settles in......I'm hoping for great things.

I'll be around tomorrow but I'm on west coast time so it might be long after you shoot....but I'll check in.

Hugs....it's going to be fine

Re: 4/9 Leo PMPS 295, +4 160

WOOHOO!!!!!!!! HOORAY FOR THE SWITCH!!!!!!!

Hope it does the trick for our little Leo!!!!!!!

Paws crossed for a smooth transition!

Hi Tracy - wishing you luck with the Lev - Exciting times for Leo. I hope it helps him - wishing you guys the best!