Insulin Degludec for cats?

Status
Not open for further replies.
Stacy & Asia

Stacy & Asia

Member Since 2017
Forgive me if this isn't the right place to post this, but I wanted to see what others have heard about this insulin. It looks promising, could be a longer acting once a day insulin and sounds to be more even keel than Lantus and Levermir with potentially less incidents of hypo. This article is older and it wasn't approved in the U.S. yet when it was written. It now is available in the U.S. Anyone heard of any studies or veterinary use of it yet? I found a couple brief mentions of it being used in cats in other countries, but nothing of substance in those articles other than it was indeed prescribed for cats.

"Insulin degludec (Tresiba, Novo Nordisk) is a new-generation, ultra-long-acting basal insulin analogue. This latest insulin analogue differs from other long-acting insulin preparations in having a longer half-life, flat time-action profile (less likely to cause hypoglycemia) and less day-to-day variability (less glycemic variability).19-21

Degludec is a neutral, soluble ultra-long-acting insulin that forms large soluble multihexamers at the subcutaneous injection site. Its molecular structure is similar to the human insulin amino acid sequence, apart from deletion of Threonine at position B30 and the addition of a 16-carbon fatty diacid attached to Lysine at position B29 via a glutamic acid spacer.

After SC administration, degludec results in the formation of a subcutaneous depot of soluble multihexamers that results in the slow release of insulin monomers into the systemic circulation. Insulin degludec has an onset of action of 30-90 minutes (similar to insulin glargine and insulin detemir). There is no peak in activity, due to the slow release into systemic circulation. The duration of action of insulin degludec is over 42 hours, unlike the 18 to 26 hours provided by current marketed long-acting insulins such as glargine and detemir. The large molecular size of the degludec multihexamers allows for continuous slow release of insulin with less pharmacodynamic variability and within-subject variability than is seen with the currently available insulin analogs.19-21

In studies in people with type 1 and type 2 diabetes, degludec was demonstrated to provide similar improvements in blood glucose control as glargine or detemir while also reducing the rate of overall and nocturnal hypoglycemia. One study found that degludec’s long duration of action makes it possible to dose the drug at different times each day (i.e., in the morning one day, the evening the next day, the morning the day after that) without sacrificing effectiveness and safety."

Here's a link to the original article, if anyone is interested. It discusses all types of insulin:

https://www.researchgate.net/profil...roblem-diabetic.pdf?origin=publication_detail
 
We've heard of it....at first it was only available in U200 which would really be hard to dose in a cat on tiny doses, but they've got a U100 now too

With a cat's metabolism being so much faster than a human's, I still think it would have to be given more than once a day ....Lantus and Levemir in humans is a once a day insulin, but we have to give it twice to our sugarcats

I'm not sure how you'd be able to dose it on a regular schedule if it lasted half the 42 hours they say it lasts!

We're all very careful with our kitties here and don't tend to want to use them as guinea pigs, so I doubt if you'll see anyone here using it. I think there may be some people using it in Europe, but nobody here.

I did a test of the new Lantus bio-similar called Basaglar several months ago on China....most people here thought I was crazy to try anything new, but since it was the same strength and supposed to be the same thing (insulin glargine), it was bound to show up here at some point and we needed at least a baseline of how it worked. She did fine :)
 
Yes, they have a U100 and it wouldn't be once a day in people (longer), but it has the potential to be in cats. This is the really interesting part (emphasis mine):

"Although dosing at roughly the same time each day would make sense for most patients, having the flexibility to vary the time of day when needed could be positive for some patients. In addition, the daily injection time of degludec can be varied to extreme intervals of 24-40 hrs without compromising glycemic control or increasing the risk of hypoglycemia. Therefore, degludec represents an improvement over glargine or detemir that require dosing at the same time each day to maintain sufficient insulin levels in the body and to avoid hypoglycemia. "

Definitely not suggesting we use our kitties as guinea pigs, o_O just was curious if anyone had heard of vet use of it yet, it sounds like an exciting development. I'd bet it's monstrously more expensive than Lantus as well, but since we're waxing hypothetically, that wouldn't be an issue yet anyway.
 
My two-legged kid is using Tresiba and it is fantastic. She's a teen, so every now and then forgets to dose basal right when she's supposed to and Tresiba keeps her amazingly level past the 24hr mark with no ketones. That would be unheard of with lantus or levemir (which was twice a day for her).

The way her endo explained the longer action is that it is like a string of pearls - but they get smaller after the first ~30 - one breaks off for use each hour....

Our cat Kahn is doing extremely well on 1u Levemir twice a day but I'm very tempted to try Tresiba ... will probably wait until we're almost out of Levemir though (we have about six months left). It would be nice to be able to use the same insulin for them both, and the possibility of once a day is massively appealing. I'll post his basal test (I don't remember what you guys call that for cats) and blood ketone data if we try it
 
Last edited:
Juliet said:
Ouch that insulin is EXPENSIVE. Have you thought about buying it in Canada? It’s much cheaper here.
Click to expand...

My daughter is type 1. Thankfully, both her insulins are covered 100% by our insurance. She switched basal from Levemir to Tresiba this year, so we're still working through the Levemir leftovers for Khan

I've heard that a 5-pack of Tresiba in Canada is about $100-$150
 
sheeboo said:
My two-legged kid is using Tresiba and it is fantastic. She's a teen, so every now and then forgets to dose basal right when she's supposed to and Tresiba keeps her amazingly level past the 24hr mark with no ketones. That would be unheard of with lantus or levemir (which was twice a day for her).

The way her endo explained the longer action is that it is like a string of pearls - but they get smaller after the first ~30 - one breaks off for use each hour....

Our cat Kahn is doing extremely well on 1u Levemir twice a day but I'm very tempted to try Tresiba ... will probably wait until we're almost out of Levemir though (we have about six months left). It would be nice to be able to use the same insulin for them both, and the possibility of once a day is massively appealing. I'll post his basal test (I don't remember what you guys call that for cats) and blood ketone data if we try it
Click to expand...

This is in line with what I've read about it for humans, they love it and it gives them a much greater amount of freedom with their basal. Was your daughter on Lantus or Levermir prior to Tresiba? If so, was the dosage similar? Or you use twice as much as the BID ones? If the dose is similar, the insulin wouldn't be all that much more expensive because you would use half the amount anyway.

I really wish I could find more info of vet use. I read about it in a vet article so it's at least in the minds of vets who have read that. It would be an amazing solution for so many people, particularly ones that have lengthy commutes and work hours such that they cannot consistently give insulin 12 hours apart.

I see the temptation wanted to share the insulin as the out of pocket cost for you would be nothing. I would be wary to try it without a vet on board to supervise and I would make sure there is some documented use somewhere on a cat. I would also be wary to mess with a good thing if Khan is doing really well on Lev already.

Thanks for sharing, it really seems promising and exciting and who knows, maybe a couple years in the future there will be a Tresiba forum on FDMB! ;)
 
I found this:

Evaluation of 2 Insulin Preparations and Validation of a Continuous Glucose Monitoring System for Use in Cats

E. Salesov, A. Riederer, E. Zini, C.E. Reusch.

Clinic for Small Animal Internal Medicine, Zurich, Switzerland

The cornerstone of treatment in diabetic cats is insulin. Among other issues, insufficient duration of insulin action may lead to poor metabolic control and persistence of clinical signs. With the aim to improve current therapeutic options, the present study evaluated pharmacodynamics parameters, such as onset of action, time to glucose nadir and duration of action, of protamine zinc insulin (ProZinc®, Boehringer Ingelheim) and insulin degludec (Tresiba®, Novo Nordisk) in healthy cats. Additionally, the accuracy of 2 different sensors, Sof- and Enlite-sensor, of the continuous glucose monitoring system (CGMS) iPro2® (Medtronic) was determined with particular attention to the low glycemic range, since reliability of CGMS in case of hypoglycemia is crucial.

Three different doses (0.1, 0.2 and 0.3 IU/kg) of each insulin and both iPro2® sensors were tested in 6 healthy purpose bred cats in a randomized crossover trial. The sensors were placed in the neck area for 7 days. Paired glucose measurements were obtained every 8–12 hours with a validated portable blood glucose meter (AlphaTRAK®, Abbot) set as standard and accuracy was assessed by using ISO 15197 2013 criteria. Additionally, to determine onset of insulin action, time to glucose nadir and duration of action, glucose concentrations were measured 30 and 5 minutes before and 30, 60, 90, 120, 180, 240, 300 and 360 minutes after each insulin administration, then every 2 hours for 18 hours.

Median (range) onset of action was 1.5 (1.5–3) hours for ProZinc® and 1.5 (1.5–4) hours for Tresiba®. Median (range) time to glucose nadir and duration of action were 4 (1.5–6) hours and 7 (5–10) hours for ProZinc® and 5.5 (3–8) hours and 11 (8->24) hours for Tresiba®, respectively. With regard to iPro2®, 100% of paired glucose measurements with both sensor types were in zone A and B of the Consensus Error Grid. At glucose concentrations <5.55 mmol/l 90% (160/177) of Sof-Sensor measurements and 87% (269/309) of Enlite-sensor measurements were within ±0.83 mmol/l of the standard; at glucose concentrations >5.55 mmol/l 43% (6/14) of Sof-sensor measurements and 40% (6/15) of Enlite-sensor measurements were within ±15% of the standard.

In conclusion, healthy cats injected with ProZinc® and Tresiba® showed similar onset of action. Later glucose nadir and longer duration of action was seen in cats treated with Tresiba® compared to those treated with ProZinc®. Both iPro2® sensors revealed good clinical accuracy and performed similarly in the low glycemic range.
Click to expand...

http://onlinelibrary.wiley.com/doi/10.1111/jvim.13647/full

Is the Clinic for Small Animal Internal Medicine, Zurich, Switzerland anywhere near you? This was from 2015, they may have more info and wider use now @Stephanie & Quintus
 
I think it's great you're looking into, and sharing this. I know nothing about Prozinc but when I Google I see it's reputed to be a long-acter, similar to Lantus. Could be very good news indeed.
 
My fingers are crossed we'll be able to use these new insulins at some point
Trying to imagine life with a bit of freedom - if someone does try one of these, we anxiously await the results
My vet goes to a lot of international conferences - I'll ask her if anything is on the horizon next visit
 
Stacy & Asia said:
"Although dosing at roughly the same time each day would make sense for most patients, having the flexibility to vary the time of day when needed could be positive for some patients. In addition, the daily injection time of degludec can be varied to extreme intervals of 24-40 hrs without compromising glycemic control or increasing the risk of hypoglycemia. Therefore, degludec represents an improvement over glargine or detemir that require dosing at the same time each day to maintain sufficient insulin levels in the body and to avoid hypoglycemia. "
Click to expand...

Wow. I've finally read this thread closely. I might call up the Zurich Tierspital or ask my vet to dig into this.
 
Stacy & Asia said:
Was your daughter on Lantus or Levermir prior to Tresiba? If so, was the dosage similar? Or you use twice as much as the BID ones?
Click to expand...

She used both (Baslagar though, not Lantus). Baslagar/Lantus needs for her are about 30% less than for Levemir. Baslagar/Lantus are about equal to Tresiba.
 
Status
Not open for further replies.
Back
Top