Why is Lantus so much more popular than Levemir?

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Steph & Quintus & L & O

Steph & Quintus & L & O

Member Since 2017
I'm aware this is a think-tanky post but it's also really an L&L topic. As I'm starting to look more closely at Levemir spreadsheets, it really looks like a good insulin for cats. I'd heard (and remembered) that the duration was longer than Lantus and the curves flatter, but the more I see it, the more I wonder why more cats are not on Levemir?

Most of the Levemir kitties seem to have been on Lantus first, and then switched to Levemir because they were struggling on Lantus. On the FR group we have one Levemir kitty, switched directly from Caninsulin, on advice of a vet endocrinologist who stated Levemir was "the best" insulin for cats. And the results are spectacular.

So why don't more vets prescribe Levemir right off the bat? In Europe we are really stuck with regulations that force vets to prescribe caninsulin (or prozinc, which costs an arm and a leg there) first. So Lantus and levemir are mostly unheard of. What about in the US? Is Levemir much more expensive than Lantus? Are there restrictions against prescribing it?
 
I can only speak to the Canadian experience, but most vet's don't have any experience with Levemir and are more likely to stick with what they know. Especially if the client isn't home testing. Heck, we got put on Caninsulin first! :eek: Because that's what the vet was familiar with. It was only through a locum vet that we got onto Lantus. Levemir is a newer insulin, less published research has been done on it with cats. The first cat on Lev was in 2005. Plus with dogs only, Lev acts like a stronger more concentrated insulin, and many vet's mistakenly think the same holds true for cats.

Costs are quite similar between the two L's. In Canada there is something like $5 difference in a 5 pack of cartridges.
 
They are relatively similar in price. I don’t think Levemir necessarily has a longer duration, I think the duration depends on the cat and the insulin that works best for them, in some humans Levemir is shorter acting than Lantus, I think it true for some cats too, like Asia. I think it’s less popular because it’s newer (new is scary). ;) I also think it doesn’t work well for dogs and many vets seem more versed in dogs in general and apply dog knowledge to cats where sometimes it doesn’t fit. Most of the vets I’ve seen just haven’t used Levemir and that’s why the are apt not to prescribe it, many vets and doctors go with what they know, like and are familiar with. Wendy recently made me aware of a UC Davis pet diabetes Facebook page and they had this to say about Levemir, I didn’t realize that Levemir is less potent and therefore more concentrated than other insulins, that could be another reason why it seems scary.

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My first kitty Smokey was on prozinc when I got him. He was from NJ. I'm in PA and the vet here did not use Prozinc as it was to expensive for his customers. I think it was over $200 at the time. So we were put on vetsulin. After a year and it wasn't working I asked about other insulins. At this time I was aware of PZI and human insulin. So I asked about Lantus. Dr. wasn't familiar with it at all and suggest N. So now I was here and got some Lantus. Dr was interested in learning but very skeptical. I had to explain how to use the pens to him. Now its his preferred insulin.

Now with Olive, Lantus wasn't working, could be I didn't give it enough time but her glucose just wasn't budging. I asked about using Levemir. Even gave him info about getting 5 free pens from manufacturer for free. He looked into it and was told by colleagues "its to harsh" so he won't use it. And manufacturer as he said will not send to vet as there are no studies for use on cats and they didn't want the liability. If I wanted to change my choice was prozinc, vetsulin or N. None of these was acceptable to me. I explained that yes levemir is more potent than lantus but its gentler in drops and lasting longer (can't use Olive as an example on this, she proved it wrong). So I got Levemir from off market sources and have been using it since March. Olive just had a follow up exam and vet did not know I changed the insulin. I showed him the lantus ss and the levemir ss. Her readings do not lie, she is much better on levemir but certainly not having late nadirs, slow drops. My vet is not comfortable with it, maybe he will be eventually.
 
Stephanie & Quintus said:
As I'm starting to look more closely at Levemir spreadsheets, it really looks like a good insulin for cats.
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I agree.
Stephanie & Quintus said:
I'd heard (and remembered) that the duration was longer than Lantus and the curves flatter,
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Duration really isn't longer, in most cats. The length of duration can be deceiving only because Lev onsets later than Lantus. That later onset makes it *look like* kitty is experiencing greater duration from Levemir.

Flatter curves... Because of the later onset of Lev, it's easier for most caregivers to shoot low to stay low because they quickly understand Lev's onset *usually* isn't until around +4, but ECID. A later onset makes it easier to shoot a low preshot number when you know it'll take around another 4 hours for the shot to "kick in". However, shooting low low to stay low works very well with both Lantus and Lev. Shooting low to stay low is how you eventually arrive at those long, flat curves both of these insulins are known for.
Stephanie & Quintus said:
So why don't more vets prescribe Levemir right off the bat?
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Because they're simply not aware of the success we've seen with Levemir and cats. Heck, many don't even know Lev can be used for cats. When Alex started on Levemir in 2009 I had to spell it for my vet. Hopefully, awareness of Lev has grown since then.
Stephanie & Quintus said:
In Europe we are really stuck with regulations that force vets to prescribe caninsulin (or prozinc, which costs an arm and a leg there) first. Lantus and Levemir are mostly unheard of. What about in the US? Is Levemir much more expensive than Lantus? Are there restrictions against prescribing it?
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Many vets don't prescribe Lantus, let alone Levemir because of price. They're both expensive... especially if you read/believe the manufacturer's pamphlet regarding tossing after 28 days (Lantus)/42 days (Levemir) of use! My vet figures there's a better chance of kitty being treated rather than PTS when treatment is affordable. When Alex was diagnosed in 2006, he offered several insulin choices depending on our budget.

Over the years, price differences in the US have varied. Sometimes Lantus is a little more expensive... sometimes Levemir. Location also plays into pricing. For example, Lantus/Lev is often notably more expensive in New York City than it is in middle Tennessee, where I call home. Taking it a step further, costs can vary greatly within a 5 mile radius. That's why I always recommend calling around for the best price when buying locally.

There are no restrictions against prescribing either for pets.
Stephanie & Quintus said:
Most of the Levemir kitties seem to have been on Lantus first, and then switched to Levemir because they were struggling on Lantus. On the FR group we have one Levemir kitty, switched directly from Caninsulin, on advice of a vet endocrinologist who stated Levemir was "the best" insulin for cats.
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Personal thoughts...
I agree. I wish Lev was considered the "go to" insulin for treating feline diabetes. I also think the action of Levemir is easier for those new to insulin and feline diabetes to understand. If I were queen of the universe, I would start all diabetic kitties on Levemir based on observations made over the last 12 years on the FDMB... specifically in this forum. :D That's not to say every cat takes to Lev like a duck to water. There have been some kitties who have done better on Lantus than Lev, but they've been few and far between.
 
My vet knew about lantus but had no experience with lev. Phoebe was on 24 units 2x a day, until we switched to levemir. She was miserable on lantus. Now we are at 2 units 2x a day! She purrs, she loves, she preens and she gets back up on the furniture. I concider levemir a miracle insulin.
 
Jill & Alex (GA) said:
Many vets don't prescribe Lantus, let alone Levemir because of price. They're both expensive...
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I never gave much thought to the fact that Lantus was said to be expensive all the time on this board. I figured maybe my vet had given me a good price, or something -- because I think I paid something like 17 CHF (or was it 27?) for my pen. (CHF=USD)

Then @Lilli Plume and Plume bought her Lantus (she's in France) and she paid 53 EUR (1EUR=1.2USD) for 5 pens. How on earth is it so ridiculously expensive in the US? Given how cheap it is in France, they should be using it all the time! (ProZinc, on the other hand, is 80EUR a vial...) I'll have to check how much they sell Levemir for.

FWIW was just told the endocrinologist who put our French cat on Lev is Dan Rosenberg... of the ISFM consensus guidelines... no wonder!
 
We will be switching over this week, and my vet's first suggestion was Lantus. I actually really wanted to try Levemir, but apparently I was too chicken to ask about it. :facepalm: I had asked last year about switching from Vetsulin to Prozinc, and my vet thought it was no longer in production. Now I'm curious to know what her process is regarding the L&Ls.
 
My vet had only used lev for sone dogs. I thought about trying it for Max but was worried he might have a late nadir that didn’t fit into my schedule at the time. Had I wanted to try lev my vet would have been willing. Pretty rare for an older IM I think.
 
I switched from Lantus to Levemir with both KT and Dakota 4 years ago. KT's health was too bad, I lost him before I could tell much. It's been absolutely wonderful for Dakota. His cycles are flatter - even when he bounces, the numbers are steady. My vet knows nothing about it and just writes my script for it since we agreed long ago that I would treat the diabetes, he'd treat everything else. I heartily endorse moving directly to Levemir from one of the 'starter' insulins.
 
For where we are in New Zealand Lanctus is likely the goto insulin. Available and not extortionate in price. It's likely supply and demand. In one of the 2 1/2 main cities it may be different. I'd also think that Lanctus would be the only insulin the vets here have any experience of.
 
Stacy & Asia said:
I don’t think Levemir necessarily has a longer duration, I think the duration depends on the cat and the insulin that works best for them, in some humans Levemir is shorter acting than Lantus, I think it true for some cats too, like Asia.
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I agree, based on my experience using Lev for the last 8 months. I switched Teasel away from Lantus (with its stronger depot action) because he didn't feel good on it. He feels better on Lev.
 
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