? Possibly switching from Novolin N to Levemir?

Mac88

Mac88

Member Since 2020
I posted in the general forum about the accuracy of the Relion Premier meter I got and explained Butters story (posting again below), but was told Novolin N isn't the greatest insulin for cats and was told Lantus or Levemir would be better, so posting here to get some input.

"Butters was first diagnosed with diabetes in early 2014, this was a couple months after a steroid injection for a skin issue he had. Novolin N was prescribed, though for the life of me I cannot remember the initial dose. Anyway, at the time we were just told to bring him in every few weeks for a blood test to check his blood glucose and to use Karo syrup if it ever seemed like he was lethargic. I had no idea that testing at home was possible. Fast forward to Memorial Day 2014. Butters was in the backseat of my car as I was travelling back from our place up north, he had started coming with me as I wanted to keep a close eye on him even when out of town as he had his twice daily insulin injections. I noticed he was acting strange, very sleepy, then meowing in pain, then shaking uncontrollably (seizure), then lost all control of his bowels. He stopped and was awake, but very lethargic. It was scary and we were between towns and didn't have Karo syrup with me in the car, so I sped and rushed to the closest Walmart, got him canned food and Karo syrup, applied it to the roof of his mouth and encouraged him to eat the food, all while frantically searching for the closest open emergency vet (remember, between towns and a holiday). Found one an hour away and drove to it. His blood glucose was 47 when tested there and that was after the food and Karo syrup. I'm confident I came extremely close to losing him that day and without the Karo syrup, he would have died. Needless to say, he was declared in remission the next day at regular vet.

The remission lasted 22 months and in early 2016, he was exhibiting the same symptoms of weight loss and thirst a month after a steroid injection. It was determined that the steroid injection had likely caused his diabetes both times. He was put back on Novolin N and closely monitored for any changes. I saw he was acting funny one day a couple months later and immediately took him to the vet, who tested his blood sugar and it was 58. Remission again.

Butters stayed in remission for nearly 4 years and we avoided the steroid injections completely. Butters has always been a fairly big boy (13lbs) and has always had a bit of a urination outside the box issue, despite the many things we've tried, but I noticed a couple weeks ago he was acting different. I chalked it up to a visiting dog that I cared for several days, as Butters isn't a huge fan of dogs, but when he didn't get better I took him into the vet and was pretty confident from the symptoms that he was diabetic again. I did a lot more research than I've ever done this time and came across this forum and realized that I could actually test him at home and hopefully prevent what happened in 2014 from ever happening again if he was actually diabetic again.

We returned to the vet last week and they did the full bloodwork panel, though from his symptoms and age, the vet wanted to rule out kidney disease and actually thought kidney disease was probably the cause of his symptoms. His kidneys ended up being fine, but the blood sugar was 587. I really like our vet as he's been spot on about all our other pets (let's just say I'm a crazy cat lady who can't say no to cats who've shown up on my doorstep), but I do get the feeling he isn't an expert when it comes to diabetes. He did tell me how to do the testing at home and is having me report the readings to him weekly so that the dose can be adjusted, but he doesn't seem to be as knowledgeable on the types of insulin. He mentioned Lantus and Prozinc to me as options, but said usually people don't want to spend that amount of money on them so Novolin N is usually the one of choice. He especially thought Novolin was worth trying this time because of Butters' history of going into remission on it."

Here's my question: Butters has been put on a starting dose of 3 units Novolin N twice daily by our vet. I was told here that is a high starting dose. In light of Butters' previous remissions, I would like to avoid him going into hypoglycemia again. My father previously took Levemir Flextouch and as such has 6 brand new pens of it, all with expiration dates in middle 2021. Dad is on Lantus now. So switching to Levemir would be free for Butters and I'm guessing the supply would last Butters a long time as each pen has 300 units of insulin.

Based on the tight regulation dosing guide mentioned here, it's 0.25 unit per kg of cat's weight. Butters ideal weight is 5.44kg, so am I right that the Levemir dose for Butters would be 1.36 units of insulin per 12 hours? Or would it be more or less? Also curious others experiences on Levemir and what the difference is between it and Lantus. Thanks all!
 
The starting dose would depend if you are going to be following the TR or the SLGS method.
Are you feeding an all low carb wet food? No dry food? If yes, then you can follow the TR if that suits you, and you would use the 0.25 units/km ideal weight formula
If the dose works out to 1.36 units, I think I would start with 1.25 unit, given his history of dropping low. Let's see what others think..

If you use the SLGS method and you fed some dry food, you would start at 1 unit.
If you use the SLGS method and feed only wet, canned food you would start at 0.5 units.

Lantus and levemir are both long acting gentle insulins very suitable for cats. Both are depot insulins..
Some of the main differences between Lantus and levemir are levemir has a later onset of insulin than levemir. Lantus onsets around +2. Levemir onsets around +3 or +4.. I found the duration of the insulin was longer with Levemir and you often had lower numbers teowards the end of the cycles. Some people get flatter curves.
I found Sheba was happier on levemir than on Lantus...more settled. I loved Levemir..
 
3.0u of N would be an outrageously large starting dose! N is also a less than ideal insulin for a cat. The American Animal Hospital Assn recommends either Prozinc or Lantus (and likely by extension, Levemir) for cats.

Your calculation for starting dose IF you're following Tight Regulation (TR) is correct. However, if Butter is eating any dry food, you really can't follow TR. If Butter is eating low carb, canned food you're fine to start with Lev. I'd suggest using 1.25u as your starting dose.

One additional point. We don't use the pen needles. You'll need U100 syringes that are marked I half unit increments. The pens will dispense in 1.0u increments only. We use a syringe with the pens.
 
First, before we talk dose, what type of food is Butters eating?

In addition to what Bron said, the onset is a bit more variable on Levemir. With my girl is was 5 hours after the shot. The nadirs or low points in the cycle are typically also a couple hours later with Levemir vs Lantus. Levemir is a better insulin for cats on larger doses, as Lantus has an acid base that can sting at higher doses.

A big difference between the two L insulins and Novolin is that we determine dose based on how low the dose takes the cat, not the preshot numbers.
 
Thanks everyone. Butters mostly eats dry food (indoor formula stuff) and occasionally some wet prescription diet urinary tract food. He was 13lbs before, I suspect this is too much and contributed to the diabetes so estimate 12lbs is closer to where he should be given his body type and age.
 
The dry food will be high carb and the wet urinary prescription food probably is as well. You would do much better looking at feeding him a low carb wet diet. You will have a much better chance getting him into good numbers and maybe remission again. In fact if you swapped him over to a low carb diet now I am sure his numbers would be much better even before you start the insulin.
Here is a list of suitable canned foods. Look for carbs 10% and under.

https://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
 
I would echo Bron's suggestion regarding what you're feeding Butters. We encourage cats be fed a low carb (less than 10%, although most people here feed their cats about half that amount), canned food diet. The vast majority of dry food is high in carbs. Since cats are obligate carnivores, they can't digest plant material or any other carb. Dry food is, well, dry and cats have a limited thirst drive so dry food can contribute to kidney issues. If there is any way to transition Butter over to canned food that is low in carb you would be helping your kitty's diabetes and overall health by giving Butter a species appropriate diet.
 
Thanks! The only tricky thing about changing his diet is I have 5 other cats, so would have to feed him separately from the others.

His BG was 430 this morning, 11 hours after the last Novolin shot. Assuming I switched him to Levemir, could I start with the next dose (tonight) and discontinue Novolin? Would I start with 1.25u Levemir or different since he's still technically on mostly dry food?
 
I think you'll love the Levemir, I know I do now that I've switched. Another thing not mentioned above is the Levemir means grazing on food or multiple meal times is encouraged. I too have multiple other cats, and switching everyone over to low carb ended up being the easiest. There are some low carb dry foods if you have die hard kibble addicts, but they are pricey. Really, general overall health for all cats should be improved if you can switch them all over to any of the lower carb foods. The friskies pate with extra gravely, and Sheba portions are currently popular at my house. Lastly, 100% listen to the moderators here, they all rock
 
There's no problem with feeding your other cats the same food as Butters. The same species appropriate diet will be good for your other kitties. If you have a chance to review the webpage that Bron linked, Lisa Pierson, DVM goes into detail regarding the nutritional needs of cats regardless of whether they have any particular medical issue.
 
Mac88 said:
Would I start with 1.25u Levemir or different since he's still technically on mostly dry food?
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Start with 1.0 unit. It's always better to start lower and increase if needed. If you can start a spreadsheet with his values, we can help you with his dosing. The instructions for the spreadsheet are here.
 
Wendy&Neko said:
A big difference between the two L insulins and Novolin is that we determine dose based on how low the dose takes the cat, not the preshot numbers.
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NPH insulins also take the nadir, "how low does your cat go on this dose," into consideration when determining a dose.
The 2 big differences between NPH insulins and the L insulins are:
1. Very important to feed 45 minutes to 1 hour before you give the dose of NPH (Novolin N, Humulin N)
2. When you first start giving your cat an NPH type insulin, the initial BG level at pre-shot test "threshold bg number" is MUCH higher (250 mg/dL 13.8 mmol/L) for decision making. Initially.

Just like with the L insulins, that pre-shot test "threshold" number on your decision to give the full dose, stall, give a reduced dose or skip entirely, can and will be lowered with time and gathering data on how YOUR cat does on the NPH insulin.

Finding the onset, nadir, duration, and when to feed is really no different on NPH that it is on Lantus, Levimir, or Prozinc.

With lantus and levimir, the test, feed, shoot cycle can all be done in 10-15 minutes or less if you can manage it. No need to wait after feeding, to have some food digested and into the bloodstream like you had to do with the NPH insulin, to cushion that rapid onset.
 
My boys started on Nph-N(Novolin). Moey was on it for over 5 years. He had 2 hypo episodes while on Nph. I was very ignorant and didn't test consistently.
When my 2nd boy was diagnosed last August I knew something significant needed to happen. I found this board and lurked for a bit. When the Vet called in the script for Lantus everything changed. I started posting on the Lantus/Levemir forum because I knew we needed help. I had to put what I thought I knew aside and really educate myself. This forum is a kitty saver! W/o these experienced and caring folks I'd be lost(along with many others) and would have given up. If only, I would have found the forum sooner. Moey could have gone into remission by now.
You're in the best place to learn everything you didn't want to know about feline diabetes. Best of luck to you and Butters. I look forward to seeing his progress.:)
I hope you have a wonderful day.
 
Wendy&Neko said:
Agree with above @Deb & Wink but we don't typically change what we are going to dose that particular cycle based on the preshot number when giving Lantus or Levemir.
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You don't typically base the dose for ANY of the in-and-out insulins based on the pre-shot number alone either. Not NPH, not Prozinc, not Vetsulin/Caninsulin. You give the pre-shot numbers a little bit of consideration, but it's the nadirs that determine the dose changes. Just like with the L insulins.

You hold the dose for a particular number of cycles with the in-and-out insulins just like you do with the L insulins.
You stall, reduce to a token dose, skip or "manage the curve with food" in the same manner with an in-and-out insulin as you do with the L insulins.
You take the same precautions when switching your cat from dry to a lower carb food or from one low carb food to another one.

Not as much flexibility with your shot times with the L insulins.
But all the in-and-out insulins are best dosed on a 12 hour schedule also. UNLESS your cat is not getting the needed duration. Then you can give doses closer together. Really rough on the caregiver to do that, but not much tougher than some of the lantus and levimir folks are doing here with the L insulins.

You get the same bouncing, you need the same amount of testing, you need to monitor when you are increasing the dose, all the same "stuff" that you need to be aware of when giving any cat insulin.
 
So I just took Butters bloodsugar and it's 142. It's been 12 hours since his last dose of Novolin N 3 unit. He vomited earlier, but it was just white foam. I just gave him some food and he ate. Would it be safe to start him on the Levemir or should I hold all insulin tonight? You guys are definitely right, 3 units of novolin is too much.
 
If you want to add a question mark to your condo(title) it may bring some attention to your thread. Click on thread tools...right hand side of the screen, located near your title. Click on edit title. There's a drop down menu at the beginning of the space where you type your title. If you mouseover the menu pops up. Go down to the question mark icon and click on it. Then click save changes. Once your question is answered remove the question mark....go back to the drop down menu and click no prefix. Hope this helps get some eyes on your thread.:)
 
Update: I did not give him any insulin tonight and took his BG a couple hours after the last time, it is up to 236. I am still unsure what insulin to use for his next dose.
 
Mac88 said:
Update: I did not give him any insulin tonight and took his BG a couple hours after the last time, it is up to 236. I am still unsure what insulin to use for his next dose.
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I switched to Lantus as soon as I possibly could. It takes time for these depot type insulins to build in the kitty's body. You usually don't see immediate results.
I wanted to get the insulin in my boys asap so, we could begin to see improvements in time. Just my thoughts.
You will be pleased with Levemir, I think.
 
I would start the 1 unit of Levemir tomorrow. Could you also start a new post tomorrow? Otherwise new additions to this one might get missed.
 
142 was a bit low to give Butters any insulin.
Do please work on getting your spreadsheet (SS) set up.
So much easier to see what is going on when that is available.
And update your signature to change the insulin from the Novolin N to the Levimer.
No need to state the dose in the signature, as that changes so often.

SS set up instructions are here. FDMB Spreadsheet Instructions

What is all means is here Understanding the Spreadsheet/Grid

New thread for today, when you wake up that is.:coffee::coffee::coffee:
 
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