05/10 - Switching from Lantus to Levemir

[Melissa & Pinkie]

Hello Everyone,

I have been messing around with Lantus for the better part of a year trying to find the right dose for Pinkie. I have yet to get consistent results. At this point I think I am ready to make the switch to Levemir as I have heard some cats do better on it. A couple of questions:

1. What should my starting dose be? I am currently doing 0.75 of Lantus.

2. What types of differences should I expect to see with her curve?

If anyone has any suggestions/feedback that would be great. Spreadsheet is attached!

 

[Chris & China (GA)]

. What should my starting dose be? I am currently doing 0.75 of Lantus.

We usually recommend starting at 70% of the former dose.....since that's really hard to figure for .75, I'd just start with .5

What types of differences should I expect to see with her curve?

Levemir usually has a later nadir than Lantus (as well as a later onset) so you'll have to do some extra testing to see how Pinkie is responding so you can re-learn her pattern. Often, the PS number may be one of the lower numbers you see so you have to be willing to shoot (knowing that the insulin won't start to "kick in" until +4 or later for most cats)

 

[Sienne and Gabby (GA)]

One thing to keep in mind is that Lev is also a depot-type of insulin. However, the pharmacology of Lantus and Lev differ so it will take about 5 - 7 days for the Lev depot to build -- it doesn't pick up where Lantus leaves off. Some cats do have an initial (think first couple of doses) marked response to the switch to Lev but there's often a drop off as the depot start to build. In other words, you are unlikely to see lasting results until the depot is in place and you get the dose back up to where it was with Lantus. At present, it it looks like Pinkie needs more insulin so it's likely you will need to go beyond the current dose to see improvement.

If I can make an observation about Pinkie's spreadsheet...
You are testing enough to follow Tight Regulation. As long as Pinkie is on an entirely low carb, canned food diet, TR may be a better route. I can't actually tell from your spreadsheet if you're following TR or SLGS. At least to me, it looks like you've been holding doses for too long. When that happens, it can cause glucose toxicity (this means that your cat gets used to the higher numbers and those numbers act as your cat's "new normal"). Even with SLGS, you need to evaluate the dose every week and if numbers aren't in a closer to normal range, increase the dose.

 

[Melissa & Pinkie]

One thing to keep in mind is that Lev is also a depot-type of insulin. However, the pharmacology of Lantus and Lev differ so it will take about 5 - 7 days for the Lev depot to build -- it doesn't pick up where Lantus leaves off. Some cats do have an initial (think first couple of doses) marked response to the switch to Lev but there's often a drop off as the depot start to build. In other words, you are unlikely to see lasting results until the depot is in place and you get the dose back up to where it was with Lantus. At present, it it looks like Pinkie needs more insulin so it's likely you will need to go beyond the current dose to see improvement.

If I can make an observation about Pinkie's spreadsheet...
You are testing enough to follow Tight Regulation. As long as Pinkie is on an entirely low carb, canned food diet, TR may be a better route. I can't actually tell from your spreadsheet if you're following TR or SLGS. At least to me, it looks like you've been holding doses for too long. When that happens, it can cause glucose toxicity (this means that your cat gets used to the higher numbers and those numbers act as your cat's "new normal"). Even with SLGS, you need to evaluate the dose every week and if numbers aren't in a closer to normal range, increase the dose.

The problem is I'm only able to test this much because I'm on maternity leave right now. I go back to work at the start of July and won't be able to do any daytime testing.

Good to know about the glucose toxicity, I wasnt aware of that. I often get conflicting information from here and a Facebook group I'm in -- most recently it was suggested to hold at 0.75 for another week because there was a possible FS. Now this morning her numbers look good so hopefully it sticks otherwise I'm not sure whether I should adjust the dose or try Levemir.

 

[Sienne and Gabby (GA)]

The FB group is not supposed to be dispensing dosing information. That rule was established when the group was put in place. The vast majority of people there have limited experience -- not all, but most. In addition, people in that group rarely look at a spreadsheet. The folks here will usually tell you if their experience is limited and the experienced members always open a spreadsheet before offering a recommendation about dosing. I'm tagging @Chris & China (GA) since she's one of the admins for the FB group. There is often incorrect information that's dispensed from the group and unfortunately, neither Chris nor experienced members can patrol the page given the fast and furious nature of FB posting and the good intentions but inexperience of people who are dispensing information.

There's a post on how to do TR if you work/go to school full time. I was working throughout the 6.5 yrs I was managing Gabby's FD. A full time job and FD are not at odds with one another. There's information on handling TR when working full time that's incorporated into the dosing methods sticky.

I stuck with Lantus primarily because of the way Gabby handled insulin. She had a very early nadir, usually around +3. This allowed me to get up early (shots were at 5:00 AM/PM), be home to grab a couple of tests and intervene or leave HC food if needed, and rush home for her PM shot. Fortunately, I didn't have a long commute. If I needed to go back to the office, I did. If I'd switched to Lev, given that the onset and nadir are later and given Gabby's tendency to dive into low numbers, I would have been a wreck. I encourage people to do what works for them and their kitty. There isn't one right answer.