Miss Stubborn does not want to clear her bounce today!!
Ok...thanks for your patience. Levemir, like Lantus, is a depot insulin although the way it works is a bit different. No need to get into the weeds on that right now. It’s a really great insulin for duration in many cats but, of course, ECID. What you need to know about Levemir is that it doesn’t onset until about +4 and nadirs +8 to +10 but, again, ECID. Gracie often nadired at +13 - +15. That meant I not only had to learn to shoot low to stay low (never below 50) but I also had to deal with her carryover and overlap so one dose would carry over into the next cycle and the cycles could overlap so she would nadir from the morning shot, let’s say, and then immediately onset from the evening one. Now, she didn’t do this all the time but she definitely could do it often. It was such an improvement over lantus where Dr. Lisa told me that Gracie often had “BIPO” which is “big insulin poop out” which is loss of duration.
When we switch from Lantus to Levemir, we back the dose off so the first Levemir dose is 80% of what the Lantus dose was. Some cats switching from Lantus to Levemir have a very, very active first cycle. Gracie did not but we always err on the side of caution because we can quickly move the dose back up to what the Lantus dose was if we need to.
CGs must consider whether their lifestyle is conducive to such a different curve. I would think with the Libre, it would be very helpful as you could grab some sleep and the meter would let you know if she was dropping lower around those later nadirs. You will also have to learn to change her feeding schedule some because AMPS, +1, +2, +3 are at the end of the previous cycle; most of us still feed/fed at AMPS but then I would feed at +2, +3, +5, +6 unless she had a really active cycle.
You might want to check out Gracie’s SS (she was on Levemir starting in mid 2011), Neko’s SS (she was acro), and Christie’s Maverick is still FD and on levemir. As you move around the LBL board, take a look at signature blocks and see who else might be on it.
If you haven’t read
this in a while on the depot, it’s got some info about Levemir. You’ll note that it discuss duration and absorption and, on the latter, talks briefly about absorption can vary based on insulin, dose, where you shoot, how you shoot, etc. I haven’t asked before but do you rotate her shot site every shot? I had six locations where I gave Gracie insulin. In the mornings, I always shot right side and evenings I shot left side. On each side, I would rotate between chest, side, and closer to the flank in the subq layer.
The other thing you should consider is availability of the insulin. Will it continue to be available in Canada?
@Christie & Maverick
If it won’t be, are you using enough to be able to use the vial? After December of next year, which insulin will you use if Levemir is no longer available in Canada.
Very excited. (The things that now excite me, ways to keep kitty safe!!)
. If I understand correctly, it is being discontinued in the US market, with supply chain disruptions likely early this year and pens being phased out by April and then vials by the end of the year. What is not clear is whether it will still be available in the Canadian market, which might mean still being able to source it via a Canadian distributor. I am planning on talking to my pharmacist about what she has heard, but it is a concern if it becomes completely discontinued.