12/20/2010 wondering about switching from Lantus to Levemir

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BJM

BJM

Member Since 2010
Poor old Spitzer just hasn't been very stable on Lantus (admittedly partly due to life events in his bean). I'm wondering about asking the vet to switch him to Levemir.

For those who've had cats on both (not at the same time, obviously!), what were the pluses and minuses, costs and benefits you encountered with each?
 
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Wow, I just looked over your SS - that must have been really scary when he was given 10u by mistake!

My first thought is that he has been getting too much insulin followed by none, so he is swinging down and back up - the 300s look like rebound to me. I think he would do better with a much lower dose that is consistent (bid) even on lantus. I would suggest you try .25u, but he may need even less that that.

I see some indication that he is toying with remission. When started getting those low numbers he responded very well to reductions in the dose in .1u increments. On .5u he was rebounding, but when I got him down to .3u his numbers got better and I just reduced him by .1u every time he got a low number (below 40 or so). He was even on .05u for a few weeks and "as needed" sometimes only needing once a day dosing.

Do you know how to get the tiny dose increments? I posted about it to Pam and Alley. I call it the drop method. I'll go see if I can find a link to it. (here it is):

Here are my microdose instructions again:
The drop method I use is to practice with a used syringe and water or expired insulin and draw up 1u, then twist the barrel (clockwise if the needle is pointed away from you) slightly until a drop forms on the end of the needle. It will be about the size of the end of a straight pin. Flick it off and twist to form another one. Practice until you get 10 drops that size from one unit and 5 drops that size from a half unit. Those would be .1u drops, so you can dose fairly easily in any increment of .1u. If you want to perfect that, try for a drop HALF that size. Those would be .05u drops. Loads of fun to draw! I have to take off my glasses to see to do that.

I would try a dose reduction on lantus first before switching. I don't know how lantus works in the .1u increments, but I am guessing it is similar to levemir.
 
I have used both for my two acros; Oliver does not care, Shadoe does much much better on Lev.
 
I'm definitely trying to sneak down the dose, within the limits of my crappy vision. I really wish they had a diluent for Lantus! I've got him down to 5% carbs or less in the past week or so, and these past couple days, he's been too low to shoot on the 12 hour schedule, so I've been lagging it a few hours each time, rather than trying to shorten intervals. It almost seems like he's on a 14 hour cycle exactly. Although he must've eaten out of some near hypos before I was testing (back in Oct), I just feel nervous shooting below 100.
 
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BJ, what are your vision limitations? Could you see with strong reading glasses or a magnifier of some kind? I can only see the details on the syringe (lines, etc.) without my glasses and held very close to my face, and really only through my right eye.

I really think that he will do very well on much lower, consistent doses. One of the other people here, Vicky, uses a micrometer to get very exacting doses. For me, I think the device would be more trouble than it is worth, but maybe for you it would help you to see the finer doses.
 
Cataracts, right in the center of the focus & glare from really thick glasses.
 
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I'd love to find consistency; life, however, is fighting me tooth and nail on it.

I do not have anyone at home and am relying on a friend to shoot when I have rehearsal; he didn't one night and that changed the schedule.

He also misread the syringe when I got a new batch, resulting in a whopping insulin OD of 10 units, rather than 1 unit and Spitzer spent 24 hours at an emergency vet. His go home instructions were to wait until the next morning before resuming.

He earned the decrease from 1 to .75 on 12/10, from consistent dosing.

I wasn't willing to shoot him with a glucose of 60 on 12/19 and delayed until 11 am. which of course made the evening dose need to be at 11. Trying to get back by shooting earlier isn't going to work as it is like a dose increase, so I'm going the other direction and shooting later in blocks of a couple hours each time. I hope to be back on a 12 hour schedule by tomorrow morning, with a decreased dose of .5 which I hope gets him to a level we can do consistently.

There has been 1 blind shot since I started testing. Other gaps on the sheet are because there were delays or the vet instructed me to omit insulin.

I have a sleep disorder which makes getting up in the middle of the night problematic, as it usually results in nap attacks at work the next day. I need to stay employed to afford the food and vet bills for 11 cats. It also sometimes results in me being asleep when I should be testing, feeding, and giving the insulin.

And of course I've screwed up on shooting when I shouldn't (see 10/17) and got everything whacked out too.

In short, I am doing what I can with what I have.
 
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Magnifiers don't help when there is a cataract in the way. A cataract is opaque in spots and bounces around the light in others. I'm seeing a surgeon to determine what the best option is going to be.
 
I hope you can get the cataract surgery. My aunt and my father both had it and it made a huge difference for them.

One thing I do know from my own experience is that you can pre-draw levemir and keep it in the syringe in the fridge. So my thought there is that you could get someone to draw .25u for you, maybe a weeks worth at a time. I pre-drew syringes for Beau when I was gone for 6 days once. My sister ended up never shooting because I set a high "do not whoot" number, but I used them when I got back, so they were 2-3 weeks "old" by the last one and still worked.

Unfortunately, you can't predraw lantus because it reacts with the syringe coating inside.
 
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