a quick Lev question

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George&Bert

George&Bert

Member Since 2009
I am a fairly new Lantus user and have been told that Levemir and Lantus are very similar.

One thing i don't like about it is it loses it's steam quickly after 8 hours or so. Is Lev longer acting?
 
George&Bert said:
I am a fairly new Lantus user and have been told that Levemir and Lantus are very similar.

One thing i don't like about it is it loses it's steam quickly after 8 hours or so. Is Lev longer acting?
Click to expand...

hi there,
You have a spreadsheet? It helps to see the numbers because what YOU see may well have a simple explanation as to why your cat is doing what with Lantus.

I am not sure what you mean by lose steam.... you will see a curve with a dip to nadir and then you will see a rise.... think Mona Lisa smile. It could well be that you are just seeing a natural rise around +8

How to do a Curve
Example of a typical curve:
+0 - PreShot number.
+1 – Usually higher than PreShot number because of the last shot wearing off. May see a food spike in this number.
+2 - Often similar to the PreShot number.
+3 - Lower than the PreShot number, onset has started.
+4 - Lower.
+5 - Lower.
+6 – Nadir/Peak (the lowest number of cycle).
+7 - Surf (hang around the nadir number).
+8 - Slight rise.
+9 - Slight rise.
+10 - Rising.
+11 - Rising (may dip around +10 or +11).
+12 - PreShot number.


By 8hours, you will likely see the numbers start to rise.
 
I'm beginning to think that the only similarity between the two insulins are that they are both long-acting ones. Their mechanism for creating a "time release-type" action is different. Lantus forms a precipitate (clumps) in the subcutaneous tissues and as those clumps break down the insulin molecules can get into the blood stream. Levemir binds with albumin in the sub-q tissues, but more so in the blood stream. They have different ph and seem to effect different cats differently (I get the prize for the most uses of "different" in a sentence!). ECID, as they say.

Dose size, daily activities including the timing of food, as well as the individual cat will effect duration and nadir. Some cats nadir mid cycle, other later, and others early (which could actually be a a > +12 nadir, so really very late).

Also, if the dose is too high be even a little bit there could be a fast rise after an earlier nadir (which might be on the low side) - a bounce or rebound, and lowering the dose will soften the curve and extend duration.
 
Thanks Gayle, but it's not me saying it. It is the way people on Lantus TR explain it. They don't feed after +7 as I understand it because the insulin drops out.

All I want to know is..in general..does Levemir last longer during the +7 to +12 upswing. Tech sheets may say one thing, but the experience of users is another.

It has nothing to do with my cat or testing.


Thanks again :)
 
Does Levemir last longer? According to the literature, yes.

Here's my best source: https://www.ideals.illinois.edu/bitstream/handle/2142/16049/1_Gilor_Chen.pdf?sequence=3

Page 24:
The onset-of-action of insulin detemir [Levemir]was 1.8 ± 0.8 hours, the end-of
action was reached at 13.5 ± 3.5 hours and there was a significant variation in the time-
action profile between cats. Surprisingly, the duration of action of insulin glargine [Lantus] was
much shorter than previously reported (11.3 ± 4.5 hours), and like insulin detemir, there
was a significant variation in the time-action profile between cats, ranging from curves
that were essentially flat to others that had pronounced peaks
Click to expand...

And page 86:
We found no significant differences between insulin detemir and insulin glargine
except for longer onset of action of insulin detemir (indicating a more protracted
absorption). The difference in onset of action was small and it did not affect the duration
of action. In 3 of 10 cats the end of action of insulin detemir was longer by over 7 hours
than the end of action of insulin glargine. This may suggest that, in some cats, there
might be a clinically relevant difference between the 2 analogs, but this is only true if the
day-to-day effect is fairly constant.
Click to expand...

That's significant. Of course, it's always ECID, so your cat's results will vary compared to others.
 
Where did you find that, Vicky? That is exactly what I needed to know.

That is what I was seeing/hearing, but not in those words. It was a suspicion and that is why I asked.

I wanted my hard headed vet to prescribe Lev, but he never heard of it!! Once I have Andre' somewhat regulated on Lantus I'll consider making the changeover with another vet.

Thanks Vicky, Sheila, Gayle and everyone for your input. Much appreciated! :)
 
George&Bert said:
Where did you find that, Vicky? That is exactly what I needed to know.

That is what I was seeing/hearing, but not in those words. It was a suspicion and that is why I asked.

I wanted my hard headed vet to prescribe Lev, but he never heard of it!! Once I have Andre' somewhat regulated on Lantus I'll consider making the changeover with another vet.

Thanks Vicky, Sheila, Gayle and everyone for your input. Much appreciated! :)
Click to expand...

You're welcome! AFAIK the University of IL is the only university in the US which has studied Levemir in cats. They were the first to publish something in the ACVIM abstracts in 2008. My vet called there in 2007 when I asked to switch Gandalf and they were able to tell her enough about it even then that she agreed. Another leading veterinary school, University Of Missouri, was not. They had just begun recommending Lantus, which makes sense as it was after that time we began hearing of more clinics offering Lantus as treatment option.
 
Those types of variances also explain why one insuiln "works" better over the other one is specific cats.

Vicky, I had not seen that info before. Thanks for sharing. It "makes sense" of my observation that very early nadirs are actually very late nadirs off the previous shot.

But in TR, I think there are other factors at play such as wanting to keep numbers so low and flat that feeding messes with that and also I think there is some overdosing to a degree that causes bounce which would overpower the fading insulin duration at about the same time. So, put that all together: food on board, insulin fading out, and bounce beginning and it seems to intensify the fading insulin.

That comment on overdosing is my opinion. I don't practice TR because I don't like the idea of forcing the BG numbers into a statistical normal range that may/may not be my particular cat's normal range* and which doesn't leave wiggle room for a day when he might eat less, be more active etc. so the insulin drops him to the 30s.

*How many owners of FDs tested their cat's BG regularly before diagnosis to know that cat's normal range? I had no idea what Beau's normal range was before he went OTJ. He now ranges from the 70s to the 90s (occasional low 100s), which is higher that the 45-65 I see as a target range on some TR cats, but he has not had insulin in over 3 years so I am not worried about it.
 
Points well taken, Sheila. Sounds like you have a good handle on it and know where you and kitty need to be.
 
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