can anyone explain in simple terms the difference?

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PeterDevonMocha

PeterDevonMocha

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Mocha is on lantus currently (F)1.0u and is having a hard time maintaining any decent numbers. We front load, meaning we feed her at amps, +1, +2 and +3 and the same at night, plus a late night +6 snack.

What are the benefits of keeping her on lantus or switching her over to levemir? I would have to say 100% of the time we can do a 12/12 schedule and I'm home to monitor daily. I just don't know if it would be beneficial, and it's a lot of money to just "try it" as I'm sure you all understand.

Oh, and I have read the stickies about both, but ... I still need it explained in simple terms .. :oops:
 
Hi there,

I know that Lantus and Levemir are similar, but quite different in composition. They are both long acting insulins. Lantus is not very stable, which is why it is suggested to replace in 28 days. Levemir is much more stable and lasts longer.

In humans, which is what I know more about, Levemir uses require more insulin to achieve the same results that Lantus users get. Where they would use 1 shot on Lantus, they need to use a bid dose (twice a day) on Levemir. The dose is not quite double, but almost

For cats, what I am seeing is that Levemir can level out the curve over the day with one shot. I foster diabetic cats and use Lantus because it is easily accessible for me. Newly diagnosed cats do well and often go into remission on Lantus.

When I see a cat that doesn't regulate well after 6 months on Lantus, I would move to Levemir. My reading research indicates a good response to that switch.

Maybe we can come up with a cartridge for you to try. I don't have any on hand. Have you checked the Supply Closet?

Best of luck.

Claudia
 
Never having used Lantus I don't have examples of differences for you. General thoughts are their action is enough alike that the same dosing guidelines work for both, hence Tilly and start low, go slow.

I would not recommend "front-load" feeding on Levemir. Can you explain the reasoning behind that on Lantus? Levemir wants to maintain BG at a more constant level, as does Lantus as far as I know. I have always left food out and am lucky that Gandalf is snacker, so he will eat small amounts throughout the day.

There are chemical differences of course and the simple fact of how Levemir works by binding and unbinding to albumin might cause enough change in her system to be a reason to switch.

If you were using Levemir with the numbers you currently have I would recommend lowering the dose to .5U. So if you switch, please consider starting with no more than that.
 
cjleo said:
For cats, what I am seeing is that Levemir can level out the curve over the day with one shot. I foster diabetic cats and use Lantus because it is easily accessible for me. Newly diagnosed cats do well and often go into remission on Lantus.Claudia
Click to expand...

I am a little confused as to the one shot with Levemir. I believe Lev works best when given the same dose twice a day.

Devon I switched Putty to Lev after about 18 months on Lantus. He did go OTJ on Lantus after 24 days but only went back on after 4 months. He has been on Lev since June 2010.
I am not sure if I see a big difference but he is on pretty much on the same dose of Lev as he was on Lantus. I think it is worth a try. I had heard that sometimes a hospital pharmacy is willing to sell on pen. When I first started Putty on Lev I was able to buy one pen at a local supermarket pharmacy. Most will not sell it that way but it may be worth calling around in your area to see they will.

You can also post this question in LL where there are many people that have switched from Lantus to Lev.
 
cjleo said:
Hi there,

I know that Lantus and Levemir are similar, but quite different in composition. They are both long acting insulins. Lantus is not very stable, which is why it is suggested to replace in 28 days. Levemir is much more stable and lasts longer.

In humans, which is what I know more about, Levemir uses require more insulin to achieve the same results that Lantus users get. Where they would use 1 shot on Lantus, they need to use a bid dose (twice a day) on Levemir. The dose is not quite double, but almost

For cats, what I am seeing is that Levemir can level out the curve over the day with one shot. I foster diabetic cats and use Lantus because it is easily accessible for me. Newly diagnosed cats do well and often go into remission on Lantus.

Claudia
Click to expand...

Regarding remark in bold above: do you mean 1 shot over 12 hours and or over 24 hours? And is that Levemir or Lantus? You use Lantus, but are commenting on Levemir as if you use it. Please clarify.

And information about how the insulins work in humans can be confusing. Best to disregard that, Peter, or Devon :?: I would not recommend a doubling of the dose from Lantus to Levemir in cats!
 
Hi Devon,
How far are you from the Blue Water Bridge? (Port Huron) or Novi?

I live near Novi, and have been driving to Ontario to buy Levemir. The 5-pack of cartridges costs about $120 US.

Right now, I have 1 spare cartridge and we just started a new one this week, so we won't need more for a couple months.

If you want to try it -- let me know and we could meet up somewhere for a handoff. Then later, we could split 5-packs if you (and Mocha) like it.

(I live closer to Windsor, but less traffic / hastle at Blue Water / Sarnia)
 
Thank you everyone for the replies. I am just gathering information right now ... I'm not 100% totally sure we are going to switch, I just wanted to see if anyone who had a cat on lantus and made the switch over to levemir had noticed a large difference in their cats numbers.

Phoebe, thank you for the offer. If we choose to switch, I might contact you and see how you are doing on pens at that point. I thought about going across the blue water bridge (about 45 min. away) for lantus early on, but peter had me scared witless that border patrol was going to detain us! nailbite_smile

Vicky, we are front loading mochas cycles because of her crazy number range. It was suggested to front load to try and help balance her numbers out. So far we are not seeing any drastic improvement with that schedule, but we were told it might take awhile. Unfortunately, we cannot leave food out for mocha at all times but I can alter her feedings as needed.

All I really know about this FD stuff is that mocha is coming up on her two year anniversary in a few months and we have yet to gain any sort of regulation with her. We started out on vetsulin until we switched to lantus in hopes of better numbers, but we only see them a few times a week. It is becoming harder and harder to watch her numbers creep up and drop down every other day. I know it isn't good for her little body but I just don't know what to do for her anymore.

Thanks again for all the replies everyone!
 
I don't post much here but I found your question interesting so I thought I would give it a shot.
My first answer to you would be is that you never know how a cat will react to an insulin.
I have seen Caninulin act like lantus and Lantus act like humilin N with different cats. The point of this statement is that I would recommend that you use the insulin you are on till you can prove it won't work

So the next thing I did was look at your spreadsheet. I noticed a few interesting things.
First you never had a streak where you had a week of sub 200 numbers. To me that means the glucose toxicity has never really been broken and until it is, it is hard to find the correct dose.
2ndly, you seem to be fighting success. Every time you get a 40 or 38 you are feeding high or medium carb foods
You are there to watch as I can see as there are many spotchecks afterwoods so there is no need if there are no symptoms to feed high carb foods. I understand you are scared of hypo but you do go out of the house at times and are not there 24/7 so you need to see how your cat reacts on her own. If there are symptoms, then that is different. If you have a 25 at +2 then that is different. If you have a 38 at +2 then watch him and check again in 30 minutes or feed low carb food and see what that does. Most times the body will do the work. Since these numbers can come out of nowhere you also need to know how your cat will react if you weren't around
Next, Why are you feeding her at +1 and again an hour later and again another hour later. Again you are fighting the insulin I do believe in either a schedule or free feeding with 2 fresh meals a day. If i were you I would consider putting down all the food at once in 2 meals or even 3 (1 before bed) and let her decide when she needs to eat the rest of what is left after the meal. I see the possibilities of this working for you so I would give it a few more months with a few adjustments I hope this helps some Best of luck
 
Thanks Ken for the reply.

We give mocha either HC or MC when she drops because she can sometimes continue to drop even after we give her the MC and HC. She has never displayed any symptoms of hypo, even when we have caught her down to 24, but we have been told those low numbers are a strain on a cat, and not to let them surf that low.

As far as the front loading (+1, +2 etc) we have only been doing that for awhile because it was suggested to us that it might help even out mochas numbers. Unfortunately we cannot leave food down for mocha unsupervised due to another cat in the house.

It is hard figuring out mocha's break through dose. She started out last year over 3u and earned herself all her reductions to todays dose of (F)1.0. She never had that aha moment where we knew what dose would work best for her.
 
Ken and Sneakers said:
My first answer to you would be is that you never know how a cat will react to an insulin.
The point of this statement is that I would recommend that you use the insulin you are on till you can prove it won't work

I am a little confused by this statement. How long do you wait and how do you actually prove it won't work?

So the next thing I did was look at your spreadsheet. I noticed a few interesting things.
First you never had a streak where you had a week of sub 200 numbers. To me that means the glucose toxicity has never really been broken and until it is, it is hard to find the correct dose.
2ndly, you seem to be fighting success. Every time you get a 40 or 38 you are feeding high or medium carb foods

I am concerned you will send the wrong message to newbies and long timers here like myself that feeding high carb food on a number below 50 is uncalled for. Any number below 50 needs food. Whether or not that cat needs low carb, medium carb or high carb depends on how well you know your cat and how that cat reacts to different carb foods which takes a lot of data and an experienced caregiver. Not feeding a cat higher carb food with a bg of 38 can be downright dangerous.


You are there to watch as I can see as there are many spotchecks afterwoods so there is no need if there are no symptoms to feed high carb foods. I understand you are scared of hypo but you do go out of the house at times and are not there 24/7 so you need to see how your cat reacts on her own. If there are symptoms, then that is different. If you have a 25 at +2 then that is different. If you have a 38 at +2 then watch him and check again in 30 minutes or feed low carb food and see what that does. Most times the body will do the work. Since these numbers can come out of nowhere you also need to know how your cat will react if you weren't around

Again...a misleading statement especially for newbies. Do you wait until your cat shows symptoms of hypo before you react? Some cats may be dangerously low and not show any clinical signs of hypo then there are others that could be in the 30's that do show clinical signs of hypo which in my opinion you never want to wait until that point. Most times when cats show clinical signs of hypo it can become an emergency situation and believe me I don't think anyone here wants to take a "wait and see," as to whether or not your cat will show signs of a hypo.

Next, Why are you feeding her at +1 and again an hour later and again another hour later. Again you are fighting the insulin I do believe in either a schedule or free feeding with 2 fresh meals a day. If i were you I would consider putting down all the food at once in 2 meals or even 3 (1 before bed) and let her decide when she needs to eat the rest of what is left after the meal. I see the possibilities of this working for you so I would give it a few more months with a few adjustments I hope this helps some Best of luck
Click to expand...

Feeding small meals at the beginning of the cycle can help those cats that tend to drop quickly early in the cycle. Over time it can help to flatten out the curve and avoid those big drops. It has been very successful for some and not always successful for others but with enough data and experimenting with the feeding schedule it can be beneficial. Once again you have to know your cat and how he reacts to insulin and have enough data to know how to feed the curve.

I hope you don't take my post to be nasty toward you at all because that is not my intent. There are a lot of newbies and even those of us that have been here for a long time and are looking to learn how to treat a cat with FD. I think we need to be careful of how others may interpret the information we share. I certainly have rewritten many posts of my own that may have been written without taking into consideration of how some may read the information I put out there. :smile:

 
Ken's quote"
"You are there to watch as I can see as there are many spotchecks afterwoods so there is no need if there are no symptoms to feed high carb foods. I understand you are scared of hypo but you do go out of the house at times and are not there 24/7 so you need to see how your cat reacts on her own. If there are symptoms, then that is different. If you have a 25 at +2 then that is different. If you have a 38 at +2 then watch him and check again in 30 minutes or feed low carb food and see what that does. Most times the body will do the work. Since these numbers can come out of nowhere you also need to know how your cat will react if you weren't around"

Miriam's reply:
"Again...a misleading statement especially for newbies. Do you wait until your cat shows symptoms of hypo before you react? Some cats may be dangerously low and not show any clinical signs of hypo then there are others that could be in the 30's that do show clinical signs of hypo which in my opinion you never want to wait until that point. Most times when cats show clinical signs of hypo it can become an emergency situation and believe me I don't think anyone here wants to take a "wait and see," as to whether or not your cat will show signs of a hypo. "


I don't want to rock the boat here, but I can see a some merrit on waiting to see what your cat can do. The reason I say that is because I'm home during lunch hour and a couple of times Tucker was low I threw a bunch of food at him and brought his number up quickly because I had to get back to work. But being FD since November of '05 I have to believe that at some point he went low when I was either sleeping or away for the day.

Many times if I'm out for more than 10 hours I leave extra food and cross my fingers. So far we've been fine so in retrospect I'm guessing if things like this did happen, Tucker took care of it. I cannot promise that the extra food I put out stays for 10 hours or goes in one hour as I have a multicat household with HyperT kitties and FDs.

I might tailor Ken's numbers a bit, depends on the 38 at +2, what Tucker was coming down from, if his PS was in the high 100s or high 300s that would change whether I'd be willing to wait and see, but I don't think the statement in general is something I would immediately tag as misleading. Again, I don't want to rock the boat or upset anyone, but I think the thought is an interesting one.
 
Thank you for everyone's input. There is a lot of information to take in but I do enjoy reading what everyone is saying and all the different points being made.
 
I just want to say that the feeding discussion would be a great topic to bring to Think Tank.

I hope we can now direct this thread back to the original intent that it was posted so that Devon can get responses to her original question from Levemir users. :mrgreen:
 
1. Levemir is physically more durable than Lantus. This is picture of a vial of Levemir that I mailed to someone here. It arrived full of bubbles. I was told that it retained its efficacy despite this abuse. Many people feel that Lantus needs to be handled like nitroglycerin. Many people feel that Lantus loses its efficacy at or near 28 days, whereas many Levemir users say they use a pen to the last drop. The rule is not to shoot Lantus back into the pen/vial because the silicone contaminates the insulin. Although some also follow that rule for Levemir, many of us shoot back into the vial/pen. The prices for Lantus and Levemir are similar, but the longevity of Levemir makes it more of a value.


2. (These are my opinion only and are based on observation. I cannot cite a study to support any of this. So there's no need for people to spend alot of time beating me up about these if they disagree.) Early on, Lantus usually produces more "bounce" in curves than does Levemir. It takes cats longer to produce a smooth curve on Lantus than on Levemir. Once a long-term diabetic is fully regulated, s/he tends to hold regulation better on Levemir than on Lantus.

As full disclosure, I use Levemir on Ennis and do recommend it to others over Lantus. The physical durability was the reason I chose Levemir over Lantus 4 years ago. At that time, there was little evidence of the way it functioned in cats. However, the functioning of Lantus in cats at that times seemed too haphazard to me. Since that time, however, the protocols have been developed/more widely applied.
 

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Thank you venita. Has anyone noticed a big change in how late their kitties have their nadir at? I noticed several people commenting that their cats nadir moved to much later in the cycle. Is this true for majority of cats?
 
hi devon, thought i'd pop in here as a brand new week old lev user. my days are flat and even, about as exciting as watching paint dry. i would like to get lower but am going slowly. my nadir's are later than pz which i know you are not asking about but honestly a nadir could be a 5 hour event from my observations. it just hangs and hangs and hangs. i have not really observed this with the few kitties i follow on lantus. i almost cannot imagine bouncing on this lev. the lantus bounces seem to be part of the expected.
NOTE: i know my kitty was not bouncing with his am highs becuase he did'nt go low and he did'nt travel fast. but this has been under debate amoungst my advisors. (i do know why he rises but not for disucussion now)
so from what i've seen with my untrained and unexperienced but observant eye...levemir is a flatter line slower moving insulin less prone to bounce and general excitement.
i personnaly love it. but am still waiting to get more out of it.
lori
hope my observations help.
 
Thanks lori .. It sure would be nice to stop mocha's bounces .. sometimes this crazy cat bounces going from a high pink to a low pink .. because lev and lantus seem so similar we are leaning towards switching, just in case it's just different enough to do something for mocha .. the only thing holding us back at this point are the late nadirs ..
 
Sorry to confuse everyone. I did mean to say Levemir with 2 shots would level out a curve. Sorry, need to proofread more carefully.

Claudia
 
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