Chuck is back from the falls...

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Chuck and Susan

Chuck and Susan

Member Since 2010
... after over 4 years!!! :sad:

We did a curve last Saturday and spoke with the vet today (long story). He thinks Chuck needs to go back on insulin, mainly because the dental and 4 anti-biotics for a UTI didn't bring his numbers down. He doesn't want to start on insulin unless we can observe him for a couple of days, so that means a weekend start, probably next weekend as we are out of town tomorrow. 2 months ago, I would have been able to start him immediately, because I wasn't working. Figures, doesn't it? I don't work for 3 or 4 years and he's fine. Go to work and he needs to start on insulin...

First, sticker shock! The vet suggested Levemir (Wal-Mart, $160); we used Lantus (Wal-Mart, $152) 4 years ago. The vet only prefers Levemir because that's what he's familiar with. So, we can do either. Pros and cons of Levemir? I know Lantus (gentle, long-acting) but don't know Levemir. And is there a more cost effective place to purchase either Lantus or Levemir? We're in a little town, about 4500, so my options are pretty limited. I did call Walgreen's (35 miles away), and they were cheaper on Lantus by a couple of dollars, but Levemir was over $30 more!

Second, we're trying to decide on a dose -- vet said a "little bit" to start. Given Chuck's numbers over the last few months, does anyone have a suggestion? I'm thinking no more than 1/2 unit twice a day (Lantus -- don't know dosing cycle for Levemir). Because he developed insulin sensitivity after his hypo event, the vet wants to start low.

Last, given Chuck's age (18 next month), are we just prolonging the inevitable? Other than his BG's being high, he's in fairly good health -- kidney values are good for his age. He looks very thin, but we've been told that's because he loses the fat pads as he ages -- he's about 7 1/2 pounds now. He's still social, until he figures I'm either going to stick him or throw some medicine down his throat, litter box habits are normal. He is drinking more water now, am guessing that's due to having the high BGs for the last 2 months. He doesn't eat like he's starved, but he does have a good appetite.

Thanks for any advice you can send my way! Wish we didn't have to have a condo here in Lantus Land, but we know we're with the best kitties and beans in the world!
 
Hello.
Sorry things are bringing Chuck back... but as you know, it's the best place you can be.
I think I paid 136 for a vial of lantus at a Kroger's/Smith's pharmacy (but that was July ) . I hear the cheapest place is Costco (and apparently one doesn't haveto be a member to use the pharmacy?) but obviously driving to Dallas or Shreveport probably doesn't save you anything.

The new to the group sticky at the top of the TR Lantus
page tells a lot about the difference between Lantus and Levemir.
I think you might want to add/ or change your subject line to Questions? Levemir vs Lantus or something like that to get attention.

I think many of us are really sad from the loss of three special kitties this week and also it's friday.... there seems to be less activity
on friday nights and it's a holiday weekend. So keep posting until you get answers...

Your numbers do seem as if starting insulin would be necessary.

What are you feeding him?
 
Sorry to hear that Chuck is back from the Falls. Hopefully, it's a short term condo rental.

The dosing protocol for Lantus and Lev is the same. They are both long-acting, gentle insulin. The biggest difference is that the onset and nadir for Lev are later than Lantus (e.g., the Lev nadir can be at +8). You may want to consider this if you're going to choose between one or the other insulin. Here's some info on the difference between Lantus & Lev.

I would strongly encourage you to start ketone testing. Given where Chuck's numbers are, I'm a little nervous about your delaying getting him started on insulin.

I want to check in with a few folks re. Chuck's starting dose. Do you recall what his max dose was previously? Also, what's Chuck's ideal weight?
 
Hi Susan & Chuck,

Too bad you are back from the Falls and hopefully you'll be right back at the Falls again soon. I'll leave the dosing issue to those who are more knowledgeable, but just say here that having had experience with both Lantus (Stu, GA) and Levemir (Rusty), I think that I prefer Lev. But after Lantus it took some getting used to. Onset is later (after +4) and nadir can be anywhere from +7 or +8 to +10 or thereabouts (ECID). I like it because I can shoot a low PS number and know that I have at least 4 hours before the insulin begins to "kick in". Many Lev. users say that it affords fewer bounces and drops and that it gives a more shallow curve. Once again, ECID. Rusty tends to have shallow curves in any event, but both Marje's Gracie and Ann's Tess were able to smooth out their curves on Lev. I hope that others who use Lev. will chime in with their experiences (we have quite a lot of Lev. users on this forum).

I haven't bought Lantus in 3 years. Prices on Lev. can vary depending on location. Most buy the pack of 5 FlexPens because it is more economical in the long run. However, I think that the WalMart price for a vial of Lev. is pretty reasonable. It used to be possible to order from Canadian online pharmacies and get a really good price, but a new law prohibits them from selling any medications that must be kept cold in shipment.
If I were you, I would start with the vial. It keeps very well in the 'fridge. As long as you keep it at a safe temperature it will last a long time (the 42 days the manufacturer states is for human diabetics who don't refrigerate their pens after opening them).

Good luck, and welcome--again--to Lantus Land (sorry, I don't remember you from before).

Ella & Rusty
 
?? Lantus vs. Levemir -- Chuck is back from the falls...

Rhiannon (and Shadow) -- Chuck is on FF low carb exclusively, has been since he was diagnosed back in 2008. "Treats" are Halo Liv-A-Little Chicken (dried chicken) but only a little, not like I give the civvies...

Sienne, Chuck's max dose on Lantus was 1 unit 2x daily. I'd guess his ideal weight to be around 8 pounds. He's never thrown ketones, and these numbers, while higher than usual for him, aren't as high as when he was on insulin before, so neither the vet or I am overly concerned about ketones. I do have test strips and will likely try to "catch him in the act," just to rule out ketones. I wish I could start him sooner on the insulin, but agree with the vet that he should be observed for the first couple of days. I can't do that while I'm at work (nor can hubby), and I certainly don't want Chuck to spend a couple days at the vet for observation, due to vet stress skewing the BGs.

I saw that Moonie and Scrabble crossed the Bridge, but missed the 3rd kitty. Chuck was here when Jojo and Bunny were around, Greg and Carmelita, D and Noisy; the only one I really recognize now is Jill and Alex...

Thanks for the information!!
 
in an effort to bring everyone up to speed...

Chuck's data from his first time on insulin (before we used spreadsheets):
https://docs.google.com/document/pub?id=1nJHstu-f8gJZZJ9zILKBXbtEo5Ty2_fzIoNlgMTjluo

chuck survived an awful symptomatic hypo on a 1u dose while at the vet's office for a curve. despite intervention with IV fluids and dextrose, he dropped so low they couldn't even get a reading on a meter. chuck's numbers finally rose to 280 at +23.

the symptomatic hypo left him extremely sensitive to insulin.

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hi susan! i was hoping chuck's numbers would come down since we chatted a couple of weeks ago. i'm sorry he has to restart insulin after such a long honeymoon at the Falls.

lantus and levemir are similar in that they're long-acting insulins. imho, either one would be a good choice for chuck. prices are similar... a negligible difference between the two. over the years we've learned lantus is not as fragile as we once thought. when refrigerated and handled properly, there's no reason to throw out lantus every 28 days like we thought. discard only if frozen, discolored, you see particles or "floaties", or if the rubber seal on the vial/pen is cracked.

lantus is a known entity to you. you'd have to learn about lev... which isn't a big deal... later onset and later nadir. there's a link in my signature to an article about the differences. some cats do better on lantus. some on levemir. i haven't seen enough kitties smooth out their bounces on lev versus lantus to come to the conclusion that lev is better for bouncy kitties.

this time around, we don't know if chuck will exhibit the same insulin sensitivity he had after his hypo. i understand the caution in wanting to start him on insulin when you'll be around to monitor. in the meantime, as a precaution, testing for ketones is always a good idea.

as far as suggesting a starting dose...
since chuck is underweight, we would normally suggest a starting dose based upon his actual weight. that dose comes out to 0.85 unit. however, until we know if he'll be as insulin sensitive as he was last time... i think i'd start with either 0.25u or no more than 0.5 unit twice a day. we can always increase the dose rapidly if necessary. i'd also start on friday night to begin building the insulin depot. that'll give you a head-start before you have to go back to work on monday.

hope this helps...
 
Good Morning Susan ~O)

When I was "window shopping" for Lantus vials, the local "mom & pop" pharmacy was by far the cheapest ($136).
I switched to Lantus pens and was able to buy one at a time. Using an online coupon, I got the pen for $25 (which will last me at least 1.5 months or more).
 
Hi Susan and Chuck! I remember you - Chuck was going OTJ right about the same time Lucy and I arrived here. There was a whole slew of OTJ parties then, so you could say that you and Chuck were among those who inspired me and showed me that I could make Lucy well. :smile:

I used Lantus with Lucy and Levemir with Jazzy. Both are great insulins and you can't go wrong. There was no particular reason that I switched Jazzy from Lantus to Lev except that I was helping people here who were using both insulins so I thought I would put her on Lev so I would have experience with both.

I agree with Jill that a small starting dose (0.25u, or at most 0.50u) makes sense for Chuck just in case he still is as sensitive as before. Much of the time, we see that cats returning from the Falls will end up needing a higher dose than before, but not always and I think caution would be smart here. Also you can't always equate a cat's Lantus dose with their Lev dose (they don't always need the same dose when they switch insulins), so better to start low IMHO. You can always increase the dose quickly if you see that it is clearly not enough.

Sorry to see you back, but I bet you can get Chuck feeling better very quickly.
 
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