Diluted Levemir? need advice

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dosgatos

dosgatos

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Hi,
My cat, Akane, 12 yrs old, has been diabetic for 2.5 years and we have been using BCP PZI
since he was diagnosed (but only one shot in the morning without hometesting). (Scary!!)
Last autumn he developed into very serious ketoacidosis and the vet was doubtful if he could get over.
But, thank god, Akane managed to survive and he is now doing very well after introducing hometesting and TR by
Dr Hodgkins last November. He has gained weight since then and now he acts like before he became diabetic.

The thing is... PZI is no longer available in Japanese market and we are now using vials that our vet personally imported before and they only have one bottle left. So we may have to switch insulin to Lantus or Levemir (our
vet recommends Levemir) soon.
We once tried Levemir in November for about a week last autumn but we had to stop
because Akane was not regulated.
Also because my cat needed only small amount of insulin, the vet gave us diluted Levemir.
That diluted insulin's dose I gave him was 1scale of 100U syringe and that means 0.4U?
Even now he only needs a tiny dose of PZI- 0.4U-1U (1 scale - 2.5 scale of 100U syringe) per shot
depends on BGs, 2 or 3 times a day.

The vet told us Levemir is all right to dilute but I read "do not dilute Lantus or Levemir" in the sticky of this forum.
But if it is not diluted, I am not sure how to measure the dose he needs...

I would appreciate any information or advice from you. Thank you in advance!

Mami + Akane
 
Sorry, the diluted Levemir's dose I gave him was 0.2U, not 0.4U, I think...
Confusing..

Mami + Akane
 
Levemir should NOT be diluted, the manufacturer staes this clearly in the package insert. Lantus also cannot be diluted as the pH is required to activate the insulin once injected, by diluting it the insulin is destroyed and useless.

Levemir (and Lantus) are both great insulins to use in cats. I used Levemir and was also giving very tiny doses. Most people here are giving 1U or less and although difficult it is possible to use these insulins UNDILUTED to give small doses. First it can be made easier by using the smallest availble syringes. Beckton Dickson makes a ,3ml syringe (holds 30 units of U100 insulin) and has half unit markings. In Germany it's sold under the name "BD Microfine + Demi U100 insulin syringes" perhaps it is simular in your area. If you look at the topics in the top of this forum specifically the one "New to lantus" there is alot of information about these insulins and pictures of the syringes and those small doses.

It would not suprise me that you were unable to achieve regulation if your Levemir was diluted as this likely rendered the insulin ineffective and was the equivelant of injecting water into the cat. If you choose to try Lantus or Levemir I would suggest keeping the same dose you have been using with PZI to start with and reading all the information here about those insulins and when and how often you should be testing.

Good Luck and Welcome to FDMB!
 
Aside from the dilution issue which Monique eloquently addressed, you should not expect to see the same response to a long acting insulin, like Lantus or Levemir, as you would to a shorter acting insulin like PZI. Making a switch from PZI to Lantus or Lev will also take some time for the depot (or what we call the "shed") to build. You will not see an immediate response. Not all of the insulin you are giving is immediately available for use. The shed needs to be established and this takes roughly 5 - 7 days on from the initial dose. If you read the Tight Regulation Protocol, you will also note that while Lantus and Lev have a longer duration than other insulins, they are lower potency. Thus, you will not get the immediate response that you are used to seeing with PZI. However, this is also what makes Lantus and Lev a gentler insulin.

Also, neither Lantus nor Levemir should be dosed 3 times per day - they are twice per day insulin. Because of the overlap between doses on a 12 hour cycle, if you dose three times per day, you could easily create a situation where Akane became hypoglycemic.
 
hello and welcome to the group!

forgive me if you already know this... levemir is a U100 insulin. here's a good explanation of U40 vs U100 insulin: http://www.felinediabetes.com/phorum5/read.php?8,1503274,1503274#msg-1503274. here's another link with conversion information: http://www.felinediabetes.com/insulin-conversions.htm. please read through the top of the page. it explains insulin strengths.

from what you've written, i'm assuming the pzi you were using was a U40 insulin. since levemir is a U100 insulin, are you sure your vet has diluted the levemir?

the manufacturer does state that levemir should not be diluted for the reasons already posted. however, there have been a few who have had some success with dilution in order to measure microdoses. they did this on their own. it's NOT a recommended method.

as was mentioned, lantus and levemir are usually dosed twice a day... every 12 hours. there are few exceptions. these exceptions are made in special cases when a custom plan is needed for a particular kitty. most lantus and levemir kitties are dosed twice a day only. tight regulation can be achieved using this method: http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581.

good luck with your switch to levemir! :-D
 
Thank you for your replies!

Jill & Alex said:
from what you've written, i'm assuming the pzi you were using was a U40 insulin. since levemir is a U100 insulin, are you sure your vet has diluted the levemir? :-D
Click to expand...

Yes, I am using U40 PZI, and yes, our vet told me they had diluted it x 2 and said it was OK to dilute.
Actually Akane's BGs dropped quite well but now I understand that it is cleary stated by the manufacture
not to be diluted and it is not recommended, I would like to stick to undiluted one
as long as the dose can be measured right.

I came here because I was interested in Lantus-Levemir German TR Protocol but I was not aware that
Levemir is 100U!
Then it must have been 0.5U I gave to my cat, am I right? (the vet diluted it x 2 and they instructed me to
give 1 unit-mark of 100U syringe.)

The picture guide to fine dosing is very helpful!
I also use BD 3ml syringes for 100U insulin but without half-unit markings.
I think I will try look for one.
If the dose my cat needs is 0.5U, it may not be awfully difficult to measure even with a syringe with whole-unit markings
I guess but if I have to adjust the insulin by, for example, 0.1U, I am not confident to do that...
Is it also possible..?

Mami + Akane
 
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