Getting help/advice on administering Levemir FlexPen

[my Casey bear]

I am so frustrated with jumping through so many hoops!! I have been trying to get the diagnosing vet to prescribe Casey the Levemir FlexPen and she keeps changing her mind. The vet usually prescribes Humulin H, and does not really want to venure into any other kind....until I mention going to someone else. Once she heard that, she became accommodating until she learned that I deside to stay w/her. cat(2)_steam


:?: Would someone be able to advise me on how to give Casey the FlexPen shots? :?: And on the proper dosing guidelines? Which brings up another question....The vet voiced her concern that the HT #'s I have been getting are too low for that type of insulin. I have run 4 tests in the past 4 days with results: (Fri - Mon respectfully) 280, 285, 286, and 246. The 285 and 286 reading were the days that HT stressed Casey the most. :?: Do you agree w/the vet or not?

Could I please get some input before I go and sign a waiver/disclaimer so I can get Casey her meds. Thank you.

Roberta
and Casey

 

[Just-As-Appy]

Hi Roberta,
I use the Levemir flex pens, and they are very simple to use. There is a rubber end just like on a vial of insulin and the syringe is inserted through the rubber and the dose is drawn out. There is no need (actually shouldn't be done) to inject air into the pen as the red sealed stopper at the other end moves towards the needle end as insulin is withdrawn. No shaking, rattling, or rolling - just gentle handling, insert syringe and draw dose. Because you only handle one pen at a time and the rest of them stay in the box at the back of the fridge, they last a long time. You will need to get U100 syringes as well when you get your insulin.

As for dose, normally people start at 1 unit and hold for a few days, unless there are underlying conditions that would say the cat should start higher.

What is the current dose of Humulin? If the numbers that you posted are blood glucose (bg) from home testing, they are not too bad, but definitely not too low in general. Were they pre-shot numbers?

Have you read the info about how Levemir works? Check both the Lantus and the Levemir insulin support groups - there is a wealth of information in the topics at the top of the pages.

 

[Vicky & Gandalf (GA) & Murrlin]

Hi Roberta,

I am not sure what you mean by HT #.

If the numbers you reported are blood glucose values, they are certainly high enough to warrant treating with insulin. However, on the Levemir ISG we would recommend you start with no more than .5U (1/2 unit) or even .25U (1/4 unit), especially given those blood glucose values you reported. Levemir is a much longer acting insulin than Humulin N and works by building a reserve or "shed" so sometimes a very small dose is effective. Levemir still should be dosed twice per day, with each dose as close to 12 hours apart as possible. Pick times which are most convenient for your schedule.

Otherwise the info Just-As-Appy gave about using the Flexpen with a normal syringe is fine. Try to find syringes which have half-unit markings as that will make it easier to dose .5U. If you need the vet to write a prescription for those (some states require a scrip for syringes), please ask for that kind. Also a short, small gauge needle like 30 or 31G is best. Short would be 5/16ths. A Wal-Mart or Costco pharmacy might have them in stock.

Hope that gets you going in the right direction. Here's the direct link to the Levemir Insulin Support Group in case you want to read the stickies or have further Levemir specific questions. http://felinediabetes.com/FDMB/viewforum.php?f=10

 

[my Casey bear]

Hi Roberta,
I use the Levemir flex pens, and they are very simple to use. There is a rubber end just like on a vial of insulin and the syringe is inserted through the rubber and the dose is drawn out. There is no need (actually shouldn't be done) to inject air into the pen as the red sealed stopper at the other end moves towards the needle end as insulin is withdrawn. No shaking, rattling, or rolling - just gentle handling, insert syringe and draw dose. Because you only handle one pen at a time and the rest of them stay in the box at the back of the fridge, they last a long time. You will need to get U100 syringes as well when you get your insulin.

As for dose, normally people start at 1 unit and hold for a few days, unless there are underlying conditions that would say the cat should start higher.

What is the current dose of Humulin? If the numbers that you posted are blood glucose (bg) from home testing, they are not too bad, but definitely not too low in general. Were they pre-shot numbers?

Have you read the info about how Levemir works? Check both the Lantus and the Levemir insulin support groups - there is a wealth of information in the topics at the top of the pages.

The numbers were prior to ever administering any insulin. (Her diagnosis # was 445+, w/UTI) I am very new with this and just starting to (trying to) treat Casey's diabetes. I have first tried to regulate her by changing her diet, having a some improvement in some symptoms, but not in others. During this time I came accross FDMB, and found a lot of advice/suggestions that gave cause to my subconsious hesitasions to go through the vet's treatment suggestion. (The vet was talking about giving 5units of Humulin H 2x a day.) I was sent a newbie kit, and while in the prescription battle, I deside to get Casey and I comfortable w/the HTing in hopes that once I get the script, it would be less stressful once I start w/the insulin shots.

I did look at the Levemir support group, Levemir 101, to be exact. It may be that I am new at this and/or my frenzy that have of what I was reading seemed over my head. Or are you talking about looking in a different location?

 

[my Casey bear]

Hi Roberta,

I am not sure what you mean by HT #.

HT # was my attempy to abbr. Home Testing numbers

 

[Vicky & Gandalf (GA) & Murrlin]

Hi Roberta,

I am not sure what you mean by HT #.

HT # was my attempy to abbr. Home Testing numbers

Awesome! I forgot to add how marvelous it is that you are Home Testing her BGs.

We use BG for "blood glucose."

Nope you were in the right place - you found the Levemir ISG if you found the "101" sticky. There is also info in the Lantus ISG as that insulin is similar to Levemir and they cover both. A lot of things about Feline Diabetes are over people's heads when their cat is first diagnosed. So don't feel bad for asking.

 

[squeem3]

Here are pictures:

 

[BJM]

Download Dosing protocol for cats on glargine or detemir using daily home monitoring of blood glucose concentrations to adjust insulin dose and print it out for your vet to read. It is from a veterinary journal, so will have more clout than saying you found it on the internet!

You also may refer the vet to the University of Queensland Centre for Companion Animal Health Information for veterinarians on management of diabetic dogs & cats where there are some more articles by Dr. Rand

 

[Just-As-Appy]

Not sure if we get a different product in Canada, but I have taken a pic of the box of refills that I get at the Costco pharmacy (price on last box was $108.59). The second pic is the 5 cartridges out of the box sealed in the package and a cartridge that is about 2/3 used with the syringe in position to insert and draw dose. You can see that the red stopper has been drawn down the cartridge as the insulin has been withdrawn.

 

[Vicky & Gandalf (GA) & Murrlin]

We only have the Flexpen available in the US. It's essentially a holder for the cartridge, which is available in Canada. US users who order from Canadian pharmacies get the cartridge as well. You CANNOT take the cartridge out of the pens, however.

here's a close-up picture how using a syringe with pen works

 

[doombuggy]

I am so frustrated with jumping through so many hoops!! I have been trying to get the diagnosing vet to prescribe Casey the Levemir FlexPen and she keeps changing her mind. The vet usually prescribes Humulin H, and does not really want to venure into any other kind....until I mention going to someone else. Once she heard that, she became accommodating until she learned that I deside to stay w/her. cat(2)_steam


:?: Would someone be able to advise me on how to give Casey the FlexPen shots? :?: And on the proper dosing guidelines? Which brings up another question....The vet voiced her concern that the HT #'s I have been getting are too low for that type of insulin. I have run 4 tests in the past 4 days with results: (Fri - Mon respectfully) 280, 285, 286, and 246. The 285 and 286 reading were the days that HT stressed Casey the most. :?: Do you agree w/the vet or not?

Could I please get some input before I go and sign a waiver/disclaimer so I can get Casey her meds. Thank you.

Roberta
and Casey

This vet wants you to sign some kind of waiver to get the script for Levimar (or something else besides Humulin?) I'd be out the door and at a new vet lickity split. What kind of vet is this? (rhetorical question, but she's getting my knickers in a big twist!)

 

[my Casey bear]

This vet wants you to sign some kind of waiver to get the script for Levimar (or something else besides Humulin?) I'd be out the door and at a new vet lickity split. What kind of vet is this? (rhetorical question, but she's getting my knickers in a big twist!)

Thank you, thank you, thank you!!! I had basicly given up on my search for another vet that was close to home and was not looking to drain my pocket-book dry, so I had figured I would stay were I was.

Then I read your response, you said just the right thing to spur my search again! I called the one clinic I had not tried yet... I now found a vet I am very pleased with! She is nice, thorough, accommodating, seems competent, and is willing to explore all options of treatment for Casey.

So, once again...thank you