Lantus vs. Levemir

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Cherylockholmes

Cherylockholmes

Member Since 2013
Joplin has been on Lantus since June. A couple months ago it was looking like he was heading towards remission, but then his numbers went a bit haywire. He has not gotten used to low numbers, and is in a constant state of bouncing from 50-60's up to 300's. I had hoped this would even out, but it has not and I'm wondering if trying Levemir might be an idea. I read on the FMDB FB page someone who had success with doing so, but wanted to see if there were any similar stories out there.



Any thoughts are appreciated. Thanks!
 
Pop in to Relaxed Lantus and take a look at Lucien's spreadsheets for what switching to Levemir did to a very bouncy Lantus cat.

Sometimes, it may help to aim for nadir's between 100-200, then gradually go for more tightly controlled glucose levels.

Some folks have tried TID dosing, as it may be the insulin metabolizing faster, not bounces. If you can shoot every 8 hours and want to see if that helps, take the total insulin used for 24 hours and divide by 3. Give that 1/3 amount every 8 hours.

Some folks have very, very cautiously used tiny amounts of R insulin to take the edge of bounces.

And of course switching to Levemir may help, too, if your vet will prescribe it. The nadir is later, and the overlap is longer.
 
I am thinking of switching to Levemir because I heard that it doesn't sting as much as Lantus. I was getting good regulated numbers until recently and now we are up near 300. I don't know if it is because I am getting constant fur shots or I got a bad Lantus pen or Lantus is just not working anymore.
 
Unfortunately bouncing is very common - we call it liver training school until the liver learns not to over react and they can bounce into remission. And even if they dont, the fact he is spending time in greens is very good for him.

However I do think he may be earning decreases which you are missing -with that 56 the other day I wonder if he dropped lower. You could test taking him down to 1.5 and see how he does. Or try and get more tests in - like every hour when you see those lows.

Also I would post daily on the Lantus TR board. They can help advise you when to change dose etc. His numbers are looking good on lantus - it just might need some fine tweaking.

Wendy
 
Thanks for your posts everyone. Would still love to hear if anyone has experiences with switching to Levemir if you've had the same situation I'm having now.
 
I switched from from Lantus to Levemir after about 6 weeks, and I've regretted not giving Lantus more of a chance.

With such a good response to Lantus I'd be cautious about switching too soon when you may still be close to OTJ. I can't think of any (non acro) cat who switched from Lantus to Levemir and then went OTJ.

Looks like you might have a failed reduction?

Chip lost progress when I switched, and that may have cost him the OTJ.
 
Cheryl

I wouldn't switch just yet. I don't think Joplin looks like he was close to OTJ.....sorry. He just looks like a very bouncy kitty to me like many are. IMHO, you have a lot of missing data....even when he is yellow or pink at PS, I'd at least be getting some midcycle tests. I've seen cats go from 300 to 40 and back to 300 in one cycle. If you are missing that kind of data, you could also be missing reductions.

My kitty, Gracie, was on Lantus for a year and was also very bouncy. I switched her to levemir two years ago and she has gotten more regulated than she ever was on Lantus. She hasn't stopped bouncing but her cycles are much flatter and she spends a lot of time in normal numbers. For her, it was an excellent move. You can look at her Lantus and levemir SSs on the different tabs on her SS.

I always think it is wise to give Lantus at least six months unless there is some really extenuating circumstance....like kitty is really high dose and the shot stings or in the case where a cat has very little fat.

Consistency is your friend :-D
 
If I may throw in my 2 cents, Lucian was on Lantus for over 7 months, with regular bounces to 600+, every couple days. I battled extreme highs and lows constantly. After the switch to Levemir, that is a thing of the past. The difference is amazing. He was switched the 3rd week of July.

As with any disease and any medication, not all respond well to the same thing. Lucian's vet was more than happy to prescribe him Levemir after seeing the difference it made in his numbers and she knew nothing about Levemir.

Please feel free to look at his SS.

Will Lucian ever go OTJ, I have no idea and couldn't care less, as long as he is happy and healthy. But I know he'll be well regulated on small doses of Levemir and that would never had happened with the Lantus.

Personally, I feel there is too much emphasis on going OTJ and too many people are made to feel like failures if it doesn't happen. That isn't my goal for Lucian. I want him healthy and if that means on insulin, then fine, if he goes OTJ that's fine too.
 
Marje and Gracie said:
Cheryl

I wouldn't switch just yet. I don't think Joplin looks like he was close to OTJ.....sorry. He just looks like a very bouncy kitty to me like many are. IMHO, you have a lot of missing data....even when he is yellow or pink at PS, I'd at least be getting some midcycle tests. I've seen cats go from 300 to 40 and back to 300 in one cycle. If you are missing that kind of data, you could also be missing reductions.

My kitty, Gracie, was on Lantus for a year and was also very bouncy. I switched her to levemir two years ago and she has gotten more regulated than she ever was on Lantus. She hasn't stopped bouncing but her cycles are much flatter and she spends a lot of time in normal numbers. For her, it was an excellent move. You can look at her Lantus and levemir SSs on the different tabs on her SS.

I always think it is wise to give Lantus at least six months unless there is some really extenuating circumstance....like kitty is really high dose and the shot stings or in the case where a cat has very little fat.

Consistency is your friend :-D
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You're right, there has been missing data as of late...part of the reason for that is my frustration because when I see those high numbers constantly I have the attitude of "what's the point" because even if he drops, he's just going to shoot up again. Not a positive attitude to have, I know. I need to get back to testing more. What I don't understand is, if I do a dose reduction (if he falls below 50), and then this numbers are consistently in the high 200's to 300's, then is that dose reduction really justified? Isn't it more harmful for him to be in those high numbers, than to have an occasional low number on a slightly higher dose of insulin? If I reduce him to 1.5 from 1.75, and he stays in the upper 200's-300's, how long until I say OK, time to increase again? My goal previously was to get him OTJ, but now It's more important to me to see him more stable, as I don't know what damage is being done keeping high numbers. Sigh!
 
nckitties3 said:
If I may throw in my 2 cents, Lucian was on Lantus for over 7 months, with regular bounces to 600+, every couple days. I battled extreme highs and lows constantly. After the switch to Levemir, that is a thing of the past. The difference is amazing. He was switched the 3rd week of July.

As with any disease and any medication, not all respond well to the same thing. Lucian's vet was more than happy to prescribe him Levemir after seeing the difference it made in his numbers and she knew nothing about Levemir.

Please feel free to look at his SS.

Will Lucian ever go OTJ, I have no idea and couldn't care less, as long as he is happy and healthy. But I know he'll be well regulated on small doses of Levemir and that would never had happened with the Lantus.

Personally, I feel there is too much emphasis on going OTJ and too many people are made to feel like failures if it doesn't happen. That isn't my goal for Lucian. I want him healthy and if that means on insulin, then fine, if he goes OTJ that's fine too.
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This is a story I was wondering if I would see. But I will give it the full 6 months and re-assess there. He's been on it 5 months now, and I probably have enough Lantus left to get me through at least another month. When it runs out, I will need to consider all options. Thanks for sharing.
 
Cherylockholmes said:
What I don't understand is, if I do a dose reduction (if he falls below 50), and then this numbers are consistently in the high 200's to 300's, then is that dose reduction really justified? Isn't it more harmful for him to be in those high numbers, than to have an occasional low number on a slightly higher dose of insulin? If I reduce him to 1.5 from 1.75, and he stays in the upper 200's-300's, how long until I say OK, time to increase again?
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It is better for a cat to be high for a day than to go too low for a short time- low is hypo territory- so that is the reasoning behind the reduction. I think once they are in hypo it takes vet care to bring them out of it and it can cause long-term damage and death.

As for being high- most of our kitties have been high for a time, depending on how 'on top' of the situation and seeing what was going on. I figure Sneakers had been diabetic for months before I took her in the get checked out. Yes, long term high numbers does impact the kidneys and other organs over time so there is that concern, too.

So- the bouncy-ness of it all. Think of a pendulum- tethered to the wall of high. You start giving insulin and it starts to move just a little bit until it breaks loose and swings to the low side all of a sudden. It reacts by swinging hard back to the high side- and might get tethered again. It will do this for some time until it the swings lessen enough to keep it from sticking to the wall and moving free on its own.

I have a question now- if 1.5 is too low and 1.75 is too high how comfortable are you in doing the drop method to aim for the middle between them?

My kitty is a Lev girl. When I was switching from PZI it was questioned whether she might be acromelegic (she is) and be a high dose cat (up to 33u BID at one time, now down to 10/11u BID). I chose Lev as it has a neutral base and does not sting while Lantus has an acidic base and will sting.
 
What I don't understand is, if I do a dose reduction (if he falls below 50), and then this numbers are consistently in the high 200's to 300's, then is that dose reduction really justified? Isn't it more harmful for him to be in those high numbers, than to have an occasional low number on a slightly higher dose of insulin? If I reduce him to 1.5 from 1.75, and he stays in the upper 200's-300's, how long until I say OK, time to increase again
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If you don't have midcycle tests....you don't really know if his numbers are consistently 200-300s. And you don't know if the dose reduction is justified. I think his last reduction is justified.

What protocol are you following?

First, in order to really help you, we have to see some mid-cycle numbers so I appreciate that you recognize you need to test more. I'm not asking you to test a lot....but at least a mid-cycle test every cycle helps. But....please do not shoot without a test and I note that you are either doing it or not recording the numbers. And there are also several days (10/2-10/6) of data missing. We aren't able to really give you an accurate assessment if we are guessing at what he's been doing.

Also, when you have a cycle like 9/29 p.m. and 10/7 p.m. where the BG is green and down at mid cycle...I strongly urge you to test to be sure he's coming up. He could be dropping lower than you realize and that could be causing his bouncing.

Some of the best advice I ever got was to follow the TR protocol (or if you are using SLGS approach, that's fine, too) to get them to the nadir you want whether it be 60 or 120. Once he is at that nadir, hold the dose until he earns a reduction. Ignore the bounces. Be consistent. If the nadirs start to trend up, fatten the dose. If they start to trend lower than you want, lower the dose.
 
Marje-- I had been following (and still am, really) TR protocol. The few days missing from the SS are just my not inputting the data, but I did test. I never feed without testing. And I usually do test in the PM about 4 hours after eating, but sometimes it's right as I'm going to bed and the number never makes it onto the SS. The numbers missing are pretty much identical to what he's been doing. I recognize I need to test more frequently though. I will go back to the Lantus TR board and continue until this vial of Lantus runs out and go from there. Thank you to everyone who responded. Your insight is truly appreciated.

Edit: The best advice you gave was "ignore" the bounces. That's what I'm having a hard time doing! I'm wondering how long it will take for him to "get used to" this and level out. When I see the high numbers (like this morning, 313 after last night's 91) it frustrates me.
 
I'm throwing my two cents in as well as I've had two that I have switch from Lantus to Levemir. The first was Musette who dived and bounced for nearly 9 months plus became nasty at shot time after the switch her curve flattened out and she retained her loving personality, no more growling, biting or trying to evade the needle, she was very close to remission when she became ill and passed due to anemia not diabetes. Second is my current girl Autumn, now she responded fairly well to Lantus but again the longer she was on the Lantus the meaner she became. And she wasn't a terribly pleasant cat to start with, after the switch she mellowed out dramatically. Again not only did her personality improve so did my control over her diabetes...Both were adopted as diabetic so they were slightly different cases than having a long time family pet but in both of their cases the switch worked wonders.

Everyone I'm sure have their favorite insulins based on their own experiences and how their cats responded to it. But at this point if I was to take in another diabetic Lantus cat I would switch them to Levemir unless they were responding extremely well to Lantus. I just find it an easier insulin to work with.

Mel, Maxwell, Autumn and The Fur Gang
 
I never feed without testing.
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I hope you meant you never shoot without testing ;-) ;-) :-D :-D

We'd love to have you back in the TR board where we can help you get Joplin a little better regulated. When you finish this last bit of lantus, then it might be a good time to talk about switching to lev. Let's see how he does.
 
Marje and Gracie said:
I never feed without testing.
Click to expand...

I hope you meant you never shoot without testing ;-) ;-) :-D :-D

We'd love to have you back in the TR board where we can help you get Joplin a little better regulated. When you finish this last bit of lantus, then it might be a good time to talk about switching to lev. Let's see how he does.
Click to expand...


LOL yes, that's what I meant :-D I'm back over there now. Thanks :)
 
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