Lantus vs Levemir

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KristenP&Sam

KristenP&Sam

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Can someone educate me on the difference?

Some background: Sam is currently on Prozinc and has been for some time with steadily increasing doses that have yet to result in any kind of regulation. He's on 4 units BID and his AMPS and PMPS are typically in the 350 range. His +6 today was 247, so as you can see, not great. When I left a message with my vet about switching him to Levemir, which I've read up on and like what I've read (I also printed out a bunch of stuff for her and left it for her to read), she indicated Levemir was too potent and wanted to try Glargine/Lantus. I don't know anything about Glargine and haven't been able to find that much about it online that makes sense to me, so any help y'all can give me would be awesome.

I hate that I'm getting frustrated with her, but this is my baby and I want the best for him.
 
Hey, Welcome back, Kristen! I am sorry that ProZinc isn't working for Sam. You really gave it a shot. Glargine is also Lantus. We have lots of people who use it very successfully. Here is their support group: viewforum.php?f=9 Be sure to read the stickies at the top (because they will ask if you have, and because they are full of great info.)
 
I never heard of Levemir being more potent that Lantus. I first tried Lantus on my Tonis since my other sere using it. I got up to about 5 units without much reduction in BGs. I then went to Levemir and got about the same response. Only when I increased the does did I get a good response.
 
Hi Kristen, and, of course, you too, handsome Sam,

Nikki arrived into my heart from foster care on Lantus. We used it for about 18 months. She would sometimes yeowl about 15 to 20 minutes after her shot. She'd do for it for maybe a minute or two. Nikki has a tiny voice, except for that yeowling...

I asked some human diabetics I know who were on Lantus at the time about this. They said sometimes it burns a little while after taking the shot. I switched her to Levemir after that, which was about two years ago. She hasn't yeowled since.

At first her BGs were about the same. Eventually they were better, meaning more consistently in the 100s. Levemir seems to like Nikki. Better yet, Nikki seems to like Levemir.

ECID -- Every Cat Is Different.

Sam is absolutely adorable!

Hope this helps kind of hugs,
Deb and Nikki -- and, Giz, forever dancing in my heart...
 
You might want to take a look at "Lantus and Levemir: What's the Difference" linked in my signature in addition to the Stickies in the Lantus Group. Since we have both Lantus and Levemir users in the Lantus Group the stickies contain information for both insulins. Most users of the L insulins in the group follow the only published protocol which has been based on research with felines using Lantus or Levemir: Tight Regulation with Lantus or Levemir for Diabetic Cats.

I've used both Lantus and Levemir. I honestly can't say one is "better" than the other. The most noticeable difference I've seen is Lantus has an onset of around +2 versus Levemir having an onset of around +4 for most cats. The later onset of Levemir generally pushes nadir out to sometime between +8 and +12. However, ECID.

They're both wonderful insulins. I don't think you could go wrong using either one of them.
Good luck with which ever insulin you choose!


edited to add:
RE: your vet's comment about levemir being too potent

I've never read, heard, or seen anything about Levemir that I would ever consider it to be "too potent". If anything, i think Lantus is a little better at pulling down high numbers, but that's not to say Levemir can't do the same job. I really don't understand what your vet is basing this statement on. :?


RE: Longevity of opened Lantus vs opened Levemir:

You'll hear conflicting comments on this subject. If handled properly (this issue is addressed in the Proper Handling Sticky in the Lantus Group) Lantus should last a good 6 months or more.
 
In regards to the pain factor with Lantus because I hear this a lot--cats are on much lower doses of insulin than humans, and they have much higher pain thresholds, especially when it comes to their skin. Think about how it would feel if someone picked you up by the back of your neck vs. your cat. The large, large majority of the time the dose of Lantus is nowhere near high enough to cause any pain to the cat. It's the same thing with pricking their ears--most cats don't like it at first because they're being restrained, not because it actually hurts them.

In my opinion, both insulins work pretty much the same, they both follow the same protocol, and you're fine with either one.
 
My cat Shadoe has flinched from shots while on Lantus, plus she acts generally more tense on Lantus.
I DID test her - she was on Lantus then switched to Levemir when dose got higher. I tried going back to Lantus, and noticed an immediate worsening in her when on Lantus again. She returned to her relaxed self the first day back on Levemir.

I don't presume that all cats have a high threshold for pain; just like humans, some are better than others with pain.
Quite often, you may discover that a cat has been in pain when a maint dose of a pain med is started.
 
Here is some info from the pet diabetes wiki about the insulins:

"Lantus is the brand name for insulin glargine, an insulin analog made by Aventis. Lantus is a very long-acting insulin (lasting up to 24 hours in humans) that uses pH reactions to form micro-precipitates under the skin, which create a time-release action." (http://petdiabetes.wikia.com/wiki/Lantus)

"Levemir is Novo Nordisk A/S's worldwide brand name for insulin detemir, a long-lasting insulin analog that lasts up to 24 hours in humans. Its chief benefits according to Novo are a "peakless" action, less weight gain than other insulins, and less day-to-day variability than NPH or Lantus insulins. Levemir has been shown (by the manufacturer) to vary less day-to-day than NPH or Lantus. It was also found to vary less between patients." (http://petdiabetes.wikia.com/wiki/Levemir)

My vet decided to put Maggie on Levemir after reading about the ph action of Lantus. She thought it would cause stinging.
 
Dear Kristen and Sam,

I have to agree with most everyone here that oftentimes Lantus can sometimes cause a stinging sensation in some cats especially as you move into higher doses. some cats do better on Lantus/some do better on Levemir.

NOT all cats tho use much smaller doses of insulin then humans I'm afraid to say. That's another issue but if this were the case I would definitely recommend the Levemir then.

Testing and dosing in general are not painful so yes for sure that is not something to necessarily worry about. I'm sorry as I may have taken the one statement made above wrong - but I do feel that cats also tend to "hide" their pain more than humans do. Not that they have a higher pain threshold. It's that in nature they can't show their pain or else they are the weaker of the species - thus the one to be taken out. Just like us we can learn to tolerate certain "painful" things - kids don't like testing/dosing insulin either but learn to do it - but other skin issues can be painful.

I don't know that I helped at all but I hope it confirms for you that either of these insulins would be a good choice for you. An also that Levemir is not any more potent than Lantus.

I wish both of you the very best!
 
Kristen

Before we get too gung ho about insulin changes, since I haven't been following your info (and some others may be unfamiliar too), please let us know the following:

Have you ruled out any of the other issues which may raise glucose levels?
- Dental inflamation and abscesses
- Renal infection (stones, UTI)
- other illnesses
- any meds which could raise glucose levels, such as steroids
- getting into other food &/or what is currently being fed

You may already have ruled out these and have the food under tight control, but these are important to note when discussing glucose control.
 
Thanks, everyone, for the info. Very helpful.

BJM - My vet is currently running full blood and urine panels on Sam to make sure there are no other issues before we switch him.
 
Studies have been done on for cats for over 50 years that show they have higher pain thresholds than people--I'm not making that statement based on my personal observation or anecdotes. The large majority of cats will not be on a dose of Lantus high enough where it will cause them pain.

I'm also not saying there cannot be exceptions, like if a cat is on a very high dose due to a secondary condition, or if it has a lower-than-normal pain threshold. However, this does not appear to be the case in this instance, and in the vast majority of cases Lantus will not cause the cat pain. Most cats don't even realize you gave them an injection. Notice I am saying most and not ALL.

I just don't think that the small possibility that the Lantus might sting a little is reason enough to fight with the vet over it.
 
Julie,
Would you please kindly share the links to the studies which support your statements?
 
There are a lot. Google scholar [feline nociceptive threshold] or [nociceptive threshold in cats] and a bunch should come up.

The earliest article I can recall reading off the top of my head is this one: http://jap.physiology.org/content/17/6/1009.abstract, and the most recent this one: http://www.sciencedirect.com/science/article/pii/S0034528801905430

However, regardless of whether we want to bicker over pain tolerance, I think the sheer number of people who use or have used Lantus with no report of adverse pain reactions by the cat to the injections is evidence enough that this is not a good reason to avoid the insulin. If we are going to be anecdotal, I gave Bandit shots of Lantus every day for a year, and not once did he even flinch from the injection. I can pinch his skin tight between my fingers, and it noticeably does not hurt him the same way it would a human being. If Lantus hurt so terribly bad all the time, then why would people, who have arguably lower pain tolerances than cats, continue to use it at much higher doses? Because even if there is some stinging, the pain associated with it is negligible.
 
http://vip.vetsci.usyd.edu.au/contentUp ... hBigby.pdf
http://www.vetinfo.com/feline-pain-management.html#b
http://www.cathealth.com/pain.htm

Cats do feel pain, and Lantus does sting upon injection.

Because of the stinging at higher doses - higher than 1u BID, it is advisable to go with Levemir so that the cat is not inflicted with pain twice a day.

Just looking at some sites for diabetic humans, you will find comments about Lantus stinging but not levemir.
http://www.diabeteswith.com/1-diabetes/ ... s-668.html
Is the lantus mean to sting slightly?
Answers:
Yes it stings like hell sometimes, thats normal.

I have just changed to Levimir and that doesn't sting nearly as much if at all.


http://www.iddb.org/drugs/lantus/
Side Effects of Lantus
Low blood sugar
Injection site reactions such as redness, pain, itching, hives, and swelling
Changes in fat tissue at site of injection

I have two acro cats and one has always had problems with Lantus, but she is fine with Levemir, and don't recall her ever flinching from Lev shots.
 
I never said that cats do not feel pain. I dealt with my Gabby slowly deteriorating from stomach cancer for 7 months, and I am very familiar with the signs of pain and pain management methods throughout her palliative care. Nor did I say Lantus does not sting. What I said was that cats' skin is less sensitive than a human's, that they have a higher threshold for pain than people do, and that most doses of Lantus are low enough where stinging is not a factor.

I know my Bandit, and if the Lantus injection "stung like hell", then there is no way on this planet he would just stand there like nothing happened. His highest dose was 2u, but there are many people that have their cats on higher doses of Lantus without any signs the cat is in pain.

I already said in my previous post that I was not referring to ALL cats, just MOST cats, and that if your cat has a secondary condition that requires a high dose then I understand that Levemir is preferable. Most cats do not need a that high of a dose of Lantus, however, and it's not evident that insulin resistance or acromegaly is a factor in this particular case. In this case, I still don't think it's something worth fighting with the vet to change the prescription over.
 
Hey everyone, let's all agree that cats, just like humans, have varied tolerance to pain. They can also be very good at hiding their pain. Julia, no one is saying that you said that cats do not feel pain. I, at least, understand that you are pointing out the fact that human experience is not necessarily the same as the feline experience.

In the end, it doesn't really matter. Both insulins are great. They are both long-lasting. They both have similar costs. The stinging that can come with Lantus may bother some cats and not bother others. Knowing that Lantus can sting may help some of us make the decision between the two insulins or explain a cats reaction to their shot.
 
Maggies Mom Debby said:
Hey everyone, let's all agree that cats, just like humans, have varied tolerance to pain. They can also be very good at hiding their pain. Julia, no one is saying that you said that cats do not feel pain. I, at least, understand that you are pointing out the fact that human experience is not necessarily the same as the feline experience.

In the end, it doesn't really matter. Both insulins are great. They are both long-lasting. They both have similar costs. The stinging that can come with Lantus may bother some cats and not bother others. Knowing that Lantus can sting may help some of us make the decision between the two insulins or explain a cats reaction to their shot.
Click to expand...

Thank you for putting things in perspective, Debby!

These discussions always seem to leave out an important point (re: lantus):
"After you inject it into your subcutaneous tissue, the acidic solution is neutralized by your body to a neutral pH."
http://www.diabetesclinic.ca/en/diab/2treat/lantus_vs_levemir.htm

Gayle and Shadoe said:
http://www.iddb.org/drugs/lantus/
Side Effects of Lantus
Low blood sugar
Injection site reactions such as redness, pain, itching, hives, and swelling
Changes in fat tissue at site of injection
Click to expand...

Yes, most all medications and insulins have *possible* side effects.
Linked from the Levemir website: http://www.novo-pi.com/levemir.pdf

Injection Site and Allergic Reactions
As with any insulin therapy, lipodystrophy may occur at the injection site and delay
insulin absorption. Other injection site reactions with insulin therapy may include
redness, pain, itching, hives, swelling, and inflammation. Continuous rotation of
the injection site within a given area may help to reduce or prevent these reactions.
Reactions usually resolve in a few days to a few weeks. On rare occasions, injection site
reactions may require discontinuation of LEVEMIR®.

In some instances, these reactions may be related to factors other than insulin, such as
irritants in a skin cleansing agent or poor injection technique.

Systemic allergy: Generalized allergy to insulin, which is less common but potentially
more serious, may cause rash (including pruritus) over the whole body, shortness of
breath, wheezing, reduction in blood pressure, rapid pulse, or sweating. Severe cases of
generalized allergy, including anaphylactic reaction, may be life-threatening.


Gayle and Shadoe said:
I have two acro cats and one has always had problems with Lantus, but she is fine with Levemir, and don't recall her ever flinching from Lev shots.
Click to expand...
Interestingly enough, my low dose cat has flinched many times when receiving an injection of Levemir. We didn't have that problem with Lantus.
Go figure. Guess she didn't read the manual. :lol:

I also found this post from jojo (vet tech) on a thread started by Dr. Lisa interesting (copied in part): http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=14578&p=147158#p147048

why are mostly all the HD cats on lev? cause once they got over a certain dose back when we were getting the first HD cats in LL, i would start recommending the switch, my reasons being that very large doses of lantus *might* sting some cats (haha, and some of that was cause i *thought* it did in my own not low dosed cat, he was so bad for his lantus shots, turns out he is just as bad for his lev shots, dis cat just don't like needles, lol), and that when i originally started that recommendation we were under the impression from lack of data that lev lasted longer than lantus, was more 'fragile' which now vet med studies have proven the opposite (oops)and hence the HD cats could use lev vials rather than lantus carts for $$ savings, and...cause of the warning on lantus about rats and cancer and super super high mg/kg doses happening one in blue moon. eh i was being way over cautious, really have no worries about that nowadays. really either is fine, but if you are looking at an acro (which you prolly are) then i would go for lev just in case he ends up being an acro like say girlcat and her top doses of 60 something units bid and the possible sting thing. (most acros do not 'go there' with their doses though, there are plenty of "low-dose" acros around, meaning under 10-15 units). HD cats being on lev has just become part of FDMB culture rightly or wrongly i would not draw a firm medical opinion on (and what part i played in that i hope it ends up being rightly, lol). i havela been toying with idea lately of switching my cat back to lantus, it is a once a day insulin in humans vs. lev's twice a day in humans and i have to wonder if maybe lantus has a stronger shed than lev (longer overlap/better depo)? and cats that have switched the other way, from lev to lantus have noticed the same temporary improvement. push comes to shove the action is so similar in the end~ whichever as far as a choice for most cat, however if this cat is going to continue up the dosing scale with no end in sight, then go with lev for possible comfort reasons. last thing one needs is a larger dose cat that doesn't like his shots...trust me on that one. :roll:

BOTH these insulins are wonderful! We have kitties who have been diagnosed with high dose conditions on both Lantus and Levemir.

ECID... it's not just a slogan! The only way to know how YOUR cat will react/respond to Lantus or Levemir is to try it. If one doesn't work well for YOUR cat, try the other one. :mrgreen:

KristenP&Sam, good luck making the switch to Lantus or Levemir! I think you'll be happy either way...
 
Thank you - I apologize as I really just meant to better understand what was being said. Obviously I didn't word things properly. Please forgive me as perhaps I took more out of the one statement than what was intended. I didn't mean to take away from the main topic of the thread. But I appreciate all the articles to read too. Thanks for sharing aLl the information everyone posted here. More education for me at least. THANK you again everyone!
 
Julia & Bandit said:
There are a lot. Google scholar [feline nociceptive threshold] or [nociceptive threshold in cats] and a bunch should come up.

The earliest article I can recall reading off the top of my head is this one: http://jap.physiology.org/content/17/6/1009.abstract, and the most recent this one: http://www.sciencedirect.com/science/article/pii/S0034528801905430

However, regardless of whether we want to bicker over pain tolerance, I think the sheer number of people who use or have used Lantus with no report of adverse pain reactions by the cat to the injections is evidence enough that this is not a good reason to avoid the insulin. If we are going to be anecdotal, I gave Bandit shots of Lantus every day for a year, and not once did he even flinch from the injection. I can pinch his skin tight between my fingers, and it noticeably does not hurt him the same way it would a human being. me stinging, the pain associated with it iIf Lantus hurt so terribly bad all the time, then why would people, who have arguably lower pain tolerances than cats, continue to use it at much higher doses? Because even if there is sos negligible.
Click to expand...


to answer that question as to why people continue to use lantus over levemir? very simple. advertising as well as lantus came out before levemir with a HUGE advertisng campaign,coupons,perks etc. doctors see reps all the time and will use and write what those reps show them. also insurance companies are also part of the problem and like it or not? most insurance companies will approve lantus for diabetes but not pay for levemir. why? the all mighty dollar. this has been this way for years and years as far as lantus being more popular and available for human than levemir. the tide is starting to change with that as more insurance companies are now paying for levemir and have it in their formularies. BUT that was not always the case. and many doctors still today know about lantus and thus will rx what they they know. lantus ph is different and acidic and will sting.people tend to use both in the auto injectable dial in the dose pen and be done with it.those pentips are preset for depth of injection.many people who tend to have more body fat prefer to use a deeper needle length especially if they have more belly fat because the belly is the usual site for both these insulins. not to go off topic but i wanted to clear up your topic of why levemir isnt rx"ed more. its what the insurance companies will pay for as far as being in one's formulary and its always been that lantus was the formulary insulin while levemir was not. as well as the all mighty dollar

including a more recent article regarding pain: from 2007
http://www.aahanet.org/publicdocuments/ ... elines.pdf

im sorry but neither of those 2 links you provided tells me that cats have less pain tolerance. unless it is comparing it with humans,perhaps in a thermal situation.but we know there are many different types of pain aside from temperature.so to me there would have to be more than just a thermal discomfort test . the other article the cat is experiencing discomfort hence the use of opioid analgesics and the picking up of the analgesic working
 
One thing I do want to clarify is that there is a big difference between a cat experiencing acute or chronic pain. Acute pain is sudden, and for a limited duration. This would be the type of pain experienced by stepping on a cat's tail, or giving them an injection that stings. Cats do not hide their reactions to acute pain. If a cat flinches from a shot, it might sting a little, but not that much because the cat would react much more strongly if it did. Think about how your cat reacts when you accidentally step on it's tail. The term "pain threshold" refers to acute pain, not chronic.

Chronic pain is pain that lasts longer, and is usually caused by tissue damage from an illness or injury. Examples of this might be a cat with infected gums, or arthritis. Cats do hide their reactions to chronic pain. All of the pain management guidelines everyone has posted refer to chronic pain.

I just don't want people to be afraid to use Lantus because they think they are unknowingly causing their cats pain. If your cat stung from the injection, you would know it from their reaction.

In the end, it doesn't really matter. Both insulins are great. They are both long-lasting. They both have similar costs. The stinging that can come with Lantus may bother some cats and not bother others. Knowing that Lantus can sting may help some of us make the decision between the two insulins or explain a cats reaction to their shot.
Click to expand...

This is well said.
 
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