Levemir in the UK

Kate and Geoff

Kate and Geoff

Member Since 2019
Hello Everyone

We are looking to change Jack to Levemir as he is a bit bouncy on Prozinc. We are based in the UK and whilst our vet is happy to prescribe Levemir we collectively have a few questions which we are hoping members are able to help with.

1. Are we able to purchase in vials?
2. If pen cartridge is the only option, are we right in saying that you can easily extract with a U100 syringe?
3. Information on pack/cartridge size, availability and approximate costs.

Any shared experiences would be very helpful to us.

Many thanks
 
I don't know if Lev is available in vials. You can easily use a syringe to draw a dose from a pen. Do NOT buy the needle tips for the pens. At the same place where the needle tip would attack to the pen, there is a rubber gasket that is almost identical to what you would see with a vial. You simply insert the syringe and draw up the insulin. With the pens, do not inject any air into the pen.

Prices do not compare from the US to the UK. I'm not sure that we have any members who are currently in the UK. @Gill & George is in Europe (Spain) and may have more information. When I tried Googling, I wasn't able to access information on prices in the UK since the NICE site is blocked for those not in the UK.
 
Yes, Lev is available in vials, at least in Canada. But I much preferred the cartridges, as I could use them to the last drop. I got a package of five 3mL cartridges. Bonus, if I dropped one, or it got hot/cold or otherwise ruined, I had only ruined one of five. Don’t buy pens, that is more “stuff” around the cartridge you don’t need. A cartridge looks like a mini vial, but has a moving stopper that works by negative pressure, so you don’t inject air into it. In other words, easier to use than a vial.

Prices will be specific to the UK. I don’t recall any current Lev users in the UK.

Good luck with the change in insulin. Post over here when you are ready to switch, and we can talk dosing. Your boy sure loves to bounce! I hope the Lev will help flatten him out. In the mean time, take a read over the Sticky Notes on the top of this forum.
 
Sienne and Gabby (GA) said:
I don't know if Lev is available in vials. You can easily use a syringe to draw a dose from a pen. Do NOT buy the needle tips for the pens. At the same place where the needle tip would attack to the pen, there is a rubber gasket that is almost identical to what you would see with a vial. You simply insert the syringe and draw up the insulin. With the pens, do not inject any air into the pen.

Prices do not compare from the US to the UK. I'm not sure that we have any members who are currently in the UK. @Gill & George is in Europe (Spain) and may have more information. When I tried Googling, I wasn't able to access information on prices in the UK since the NICE site is blocked for those not in the UK.
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Excellent thank you. We can see the NICE site and it mention the NHS price as around £42 but it talks about ‘size’ as 5 so if that is a pack size of five x 3ml cartridges it sounds really good to us. This Info on the rubber seal is really useful and knowing not to inject air is helpful too. It sounds very straightforward so that fills us with confidence. Many thanks
 
Wendy&Neko said:
Yes, Lev is available in vials, at least in Canada. But I much preferred the cartridges, as I could use them to the last drop. I got a package of five 3mL cartridges. Bonus, if I dropped one, or it got hot/cold or otherwise ruined, I had only ruined one of five. Don’t buy pens, that is more “stuff” around the cartridge you don’t need. A cartridge looks like a mini vial, but has a moving stopper that works by negative pressure, so you don’t inject air into it. In other words, easier to use than a vial.

Prices will be specific to the UK. I don’t recall any current Lev users in the UK.

Good luck with the change in insulin. Post over here when you are ready to switch, and we can talk dosing. Your boy sure loves to bounce! I hope the Lev will help flatten him out. In the mean time, take a read over the Sticky Notes on the top of this forum.
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Oh that all sounds even better. The Prozinc vials expire before we use it all so this looks cost effective too and as you say a dropped cartridge is not a disaster when buying a 5 x 3ml cartridges. We are pleased to hear all of this as what we thought may be a problem is actually a real bonus.

We will post on how we get on. Prozinc has been OK but just not quite good enough. This forum is a life saver as there is so much superb experience and knowledge on tap.

As for dosing our vet has suggested a starting dose of 0.25 u per Kg. Therefore 1u. She knows we monitor him very tightly so that seems to fit with the TR method we but note that the Start low method would suggest a lower dose to begin with. He has been on wet only since last August. His Prozing dose is 2.75u bid. Do you have a preference as to which method to go with

The stickies are excellent reading. Much appreciated
 
MrWorfMen's Mom said:
Found a UK diabetic forum entry from 2017 suggesting costs were between 40 to 50 pounds for 5-3ml cartridges or the pens.
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That s great as it backs up what the UK NICE site refers to. However as this is a UK health service department we didn’t know whether we were seeing street or list prices or the cost to local health authorities. either way this looks very good. Thank you for finding this info. It helps greatly.
 
I but more info. Keep pens/cartridge in refrigerator and they will last a long time. Also levemir is a depot insulin. It will take a few days to fill the depot. You may or may not see affect right away. When you start you want to hold the dose a few days. People here will help you when ready.
 
Kate and Geoff said:
As for dosing our vet has suggested a starting dose of 0.25 u per Kg. Therefore 1u.
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That would be great if Jack was new to insulin, but he’s not. We take the dose of the existing insulin in mind, which would be more like 2-2.5 units for Jack. Speaking as someone who took months to get back on track after switching to Lantus after a higher Caninsulin dosage.

Choice of dosing method is a personal preference. You test plenty for TR so can choose either. Some people can’t test as much as TR requires, which is the preshot plus at least one other per cycle. TR has a higher chance of remission, as kitty stays in healing numbers longer, but some on SLGS also go OTJ.

Do you have the U-100 syringes with half unit markings yet?
 
Olive & Paula said:
I but more info. Keep pens/cartridge in refrigerator and they will last a long time. Also levemir is a depot insulin. It will take a few days to fill the depot. You may or may not see affect right away. When you start you want to hold the dose a few days. People here will help you when ready.
Click to expand...
Thank you for this. Good to understand about the depot. When we have changed dose in the past we’ve waited at least 5 to 7 days before changing again. We always minimise the time that the insulin is out of the fridge and guess if the cartridge is unopened it will keep for a good while. Lots of great help here
 
Kate and Geoff said:
Thank you for this. Good to understand about the depot. When we have changed dose in the past we’ve waited at least 5 to 7 days before changing again. We always minimise the time that the insulin is out of the fridge and guess if the cartridge is unopened it will keep for a good while. Lots of great help here
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Even opened, cartridge/pens lasts a long time if kept in fridge most of tine. Even an occasional left out its still okay.
 
Wendy&Neko said:
That would be great if Jack was new to insulin, but he’s not. We take the dose of the existing insulin in mind, which would be more like 2-2.5 units for Jack. Speaking as someone who took months to get back on track after switching to Lantus after a higher Caninsulin dosage.

Choice of dosing method is a personal preference. You test plenty for TR so can choose either. Some people can’t test as much as TR requires, which is the preshot plus at least one other per cycle. TR has a higher chance of remission, as kitty stays in healing numbers longer, but some on SLGS also go OTJ.

Do you have the U-100 syringes with half unit markings yet?
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Thank you. Good to know as that higher starting dose does make a lot of sense as no use in stepping too far back and undoing any good work e.g. weight gain.

TR is actually only way we feel comfortable Due in no small part to his bouncy nature

We do have some new u100 syringes leftover from when he was on short acting Hypurin neutral
Olive & Paula said:
Even opened, cartridge/pens lasts a long time if kept in fridge most of tine. Even an occasional left out its still okay.
Click to expand...
Thank you, very good and useful advice, thank you for sharing. X
 
Wendy&Neko said:
That would be great if Jack was new to insulin, but he’s not. We take the dose of the existing insulin in mind, which would be more like 2-2.5 units for Jack. Speaking as someone who took months to get back on track after switching to Lantus after a higher Caninsulin dosage.

Choice of dosing method is a personal preference. You test plenty for TR so can choose either. Some people can’t test as much as TR requires, which is the preshot plus at least one other per cycle. TR has a higher chance of remission, as kitty stays in healing numbers longer, but some on SLGS also go OTJ.

Do you have the U-100 syringes with half unit markings yet?
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Hi Wendy. We have u100 syringes but only marked for fullunits. We will hunt out supplies with half unit markings otherwise it is a little tricky trying to gauge a half unit
 
Thank you all. Just to update Jack has now been on Levemir for 3 weeks and we can say that there has been a definite improvement over Prozinc. Not perfect as yet and we are finding our but and signs are good. Now have the 3 ml penfill vials and u100 syringes with half unit markings. Onward and upward, and appreciate all the great advice.
 
Jack is looking much flatter on Levemir. One thing you will have to get used to is shooting a much lower number, especially since nadirs are towards the end of the cycle. With the depot insulins, they don't do as big drops, and are in fact great at keeping lower numbers flatter. That 164 the previous night was perfectly safe to shoot. With my Neko, I could shoot in the 80's and she typically wouldn't move more than 10 points all cycle. Now you will need experience doing that. But next time you get a lower number than you are used to shooting, and are able to monitor, try it.

It's good you got data the previous night and the 18th, in spite of the skip. It shows you what his blood sugar numbers would have done if you had shot. Note that onset seems to be +4 or maybe later, so the action of the next shot wouldn't have started for a while after shooting low, giving you several hours to get him up.
 
That sounds great advice and we have been kicking ourselves for being too timid. Having read the stickies last night, we realised we shouldn’t have skipped. Definitely also see these late nadirs and as you say the delayed onset’s. I guess it’s a matter of us getting used to a whole new rulebook really. We will continue to maintain pretty tight regulation as he always manages to surprise us. I think we are also tainted with uncomfortable Caninsulin experiences and to some extent Prozinc too.

We will certainly shoot on lower numbers in future. Experience and your excellent observation and guidance really help with the confidence
 
Yes, the depot insulins definitely require a different mind set about shooting lower numbers. Maybe gradually work your way down. You could try shooting above 150, then lower than number or time. Or give a part dose and see what happens. All data you get is good and will help build your confidence. It does help if you know they are on their way up.
 
Wendy&Neko said:
Yes, the depot insulins definitely require a different mind set about shooting lower numbers. Maybe gradually work your way down. You could try shooting above 150, then lower than number or time. Or give a part dose and see what happens. All data you get is good and will help build your confidence. It does help if you know they are on their way up.
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Thank you again, we are feeling empowered. We will keep you posted. X
 
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