Levemir

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heatherj932

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Hello All,

So today Cyrus had a check up. I took 10 days worth of BG testing into the vet. Cyrus has gone from high 350-'s to 220's. I know that I need to get on a regular testing schedule. I have been just spot testing at different time of the day. Cyrus is on 5 mg Glipizide one time daily. He is also go through a diet change. The vet said today that using insulin is golden, as long as the owner is willing to give the shots. He basically said that the choice is up to me when I inquired about switching to insulin.

I inquired about using Levemir. My vet said that cats can only use Lantus. My husband is diabetic and using Levemir, so it would be cheaper ;-) Is his statement true? I thought that when reading the new comer q & a's it said Levemir is ok. The vet also said that he wants me to give 2 units 2 times a day. I thought that this seemed high for just starting out.

Any advice is appreciated!!

Heather & Cyrus
 
i'm running out the door real quick to go home but wanted to at least tell you that indeed levemir is just fine for cats. it actually works along the same lines as lantus so if you can get it via your husband's insurance or whatever, heck yeah go for it! who wouldn't?? that's actually a really good insulin to start with if you ask me. i'll go put a heads up on the levemir forum so they know you are here and can tell you more since i gotta go
 
Heather, Levemir is fine and a good choice for cats. Does your husband use the cartridges? You won't use the pen needles - use regular insulin syringes, and start at 1 unit bid. Print the protocol and show it to your vet. http://www.tillydiabetes.net/en_index.htm

Lantus is an excellent choice - but levemir is great too, so, go the cheap route and you can better afford the vet visits :)

Best,
Pam & Layla
 
Heather, you can definitely use levemir - many of us do. I use it for my two diabetics and one of them is now diet controlled after 2 years on another insulin that didn't work as well. You also want to get Cyrus off the glipizide ASAP. It does not work well and can "ruin" the chances of him becoming diet controlled by messing up the pancreas.

What are you feeding, BTW?

And, yes, 2u bid is too high to start out. If he is down in the low 200s I would almost say start at a half unit bid. You do want to "organize" your testing into testing before each shot - called Preshot tests (PS), and then get spot checks when you can. After 3-5 days you will want to do a curve where you test every 2 hours so you can identify when his lowest blood glucose is and how low it is.
 
Hi Heather,

I use Levemir for my Paul-Kyle...works very well, long duration, gentle ( very few high high's or low low's) and stores well until the end of the cartridge if handled properly.

There are many here on the board that use levemir and have for several years.

Feel free to direct your vet to this message board for more information or print out the protocols and take them to the vet, maybe.
 
It is certainly possible to use Levemir in cats. Most vets have only heard of using Lantus (if they have heard of using any long working human analogs at all!) Lantus has been on the market longer than Levemir and therefore was used first and with good results. I used Levemir and as member of the German forum a study trial has now been completed for using Levemir in cats, the same group which completed the Lantus study a few years ago. The results of the Levemir group were almost identical to the Lantus group. Here is the study summary (print it out and take to your vet.

This abstract was presented at the 2009 ACVIM Forum:

ABSTRACT #41

EVALUATION OF DETEMIR IN DIABETIC CATS
MANAGED WITH A PROTOCOL FOR INTENSIVE
BLOOD GLUCOSE CONTROL.
K Roomp1, JS Rand2.
1. Max Planck Institute for Informatics, Germany. 2. Centre for
Companion Animal Health, Uni of Queensland, Australia.

There are no reported studies of long-term use of detemir in
diabetic cats. The aim of this study was to report outcomes
using detemir and a protocol aimed at intensive blood glucose
control with home monitoring in diabetic cats, and to compare
the results to a previous study using the same protocol with
glargine.

Eighteen cats diagnosed with diabetes mellitus were
included in the study. Cats diagnosed with acromegaly were
excluded. Data were provided by owners who joined the
online German Diabetes-Katzen Forum, and followed an
intensive blood glucose regulation protocol for a minimum of
5 months or until remission was achieved. Detemir was
administered twice daily and a low carbohydrate wet food diet
was fed. The insulin dose was adjusted aiming to achieve
euglycemia (50-100 mg/dL as measured using a portable
blood glucose monitor calibrated for human blood). Owners
performed an average of 5 + 2 blood glucose measurements
per day in the stabilization period, and supplied spreadsheets
recording daily insulin dosages, blood glucose concentration
and clinical information.

Seventeen cats in the cohort were initially treated with
another insulin type (16 with porcine lente insulin) for a
median of 9 weeks, but failed to achieve remission prior to
switching to detemir. Most (15/17) of these cats were fed a
low carbohydrate diet while on the other insulin.

The overall remission rate was 67% (12/18). For cats that
began the protocol within 6 months of diagnosis, the remission
rate was 81% (9/11) and for those that began 6 months after
diagnosis, the remission rate was 42% (3/7). The median time
to remission was 1.7 months after beginning the intensive
protocol (range = 10 days to 5.3 months). Nine cats of 12 cats
(75%) achieving remission remained off insulin, and the
median duration of remission was 12.3 months (range = 6.4
months to 2 years). Three cats (25% of remission cats)
relapsed and required insulin again. Only one of these relapsed
cats achieved a second remission.

Six of 18 cats (33%) in the cohort required insulin
throughout the study to control blood glucose concentrations
and did not achieve remission. The median length of time on
the protocol was 10.3 months (range = 5.4 months to 1.2
years). The majority (83%; 5/6) of long-term diabetics were
considered well regulated with a median blood glucose
concentration of ≤150 mg/dL and 17% (1/6) were moderately
well regulated (median blood glucose ≤200 mg/dL). Clinical
hypoglycemia was rare, with only a single event in one cat
which had mild signs. The median maximum insulin dose
administered to cats in the study was 1.75 IU twice daily.

These results are comparable to those of the glargine study.
No significant differences were identified between outcomes
for glargine and detemir, with the exception of a lower
maximal dose for detemir (p-value = 0.045). The median
maximum glargine dose was 2.5 IU (range = 1.0 to 9.0 IU)
compared with a median detemir dose of 1.75 IU (range = 0.5
to 4.0 IU).
[www.acvim.org]
 
Your vet may speak to someone at the University of IL vet school. My vet agreed to prescribing it for Gandalf after speaking to them as they have done promising clinical trial with it. The following ACVIM abstract is from 2008 and has some erroneous information, as Levemir has been used in cats since 2005. Our own Steve & Jock were the first users in Europe.

"ABSTRACT #96
HYPERINSULINEMIC-EUGLYCEMIC CLAMPS USING IN-
SULIN DETEMIR AND INSULIN GLARGINE IN HEALTHY
CATS. C Gilor, T Keel, KJ Attermeier, TK Graves. University of
Illinois College of Veterinary Medicine, Urbana, IL.
Insulin detemir (Levemirs) and insulin glargine (Lantus) are
synthetic long-acting insulins used in human medicine. Reports of
the use of Lantus in cats are rare, and the use of Levemir in cats has
not, to our knowledge, been reported. In people, Lantus is longer
acting and relatively peakless, while Levemir has significantly less
within-subject variability. Levemir is also associated with less unde-
sired weight gain and decreased frequency of hypoglycemic events.
Because Levemir may prove useful in the treatment of feline diabetes
mellitus, we performed hyperinsulinemic-euglycemic clamps in cats,
comparing regular insulin (Humulins R), Lantus and Levemir.
Five young, healthy, purpose-bred cats received subcutaneous in-
jections of 0.5 U/Kg of Humulin R, Lantus and Levemir separately,
on 3 different days, at least 1 week apart. Following each insulin
injection, the blood glucose concentration, measured every 5 min-
utes, was maintained at baseline by a constant rate infusion of
glucose, and the glucose infusion rate (GIR) was recorded. The du-
ration of action was defined as the time from insulin injection until
GIR stabilized at zero. The peak insulin action was defined as the
peak GIR. The onset was defined as the time from insulin injection
to initial increase in GIR. No adverse reactions were observed with
any of the insulin products. The median duration of action of Hum-
ulin R was 305 minutes (range: 140–370 minutes). Lantus had a
median duration of action of 470 minutes (range: 295–950 minutes).
Levemir had a median duration if action of 800 minutes (range 525–
915). In 3 cats, the duration of Levemir exceeded the duration of
Lantus by 205–505 minutes. In the other 2 cats the duration of ac-
tion of Lantus was slightly greater than that of Levemir (25 and 35
minutes longer). When compared using the Kruskal-Wallis test the
durations of action of the 3 insulins were significantly different (P 5
0.012). When compared using the Mann-Whitney U test, the dura-
tion of Levemir was significantly greater than that of Humulin R (P
5 0.008), but there was no significant difference between Lantus
and Humilin R (P 5 0.095) or between Lantus and Levemir (P 5
0.31). The peak effects of Lantus occurred between 120 and 585
minutes. The peak effects of Levemir were less variable among the 5
cats, occurring between 370 and 575 minutes. The median time of
onset of Lantus was 80 minutes (range: 50–110 minutes), compared
with 135 minutes (range: 80–165 minutes) for Levemir (P 5 0.11).
In young healthy cats, Lantus may have a more rapid onset than
Levemir, but the peak effect of Levemir is somewhat more predict-
able. The duration of Levemir may be greater in some cats. Investi-
gation of the clinical use of Levemir in diabetic cats is warranted.


You are correct that 2U is too high of starting dose. We recommend no more than 1U twice daily (BID).

Gandalf has been on Levemir for over one and one half years now. And is doing very well for a 17 year old who's been diabetic for over 5 years. I credit Levemir for that as with proper management it does not allow the blood glucose to swing as wildly and can produce an overall more stable and lower blood glucose than other faster acting insulins such as Vetsulin or even PZI, as that's what we previously used. Please see this sticky from the Levemir ISG for a graphic example of blood glucose swing comparisons between Levemir and PZI.

http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=682
 
We used Levemir too-with excellent results :mrgreen:
Lucky was all over the place on Caninsulin (Vetsulin outside Europe) and beautifully regulated on Lev.

If your using a fresh needle every time (hubby not got one of those contraptions that's attached to him as well of course :lol: ), there's no reason I can see that kitty and hubby can't use the same vial-wayyyy cheaper :mrgreen:

You really do need the hometesting. I totally agree with Sheila on the .5u start dose. Have to say if your getting 220's on Glipzide, you may have caught the diabetes in the very early stages as this isn't that far off the high end of normal non-diabetic numbers.
You also have the advantage of knowing things like how crappy hubby feels when his sugars are up and down-same for kitties. Also signs of hypo.

G;ip has a very poor outcome for kitties, so you've done really well.
Would also take up the point of what food you give. If you have under 10% carbs great-Fancy Feast and Evo seem popular choices.
You want to try and test several times a day for the first few days and you need to hold the dose (building the shed).

Just want to check that the Glip. is out of kitty's system before giving the Lev and your good to go.
You can post either in Levemir forum or Lantus (the two insulins have almost identical action and thus the same protocol).There's some sticky's in both forums that make excellent introductory reading.

Good Luck, oh, and welcome to FDMB :mrgreen:
 
HI Heather -

Just wanted to jump in and tell you how well my Molly has responded to Levemir. My vet wasn't so keen on the idea either at first but i presented her with facts and after she did her own research, she was all over it. I know it's not always easy to talk to the vet but give it a try - hell, you can even tell her all about us here on FDMB. We have boatloads of clinical data that supports the use of Levemir in cats with feline diabetes (of course i would refrain from using the term 'boatloads' as it's probably not the most professional term :-D ). Please see the Lev insulin support group.

Wishing you and Cyrus the best. -Michele
 
Ennis has been on Levemir with good results for almost 3 years. I started him on it without a script when it was first available from Canada. I changed vets around the same time, so I came to the vet as a Levemir user, and given it works great (see our spreadsheet) and the vet thinks I know what I am doing, he writes scripts (now required in Canada) when I need them.
 
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