levemir

Since I cant daily test Tubby and I dont really trust Caninsulin. I was thinking of switching to Lev. At say 1u bid or .5u bid.
I would not chase his numbers but do like the vet does and do a blood test for b/g every 2 or4 weeks and try to stay under 200.
Tubbys symptoms have disappeared but he is still getting thinner. so back to the vet anyways.
No rants about not home testing please . I try most days when his ears return to normal.

 

I recommend that you either repost in the Health forum or the Levemir forum. If you are not going to home test before each shot as most of us here do, I would start conservatively like 1/2 unit bid and do some testing after the first week and adjust up in small increments as the numbers lead you. waiting a couple of weeks is not desirable.

 

Definitely please repost (if you haven't already) on Health and read the info in the Lantus and Levemir forums about this.

 

This forum is provided for lively, provoking discussion about various aspects of the treatment of diabetes

 

Re: levemir ETA

you are right and that is true. What you might find though is a little more "lively" than you would like about not always testing before shots.

Just about everyone here tests BG before every shot with at least a few spot checks in between. Some test UG (see the Alternative Testing) but what you probably will not find is anyone supportive of shooting blind, particularly with the longer lasting insulins.

With all insulins you need to know when the insulin kicks in and when it peaks. Levemir has some "interesting" action when you first start and I, for one, would not feel at all safe administering it or any insulin with preshot testing.


ETA - Ah, nice! I see the mods moved your post to Health. This is a much better place for questions about testing and insulins

 

i moved your post to health so you can get more replies. think tank is a low traffic forum where theories and such are discussed rather than individual cases. k?

 

Why are you unable to test daily? What is wrong with his ears?

My sister has a former feral with totally battered ears - all scared and tough - who also happens to be black so that makes testing tough as well, and she tests him before every shot. If you have specific testing issues I am sure someone here can offer suggestions to deal with them. Have you tried paw pad testing?

It really is a crap shoot to give insulin and not test. I have have caught some really low BG's in Beau at shot time. I think without testing you have to shoot less insulin in the hopes that you can keep him below renal threshold and above hypo. But no one here can tell you what that dose is with any certainty because every cat reacts differently. I have seen cats drop to the 30s on a half unit of levemir by the 3rd shot. I have also seen cats hardly move at all on 2u.

I guess what I am saying is that we can't offer suggestions about doses without the blood sugar data - at least I wouldn't. But we can help will all types of testing problems so that maybe you are able to test before every shot.

 

Hi,
I agree with Susie. Levemir requires consistent home testing to be used properly in cats. Consistent means before each and every shot, as well as spot checks or curves to establish nadir and effectiveness. Spot checks need to be done every day in the beginning if the caregiver can manage it.

Diligent home testing with either Levemir or Lantus insulins increases the chances of the cat going in to remission, although remission should not necessarily be the goal of insulin treatment. The goal is maintaining a healthy, happy diabetic cat. Home testing increases the chances of maintaining the cat's health no matter what insulin is used.

Sorry to harp on it, but the best diabetic cat care requires at least a minimal amount of home testing as described above. Many members here can help with home testing tips and tricks to make it easier for both caregiver and pet.

 

Hi Mal

I confess that I have only used lantus, the animal hospital I work for only uses Lantus (in cats), and therefore have no direct experience with Levemir. However, hometesting the ears can't be done in some cases and these diabetic cats still need care and treatment, so I'll attempt to answer your question since you've not gotten a lot of support thus far. (I also think that they are more alike than different in terms of their extended duration; since you're comparing with Caninsulin, I think that's the basis of your question.)

Traditional management of diabetes in cats involves BGs at the vets and urine testing at home. Discuss this with your vet who can evaluate the safety of traditional management in light of your cat's clinical situation. The plan is usually to start low and go up based on urine tests (if you are getting ++++, insulin goes up, + it stays put, no glucose = talk to your vet before next shot, talk to your vet if in-between ++/+++). Curves will be done at the vets, usually with a day long stay.

Do I think diabetes can be treated in cats even if hometesting blood is impossible, with an insulin other than NPH and Caninsulin? Yes, I don't think there's a choice in treatment and I don't know why a long-acting insulin can't be used. I see Lantus cats managed without hometesting blood all the time; I know the management isn't ideal, and they probably spend more time on the high end than I'd want, but they can have a good quality of life in terms of energy, health, and lack of complications.

Talk to your vet when you bring your kitty in and work out a plan. Get some KetoDiastix for home, if you don't have them, as these combo sticks will test for glucose and ketones. Work on getting your cat used to you catching a pee sample, if he's not already used to it. (I use a plastic ladle I got at the dollar store.) If you are able to EVER test his ears, please do, and work on getting him more accustomed to it if you can. BG hometesting is the only road to close regulation, and it is the safest way. BUT, if it is impossible in your situation, cats can and do survive with urine hometests and at-vet curves.

 

while i unequivocally agree with the others about hometesting...
Marshall and Rand (CENTRE FOR COMPANION ANIMAL HEALTH, The School of Veterinary Science, The University of Queensland) have come up with a dosing protocol for cats on lantus or levemir and glucose monitoring every 1-2 weeks: http://www.uq.edu.au/ccah/docs/diabetesinfo/link3.pdf.

hope this helps...

 

For all of you who do not know, Lantus and Levimer work in similar fashion to each other. They are manufactured by two different companies and Levimer supposedly is not as fragile an insulin as Lantus. Aside from that, they are very similar in use, duration and process.

Mal regarding your question - would you mind telling us why you will not or cannot home test.

Maybe if we start with this information, we will better be able to assist you.

 

As cats age, many develop other health problems that may or may not impact how their bodies utilize insulin. For Lucy, Levemir responds more like PZI than Lantus. Several Levemir users have had good success with shooting split doses and/or shooting 3 times a day. It's important to understand how a particular insulin affects YOUR cat, instead of betting on generalities. Collect the data, review the charts, and then determine whether you can follow Tilly exactly or if your cat needs some tweaking of the protocol.

 

hillary,
thank goodness we now know lantus is NOT as fragile as we thought!
here's a very interesting TT discussion you may have missed: Disscussion: how long does Lantus/Levemir last once opened.

lantus and levemir were introduced in europe before they were available in the usa. in reference to the longevity of opened lantus and levemir cartridges, members of the German Diabetes-Katzen Forum have shared their collective experience: "they routinely use them for 6 months or more - when refrigerated, opened cartridges of these insulins are extraordinarily stable". this conclusion drawn by others who have used these insulins longer than we have makes lantus and levemir reasonably affordable for treating our diabetic kitties.


terri,
i agree. it's very important to learn how "YOUR" cat is responding to insulin when using any insulin type. we have had levemir and lantus users posting in the lantus group over the last several years who ended up following a "custom plan"... a plan tailored to their individual cat's needs out of necessity. these custom plans are created after collecting a lot of data to determine how kitty responds. collecting data is paramount to understanding/learning how the individual kitty is responding. the concept of ECID and "KNOWING THY CAT" definitely applies!

following the German Tight Regulation with Lantus or Levemir Protocol aka the Tilly Protocol on FDMB (which btw, has now been published), is a good starting point for lantus and levemir users. experience has shown us the German Tight Regulation Protocol does work for "most" kitties when the protocol is followed as suggested. Roomp and Rand's study, published in the Journal of Feline Medicine and Surgery*: Intensive blood glucose control is safe and effective in diabetic cats using home monitoring and treatment with glargine as well as collective experience have shown us a cat has a better chance of remission using lantus (84%) or levemir (82%) when combined with a low-carb wet diet and beginning a tight regulation protocol within 6 months of diagnosis. that chance of remission dramatically drops to 35% for cats who begin a tight regulation protocol more than 6 months after diagnosis.

in a study recently published in the Journal of Feline Medicine and Surgery*: Treatment of newly diagnosed diabetic cats with glargine insulin improves glycaemic control and results in higher probability of remission than protamine zinc and lente insulins), one of the conclusions drawn by Marshall, Rand, and Morton was: "Good glycaemic control soon after diagnosis is associated with increased probability of remission and should be the goal of insulin therapy."

* unfortunately, i have these published articles in pdf files which are too large to attach here, but i'd be more than happy to share.
if interested, please send your email addy to me via PM. i'll email them to you...

 

Collecting the data and creating custom plans is how most of us learned to handle this disease back before Tilly. Let's hope that folks are learning the basics instead of relying totally on a set protocol so that as their cats age they grasp the basic concepts needed to develop a custom plan.

 

yes, when alex was first diagnosed three and a half years ago i was one of many who floundered about with lantus before the German Tight Regulation Protocol with Lantus or Levemir was widely accepted on the FDMB. it wasn't until steve/jock referred me to kirsten @ tillydiabetes.net that i finally started to "get it". luckily, when alex fell out of remission after almost 3 years of being OTJ (thankfully i had continued to test her religiously during her honeymoon and "caught" a dental problem immediately) i had the good fortune of already knowing how to regain good glyceamic control quickly... thanks to data collection which enabled me to understand alex's response to levemir and the German Tight Regulation Protocol with Lantus or Levemir which gave me the tools needed! If you look at the differences between her 2006 Lantus spreadsheet and 2009 Levemir spreadsheet... the differences are clear and pronounced. the data and methods used speak for themselves. :mrgreen:

 

I am concerned that he is getting thinner.. have you had a blood panel run on him lately? He should not still be losing weight unless you've switched him to wet food and he was previously heavy.

I use Levemir and find it to be a terrific insulin. Recommend you follow Jill's link until such time as you can test.