? MILO VET VISIT THIS AFTERNOON need advice ASAP on switching insulin

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milosmommy

milosmommy

Member Since 2009
I am just getting frustrated with Milo. We are on our 3rd flat cycle. I am going to update his SS in a few after this post. I am going to take him in this afternoon 440 EST to see about switching to LANTUS from Levemir. He is really good about listening and researching. I was going to try to have some solid reasons for asking for the switch. Milo has been on Levemir for 3 months now and we just are going up and up in dosage. It seems the kitties around here all seem to be having success with Lantus. How would you approach this with reasons?

Also I did see there are a lot of people ordering from Marks and I know you send in the prescription to them or fax in in. My next question is I saw the LANTUS savings card where you can get the pens for $25 using that card. Does that still work? Saw some people had luck and some not but no real news on it in 2015.

Thanks!
 
Hi Meredith, I hope all goes well at the vet today. Sorry I don't have any recommendation on how to approach this subject with your vet. I also don't know about the Lantus Savings card, I looked into it briefly, but it looked like it was more hassle than I wanted to deal with. I also never ordered from Marks because I was nervous about the insulin getting warm. I am a Nervous Nelly. I do think the pens are the way to go though.
 
You could ask. Most vets are more familiar w/ Lantus than w/ Levemir. However, I don't know how much difference it would make. The main difference between Lantus and Lev is how the depot is formed. Most of us switch the other way around because we have too early an onset w/ Lantus and Lev tends to have a later onset and thus lasts longer after the shot. Neither is great for bringing down higher numbers, rather they are very good at keeping numbers more stable. I think you just haven't reached the breakthrough dose that Milo needs. Once that happens things can come down rapidly. Perhaps ask about a bolus insulin to get the higher numbers down and give the Lev a chance to even things out.

If you do switch remember that the Lantus will need time to build up a totally new shed and the Lev shed will slowly deplete. Most cats are fine w/ this, but some can get a double whammy so you need to monitor closely. As for starting dose? I think the usual recommendation is 2/3 the Lantus dose when switching to Lev, but I am not sure what the other way around would be.
 
I would not suggest an insulin switch yet. I would make sure you first rule out any reasons Milo might be needing more insulin. There are many secondary conditions that could mean a cat needs a higher dose and is harder to regulate, just as needing a dental, hyperthyroidism, kidney issues, and more. And by the way, some kitties just need a bit more - we don't consider a cat to be higher dose until they get to 6 units. I've seen a couple of kitties get to 5.5U before they hit the magic dose and go down. As Ann says, you haven't reached the break through yet and I think it's past time for Milo to get an increase. If a dose isn't getting you greens, don't linger on it because it once got greens.

We usually recommend that people give an insulin a try for 6 months. And we get more happy stories of people going from Lantus to Levemir that the other way around. The other thing to consider with a higher dose is Lantus's acid base. We hear of higher dose Lantus kitties becoming much happier when they switch to Levemir. Suki reported that Crystal stopped biting her at shot time when she switched from Lantus to Lev. Neko was not bothered with the sting of a higher Lantus dose however, but it is a common comment.

Summary, I'd wait it out a bit yet for Milo, you might be really close to that good dose. Get him checked out for any other conditions.
 
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Also, we can't get the Lantus savings card in Canada, but I think I've read that they are cracking down on it for pets. I think Mark's is a cheaper source anyway for you.
 
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Ann & Tess said:
You could ask. Most vets are more familiar w/ Lantus than w/ Levemir. However, I don't know how much difference it would make. The main difference between Lantus and Lev is how the depot is formed. Most of us switch the other way around because we have too early an onset w/ Lantus and Lev tends to have a later onset and thus lasts longer after the shot. Neither is great for bringing down higher numbers, rather they are very good at keeping numbers more stable. I think you just haven't reached the breakthrough dose that Milo needs. Once that happens things can come down rapidly. Perhaps ask about a bolus insulin to get the higher numbers down and give the Lev a chance to even things out.

If you do switch remember that the Lantus will need time to build up a totally new shed and the Lev shed will slowly deplete. Most cats are fine w/ this, but some can get a double whammy so you need to monitor closely. As for starting dose? I think the usual recommendation is 2/3 the Lantus dose when switching to Lev, but I am not sure what the other way around would be.
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What is a bolus insuling?
 
It's a fast acting, in and out in about 4 or 5 hours insulin. It can be tricky though and many vets who do consider it go w/ too high a dose. I know the ER vet who suggested it to us wanted us to use way too much. I'd ask some of the experts here for advice first.

Milo's numbers aren't that terribly high, I agree that you need to stick w/ Lantus and increase according to the protocol. Is there anything that could be elevating the BGs? Any infection or other problem?

The problem w/ the discount cards is that they require a "Physician Identification Number" (PIN) and most vets don't have them.
 
I'm with Wendy - I only know of one person who switched back from Lev to Lantus and it was pretty clear that particular person wasn't at a good dose. Other than that, I think everyone who has gone to Lev has liked it, but of course it takes getting to the "good dose." All of us with high dose cats know the frustration of feeling like you can't seem to get to the right dose, but it's out there, and it will have the potential to hold Milo's blood sugar flat. Hang in there!

I'd encourage you to increase the dose a little sooner. With Tight Reg, you re-evaluate every 6 cycles and decide then, based on the nadirs, if you need to increase again or if you should hold the dose longer. For Milo right now, I'd increase by 0.25u because he's only getting to blues. Even with green nadirs there are times that a person would increase the dose. You just don't want to linger on a dose that's not consistently getting him to green.

The last time he got to green on 3/27, it was followed by higher numbers - probably from the fur shot at amps 3/28. But when he recovered from that he only got to 114 at pmps on 3/29 - at that point you could've increased by 0.25u.

Increasing the dose:
  • Hold the dose for 3 - 5 days (6 - 10 consecutive cycles) if nadirs are less than 200 before increasing the dose by 0.25 unit.
    • if your cat is new to numbers under 200, it is recommended to hold the dose for at least 8-10 cycles before increasing.
    • when your cat starts to see nadirs under 100, hold the dose for at least 10 cycles before increasing.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
  • After 3 days (6 consecutive cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.
A bolus is a secondary insulin, Regular insulin, that is used in addition to one of the longer-lasting insulins. Most of the time the circumstances where it's suggested is when a cat has ketones or DKA, or a very bouncy cat in certain circumstances, or in high dose cats to help break through insulin resistance. I don't think any of those circumstances apply to Milo at the moment. I just think you need more Lev.
 
Ann & Tess said:
It's a fast acting, in and out in about 4 or 5 hours insulin. It can be tricky though and many vets who do consider it go w/ too high a dose. I know the ER vet who suggested it to us wanted us to use way too much. I'd ask some of the experts here for advice first.

Milo's numbers aren't that terribly high, I agree that you need to stick w/ Lantus and increase according to the protocol. Is there anything that could be elevating the BGs? Any infection or other problem?

The problem w/ the discount cards is that they require a "Physician Identification Number" (PIN) and most vets don't have them.
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Milo had his last blood work up in December and all other numbers were fine. I'm sure he will want to check the blood again today. I was interested in switching as Milo isn't himself on Levemir. He is not mean by any means but it is almost as if he is in a drug haze or a 'zombie'. I have noticed as the dosage becomes higher he just appears 'worse'. I am not saying he is out of control just laying around all day, it is just he is a different cat. That is why I was wondering if a switch to Lantus might show different results in behavior.
 
Ah, well that's a different thing. I haven't heard anyone report that before, but you know him best. I don't know why a higher dose would make him feel worse. That's a mystery to me.

I guess if he were mine, I'd try to get the blood sugar under control and then decide if he still seemed to be feeling yucky or if it passed when he got into better numbers.

Sometimes you have multiple things going on and they seem like cause and effect, but they might just be co-existing conditions. In other words, and I'm just thinking out loud, maybe he's feeling yucky for some reason but it's not related to the particular insulin, even though the timing seems like one is causing the other.
 
Thanks for all the information. I will talk with the vet, make sure there is nothing else wrong in blood work and dental and go from there. I am hoping I am just being impatient! :)
 
Looking at your spreadsheet I see a change from mainly red/pink now more blues with greens showing up. It looks to me like there is progress happening.

It looks like this is a return to insulin after a long remission for Milo? In my reading I've found that it is harder and often will take more insulin to get a cat into remission a second time around. When Smokey came out of remission we never did get her back in (mass on her pancreas) and we ended up with a dose above 10U b.i.d. just trying to keep her under 300. The lovely ladies here had to keep reminding me not to focus on the amount of insulin - whatever they need will be what they need. You might need to get farther up the dosing scale before things settle into lower numbers. Usually Lev ends up being a lower dose and has less sting for our higher dose kitties. We switched Smokey from Lantus to Lev when she got to 9U of Lantus.

Good luck. I think you are making progress even if it feels frustratingly slow.
 
Wendy&Neko said:
dary conditions that could mean a cat needs a higher dose and is harder to regulate, just as needing a dental, hyperthyroidism, kidney issues, and more. And by the way, some kitties just need a bit more - we don't consider a cat to be higher dose until th
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milosmommy said:
Milo had his last blood work up in December and all other numbers were fine. I'm sure he will want to check the blood again today. I was interested in switching as Milo isn't himself on Levemir. He is not mean by any means but it is almost as if he is in a drug haze or a 'zombie'. I have noticed as the dosage becomes higher he just appears 'worse'. I am not saying he is out of control just laying around all day, it is just he is a different cat. That is why I was wondering if a switch to Lantus might show different results in behavior.
Click to expand...

I think you really need to let you vet know exactly this. If Milo just doesn't seem right it could be the insulin or it could be something else entirely. Hopefully the vet will help you decide what the best course of action is.
 
I bought my last insulin from Mark's and the first pen which is almost finished was fine. I won't know until I get to the 4th and 5th if the time not refrigerated makes a difference. I waste a lot trying to get rid of bubbles so the pen lasted just under 2 months. The send it packed on a pharmaceutical grade ice pack but it took 6 days and it was no longer cold.
 
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