Need help choosing an insulin. Levemir?

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kittycat88

Member Since 2013
Hi everyone! My cat was diagnosed with diabetes in late November. I had him on Caninsulin and then the vet switched him to Lantus to see if he would respond better to it. He did not respond at all to Lantus (His sugar was 30) and my vet said they have quite a few cats that don't respond to it at all. So he is now back on Caninsulin and his numbers are lower than they have ever been but still range quite a bit. Sometimes his preshot numbers range from 8 - 12 so I give him a half dose of insulin or else his sugar will drop too low. The only problem with this is his next preshot number is usually around 20. I talked to my vet about switching to a different insulin but they only carry the two kinds there. However, they are more then willing to get something else in for me to try. I was wondering what everyone thought the best insulins for cats are? Something more gentle maybe to prevent the big drops / high BS levels. I know a couple people suggested Levemir ... Is this a more gentle insulin?
 
Re: Need help choosing an insulin

Hi and wecome,
When you said he didn't respond at all to the Lantus....
Can you tell us more? What dose was he on, and what sort of numbers were you seeing?

Levemir is a good insulin too, and more gentle than caninsulin, but so is Lantus. It might have more to do with how the Lantus was prescribed than with the Lantus itself.

Please let us know more?
 
Re: Need help choosing an insulin

kittycat88 said:
He did not respond at all to Lantus (His sugar was 30) and my vet said they have quite a few cats that don't respond to it at all. So he is now back on Caninsulin and his numbers are lower than they have ever been but still range quite a bit. Sometimes his preshot numbers range from 8 - 12 so I give him a half dose of insulin or else his sugar will drop too low. The only problem with this is his next preshot number is usually around 20. I talked to my vet about switching to a different insulin but they only carry the two kinds there. However, they are more then willing to get something else in for me to try. I was wondering what everyone thought the best insulins for cats are? Something more gentle maybe to prevent the big drops / high BS levels. I know a couple people suggested Levemir ... Is this a more gentle insulin?
Click to expand...
What is his weight and what dose of Lantus (and how often) did the vet prescribe? I disagree with your vet that "quite a few cats..don't respond to it at all". Lantus, Levemir and PZI are the best 3 insulins out there. Where are you located?
 
Re: Need help choosing an insulin

He had been on Caninsulin and they got him up to 4 units BID but his BS level at peak insulin time was 14.2 so they thought they would try Lantus instead. They put him on 2 units Lantus twice a day for 2 weeks and his sugar was up to 23.3 when I took him in. They increased to 4 units twice a day and his sugar was then up to 30 after two more weeks. This is when they put him back on caninsulin. I was not testing at home yet while he was on Lantus so I only know the number the vets gave me. He has lost weight since he was diagnosed ... I beleive he is now about 13 pounds.

He was also on dry food that I bought from the vet at that point. Royal Canin diabetic I beleive.
I now have him switched to canned food - Evo 95% Chicken and Turkey.
 
Re: Need help choosing an insulin

The other factor here could be rebounding. Are all the numbers preshot numbers or are some midcycle? Sometimes, if the insulin takes them low during the middle of the cycle, their body releases extra glucose and their number bounces back up by the next preshot time.

There are also some high dose conditions that do require more insulin. This thread is from the High dose forum on this site. It is not very active but the information is good.

http://felinediabetes.com/FDMB/viewtopic.php?f=12&t=375
 
Re: Need help choosing an insulin

Hmmm. That would be unusual then. Lantus has a very good track record here. Levemir or ProZinc would be other choices, but, if I were you, I might do some investigating on high dose conditions.

When did you switch to wet low carb? Did you see any changes after the switch?
 
Re: Need help choosing an insulin

I switched him to low carb canned about a week ago now and dropped him from 6 units caninsulin bid to 2 units bid because of the diet change. His bloodsugar 6 hours after his shot today was 6.4. I've seen a big difference in his numbers from switching his food so I don't think he has any issues in terms high dose conditions.

A lot of days now his preshot numbers range from 8-12. When he was on high carb dry food and 6 units of caninsulin his preshot numbers were often in the 20's.
 
Re: Need help choosing an insulin

kittycat88 said:
He had been on Caninsulin and they got him up to 4 units BID but his BS level at peak insulin time was 14.2 so they thought they would try Lantus instead. They put him on 2 units Lantus twice a day for 2 weeks and his sugar was up to 23.3 when I took him in. They increased to 4 units twice a day and his sugar was then up to 30 after two more weeks. This is when they put him back on caninsulin. I was not testing at home yet while he was on Lantus so I only know the number the vets gave me. He has lost weight since he was diagnosed ... I beleive he is now about 13 pounds.

He was also on dry food that I bought from the vet at that point. Royal Canin diabetic I beleive.
Click to expand...
I think that being on any insulin while still feeding dry food would be counterproductive...including Royal Canin (unless Recovery)....which is why, perhaps, you didn't see results with Lantus...
 
Re: Need help choosing an insulin

It's good you saw a change with the diet change. I agree that his lowering levels with the diet change make a high dose condition more unlikely,.

So your preshot numbers aren't bad and today he had a nice drop. Usually we consider Lantus a much milder insulin than Canninsulin and easier to regulate with as it lasts longer and has a slower drop. Cats can be regulated on Canninsulin, especially if they tend to have a longer cycle with it. (some cats only get about 6-8 hours and then start back up.

What you might do is put your numbers into a colored coded spreadsheet. That will give you a great visual of what is going on. Here are the directions:

http://felinediabetes.com/FDMB/viewtopic.php?f=6&t=18207

If you need help, just ask.

If he tends to have a cycle near 12 hours, you may be able to get him into good numbers as the diet change really kicks in. (takes different times for every cat). Do you still have the Lantus? It might be worth trying it again now that he is on wet low carb.
 
Re: Need help choosing an insulin

No, I don't have the Lantus anymore. I used it a couple months ago and read it was only good for about a month after being used so I threw it away once I switched back to the caninsulin. What is the difference between Lantus and Levemir? If I decide to switch to levemir what would everyone suggest for a starting dose? (for a cat around 13lbs).
 
I've asked some people who know Levemir to come over and help if possible...

Carl
 
Carl asked me to pop in and answer your questions.

I've used both lantus and levemir and they are excellent, gentle insulins. Without home testing, it would be really difficult to say that lantus wasn't working for him. From what you've said, I think there is a good chance they started the dose too high and increased it by too much. We typically don't increase by more than .25u but there are some exceptions to that.

I've also found that many vets don't understand that lantus and levemir are not dosed like caninsulin. If you don't dose them correctly, you won't get the results.

Levemir is similar to lantus in many ways. They are both long duration, depot insulins. Levemir is known for producing very long duration, flat curves but some cats still will bounce just as they do with lantus. (Cats Bounce when the BG drops lower than the liver is used to or drops suddenly; the liver's response is to release counterregulatory hormones and glucagon to bring the BG back up).

With both insulins, the first several shots go towards filling the depot and then the cat starts to use the insulin that is injected. Both insulins like consistency so we don't dose hop. Lantus onsets around +2 and nadirs around +6 but every cat is different and some will nadir earlier, some later, and sometimes it moves around. Levemir onsets around +4 and can nadir anywhere from +8 to +12. Lantus can sting at higher doses; levemir does not. We also dose based on the nadir with only a little consideration given to the preshot.

Here is a bit of information on Lantus and Levemir What is the Difference.

Please let me know any other questions you have.
 
Sorry about the delay- don't get on much.

I use Levemir- it is PH neutral so it doesn't have the sting that Lantus does going in- I have a high dose cat and don't really need to be chasing her down to give her one twice a day.

It is gentler than canisilun (meant for dogs) and is dosed on a 12/12 schedule. Normal FD cats need the structure of the dosing to help level off- both of the L's are long lasting insulins (can be up to 14 hours) while canisilun is a short acting one (6-8 hours, maybe up to 10). That means that with the L's it takes a while to get an effect of them- anywhere between 3 to 5 DAYS before it is fully working to lower bg's and it can take up to 4 hours after the shot for that shot to start bringing down the numbers. Nadir is around 6-8 hours with Lantus and 8-10 hours with Levemir. It is graphed like a wave that helps to keep the kitties at a good level with very little rises and troughs rather than the short acting insulins which have a rise, hump, and fall to a trough before the next shot.

And your food choice would have a great impact on the bg levels across the board and keep them high. As you found out when you changed the food recently.
 
Hi -

I'm Lu-Ann and my extra sweet boy Grayson (like Heather's Sneakers), has Acromegaly, and therefore is a high dose kitty. She, Marje, BJ, Sue and Carl have already offered you great resources and advice. I will just echo a few things. Especially for higher dose kitties, Levemir is often prefered as it is pH neutral. That's why it doesn't sting as Lantus can IN SOME KITTIES - not all. Lantus is most widespread, and is a very good insulin. Grayson has been on Lev for nearly a year, and ProZinc for 5 months before that, so I can't offer comment on Caninsulin. However, I understand several of our non-US friends here have used it successfully.

The key to having a clear picture on how the kitty is responding to whatever insulin you use, is to test frequently. At a minimum, it's recommended to test before you shoot (AMPS and PMPS - are morning and night preshot numbers, as well as mid-cycle. Preshots are not influenced by food (you feed immediately after testing - kitty sees this as "get poked, get food" (somewhat of a reward) - so typically preshots are the highest number you see on a short-term insulin (although Grayson used to spike about 30 points from a can of food). Lantus & Lev, the "L's" have a reserve tank or depot (or shed), that fills to help have some back-up after the current dose is expended. That's why it takes a little while to see response when you first start dosing.

All insulins are affected by the food. You've done well to switch to a low-carb food - Evo is a great choice. Grayson typically eats chicken and turkey varieties of Fancy Feast classics, partly for cost, mostly due to availability and quantity consumed - Acromegaly causes even more ravenous appetites than unregulated diabetes.

I hope you'll try to get the preshot testing, and at least a few mid-cycle tests. These, as well as a curve at home, will help you see where he's dropping to the lowest point. Testing at the vet is going to be stressful for the kitty, therefore, you'll see your numbers more consistent with where he really is normally.

Feel free to post here, and/or in the Lantus or Lev forums for insulin support groups. This will put more eyes on your kitty and great wisdom from those who have had much experience with your insulin. And you'll have even more help!

Lu-Ann

Lu-Ann
 
I prefer Levemir over Lantus because I know that some cats don't respond as well to Lantus, one of my own is a perfect example. My Shadoe acted tense and had more uneven numbers when on Lantus, but she relaxed and had smoother curves when on Levemir. She was noticeably calmer on Levemir.

Switching to ALL wet food, be sure it's low carb, is excellent; it's very hard to get decent numbers and any sort of regulation when feeding dry food. You can refer to Dr. Lisa's food list to pick a wide variety of food in case your cat decides that the current menu is no long edible.
catinfo.org/docs/FoodChartPublic9-22-12.pdf

Be sure to remove all foods 2 hours before shot times so that the number you get at pre shot is not a food influenced number. Any food will cause the numbers to rise and you will get a false number on which to base your shot.

As has been said, testing before giving each shot is very important - you need to know that the number is high enough to give a shot. A third time that it's important to test is just before you go to bed - you need to know that the number has not dropped very low as some cats do drop lower overnight. Mid cycle testing is nice but often impossible for people who work or are away from home during the day, so what you can do is get extra tests when you can, here and there, and then on the weekend or on a day off, do a curve by testing every 2 hours between 2 shots. I often did a curve on Sat and Sun, testing here and there, and still was able to go out for my weekend shopping and errands. The curve tests don't need to be an exact every 2 hours, but just when you can get the numbers. Even if you get only 3 or 4 tests in, that's useful to let you know how the insulin and the dose are working.

I wouldn't say that the Lantus did not work because Lantus needs time to settle and it does not do well to keep changing the dose all the time. Both Lantus and Levemir work better with slow and gradual changes. Hold the dose for 5 days when you first start, then after that, smaller changes of .5units are made as needed, but only every 3 days.

I am sure that you will find that you will see a big difference by gradual changes, and I would go with Levemir.

Gayle
 
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