New Here & Switching from Lantus to Levemir

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Viveca and Noah

Viveca and Noah

Member Since 2016
Hi. I'm brand new here and I have questions about Levemir vs. Lantus. My 18 yr old cat, Noah, was recently dx'd diabetic and started Lantus just over a month ago. He's up to 4iu 2x/day and it's just not controlling things. With my vet's approval, we even went up to 10 hour intervals, instead of 12, and still, while his numbers do get down to the 140 - 150 range, they're back to upwards of 500 after just 9+ hours. To complete the picture, he does have kidney disease, probably ~ stage 2 (progressing slowly), which does complicate things. He's also already on a raw diet with zero carbs for several years. Anyway, the vet wants to switch him to Levemir. My question is, has anyone had success with Levemir after Lantus did not last long enough. Any experiences (esp. with a cat with any degree of kidney disease) would be much appreciated. Thanks!
 
Hello and welcome. My Neko has stage two CKD and is on a raw diet also. I switched a couple of years ago from Lantus to Levemir, not because of the duration issue. But I think her cycles are slightly flatter with a bit better duration on Levemir.

Are you home testing Noah's blood sugars? Although each cat is different (ECID), I find with Neko that if her low point or nadirs are in the 70's, her overall range comes down. If I have her at nadirs in the mid 100's, her duration isn't as good and her high points are much higher (over 300). The same holds true whether she is on Lantus or Levemir. But I wouldn't suggest increasing the dose to bring down the numbers, unless you were testing blood sugars at home.
 
Hi Wendy and thanks for the welcome. I'm glad to see that you're able to manage Neko's diabetes, even with CKD. I am home testing Noah's blood sugar. His nadir doesn't seem to get below the mid 100's range, but his high point is sky high - today it was 538. He's already on a pretty high dose of Lantus, so I'm afraid to keep going up and up on it, fearing I might send him into a hypoglycemic state. I am think I will switch him over to Levemir and see if I can try to flatten out his ranges. Thanks again for the feedback.
 
We typically say to give an insulin about 6 months before considering a switch. I'm not sure you've given Lantus enough time. One exception is for kitties that get to higher doses and feel the sting of the Lantus (acid base), as Levemir doesn't have that sting.

Do you have your test data somewhere we can look at it? We might be able to help you with the dose. You'll see that all of us have spreadsheets in our signature. The instructions are here. There are several reasons that can make it harder to get kitty regulated and for them to need higher doses. Neko also has two high dose conditions (acromegaly and insulin auto antibodies). We got up to a high up 8.75 units. CKD can make it trickier too. Kitties need the amount of insulin they need (some here much higher than Neko ever got), but we use testing to keep them safe from hypos.
 
Just wanted to add my welcome.

Hyde was originally on ProZinc in May, then switched to Lantus in the summer and Levemir in the fall - I think she was feeling the sting from the Lantus at a higher dose. She is also a high dose kitty (acromegaly and insulin auto antibodies) and with her current dose, she would definitely feel the sting.
 
Do you mean Neko was up to 8.75 units 2x/day?
Actually, it was my vet's idea to move on to Levemir. I would be perfectly happy to stay with the Lantus until we hit an effective dose. I guess his thinking is that, because Noah is already 18, we don't have a ton of time to play with before any irreversible pancreatic damage sets in. I only just started testing bloods, myself, last week, so I'd like to build up some data before I post it, but I'll be very grateful for the help to refine the dose. Thx.
 
Thanks for the welcome, Anne. Noah doesn't seem to feel a sting from the Lantus. In fact, he's usually purring throughout the whole injection process. Go figure.
 
Punkin got up to 15.5u of Lantus and never reacted to the shots. If you're not seeing a response (stinging) at 4u, I wouldn't worry about that. Some cats don't seem bothered by it.

I wish I'd switched Punkin to Levemir, but I didn't want the later nadir.

A spreadsheet can really help us help you assess what's going on. Some cats need more insulin than others, but I'm wondering about how fast you're increasing the dose. People often focus on the high numbers, but with Lantus dosing the low numbers decide the dose. Is it possible for you to get a spreadsheet up and let us take a look at whatever data you have?

One thing that's really important to understand about diabetic cats is that if they hit a number lower than they are used to, their body can react to that as though it's a hypo and raise their blood sugar nice and high for as many as 3 days afterwards. We call that bouncing. A second phenomenon is that when a dose is increased, it can raise the blood sugar. Go figure - it doesn't make sense, but it happens. Here's a post that explains more about those 2 things.

Welcome to the group! Keep asking questions and we'll do our best to help you learn this dance!
 
Thank you, everyone, for the warm welcome and advice. I must say, I'm completely overwhelmed by this diabetes dx., but very encouraged by your responses. I'm going to read up and post Noah's spreadsheet when I've done a few more curves.
 
The more you know, the easier it all becomes. Everyone is overwhelmed at the beginning, but it gets infinitely easier. The learning curve is steep at the beginning, but you'll get it!
 
If you can stick with the 12 hour dosing rather than 10, and the same dose of insulin each time, it will be easier to spot patterns. Lantus loves consistency. In time, those high preshot numbers should come down. I'd be inclined to do that first before switching insulins. Once you have more data, you'll feel more informed and confident going forward. :)
 
Thanks Julie and Marnie for the Lantus advice. Sorry for the delay in responding, btw. I am going to stick with a 12 hour dose and the Noah's going up to 5u tonight.
I'm going to do a couple of curves on the after 2-3 cycles and then post the results. Thank you so much for your input, so far!
 
We use one of two methods to determine dose increases here, the Tight Regulation Protocol or the Start Low Go Slow Method. With both of them, and if you are still seeing low points in the 140-150 range, we would only increase by 0.25 units. I think a full 1 unit increase is too much at once.
 
I agree with Wendy - a 1u increase is too much. You can overshoot a good dose by doing too large of increment increases. You'd be amazed that even as small of an amount as 0.25u - a quarter of one unit - can make a significant difference in blood sugar.

And in one more little odd twist of insulin and diabetic cat trivia, you can actually CAUSE high blood sugar by having the dose too large. We've seen cats arrive here at 10u who had constant high blood sugar because they were overdosed - typically their dose was increased by too large of an increment, usually 1u increments, and the increases were done too often. It's not that rare of a situation.
 
My vet was the one who suggested a 1u increase - it sounds like you have a lot more experience than he does with this. Anyway, Noah's been on 4u for 5 days. Maybe I'll keep him at 4 for another day and if things don't change I'll go up by .25u?
 
Do you need some help getting a spreadsheet going? The thing is, none of us are vets, so we go by data to help people. Without the data we're just talking - and no one wants to be responsible for possibly hurting any cat. You don't really want us to give generic advice instead of specifically for your sweet Noah.

Although 1u is too large of an increment, regardless of what the numbers are, for a cat with a dose of about 4u. It's just too much.

There are folks who can help you with the spreadsheet if that's a sticking point for you.
 
OK, I'll do a spreadsheet before I change anything. I know you're giving me advice blindly w/o it. I'll do one more curve tomorrow and post. Thx.
 
Great job getting the spreadsheet going! It appears twice in your signature line - the second one (on the right) is the one that's working.

What you're seeing tonight is a bounce. Notice how there's no "regular" Lantus curve with the numbers lower inbetween the shots, but instead goes straight up from morning til the next shot? That tells us it's a bounce. Here's a little more about that in the second post in this thread.

The most important numbers here are the ones this morning - it tells you the dose can get Noah at least into the 100's. It also raises the question of how low he went last night. No way to know, but you definitely wouldn't increase the dose with this cycle today. The bounce can last up to 3 days - so count forward to the day cycle on 1/11 and he might be high until then. He also might clear the bounce before then. The more time he's spent in lower numbers the faster he'll clear this bounce. How long he takes to clear the bounce also will tell us some information.
 
Okay, I updated Noah's spreadsheet with a curve I did a little over a week ago - 12/31 (it's first in the sheet, to keep chronological consistency.) This was when he was at 3.5u and it is a proper 'curve' - starts high, goes low, than back up again. Also, he had a fructosamine test on 12/28 (about a month into his insulin treatment and at 3.5u) with a result of 202. I'm posting this a little sheepishly, because, looking back, I should have known better and not bumped him up to 4u when 3.5u yielded that fructosamine number. Anyway, I'm reading up on the bounce effect he apparently had yesterday and will do another curve on 1/11. In the meantime, I'm wondering if he shouldn't go back down to 3.5u.

Incidentally, he started a course of Zeniquin for a UTI, today. He's taken it for said reason before without incident, but not before diabetes dx. Anyone have any experience with a diabetic cat on Zeniquin?
 
no experience with Zeniquin and cats, but just a comment. I don't know if it's one that kills gut flora, but to avoid diarrhea many people give a probiotic with antibiotics. You can give a people probiotic, or Fortiflora (available from vets or online, not in stores) helps some cats. Some cats will also eat yogurt with active culture (no sugar) so you could try it as well.

Many cats have their lowest numbers at night. If you are able to, could you get a test right before you go to bed? That can really help in figuring out the dose.

Hmm on that fructosamine. That does seem low. I'm looking at this site and it might suggest that you're right in suspecting that the dose is too high. I'm going to talks with some other experienced folk but am thinking it might make sense to decrease his dose and see what kind of numbers you get.

Cats Fructosamine values
(micromol/l)
(micromol/l)
Normal non-diabetic cat 190-365
Newly diagnosed diabetic cat 350-730

Treated diabetic cats:
Excellent control 350-400
Good control 400-450
Fair control 450-500
Poor control >500
(Reference: Feldman EC, Nelson RW (2004) Feline diabetes mellitus. In Canine and Feline Endocrinology and Reproduction. 3rd edition. Saunders, St Louis, USA p. 563)​

Were all his dose increases done in 1u increments? Any chance you can add any data from the past into the spreadsheet? All of it helps clarify the picture.
 
Do you have any idea what caused his diabetes? Since you feed him raw, we know it wasn't an excessive carb-heavy-dry-food diet. He doesn't look obese in your profile pic.

Did he have steroids?
 
Just because we say it CAN take 3 days to clear a bounce doesn't mean it WILL take 3 days so we'd really like to see more tests before 1/11

Here on this board we're big advocates for home testing which means testing before every shot (to make sure they're high enough to give insulin at all!) and then if at all possible, getting a mid-cycle test on the AM cycle (around +4 to +7) and then a "before bed" test on the PM cycle. Since most cats go lower at night, that "before bed" test is very important so if it tells you they might be dropping too low you can set an alarm to make sure you wake up to get more tests in (Welcome to the wonderful world of sleep deprivation!!;))

Lantus dosing is based on how LOW it takes them, so it's important to get tests in on every cycle if at all possible. We have people who work full time jobs and still manage to test every cycle..it just takes a little planning!
 
ah, I didn't realize you were thinking you didn't need to test again for 3 days. If he really is going lower than we've seen, he may be clearing the bounce (dropping back into normal numbers) and bouncing high daily. That's completely possible and would tell us a lot if he clears the bounce quickly. Go ahead and put in any days/test numbers that you have. Your glucometer is storing them in memory, so you ought to be able to scroll back and retrieve whatever test data you have.

The very most helpful thing you can do to help us figure out whether or not this dose is too large is to get 4 tests each day for now if you can. Both preshots and one test in the daytime, and that before-bed test. If you can't get all those in, I'd get at least the preshots and the test before bed.

A sprinkling of tests tells us far more than a curve done once every so often. If you think of your spreadsheet like a jigsaw puzzle, a sprinkling of pieces scattered throughout will tell you what the picture is far better than a stripe here and there. With a stripe here and there an elephant could be hiding in one section and you'd never know it.

ok - so the answers that would be helpful:

- can you add any test data or dates of dose changes that you have into the spreadsheet?

- did your vet have any suggestion as to why he became diabetic? did he have pancreatitis, for example, or any steroid shots?
 
Viveca and Noah said:
Incidentally, he started a course of Zeniquin for a UTI, today
Click to expand...

One more thing....having an infection or inflammation of any kind can raise the Blood glucose, so it's possible that when the UTI is better, his blood glucose numbers will come down too

That makes testing more often than just doing an occasional curve even more important!

Let us know if there's anything we can do to help you with testing so we can keep your sweet kitty safe as well as hopefully getting some better numbers soon!
 
Sorry for the misunderstanding. I actually just tested him now (pre pm shot) and it was 473. I also took a little risk and went down to 3.5u. I'm just gonna post all the #'s I have, they'll be a little all over the place in terms dates and times w/in the days and then test consistently for the next several days and post it all as I go. Btw - to answer your question - why is Noah diabetic? I really don't know for sure. I haven't let a carb pass his lips for years (I wish I could say the say the same for myself.) He's a bit underweight at 7+ lbs. He does have ckd and I know that diabetes can eventually accompany that.
 
ah, ok - thanks for clearing that up!! I thought you'd said you were testing.

What you can do to put the data in order in the spreadsheet is to insert rows where you want them, then put the data in the correct row.

So if you want to put a row in above 1/8, say for 1/7, you'd click on the left side of 1/8 to highlight it, then go up to "edit" at the top, click on edit and then select "insert row above." Voila, you'll have a row to label 1/7 and can put your data in there.

Some spreadsheets are slightly different so hopefully I'm right on how to insert a row in yours.
 
Once you have the row highlighted (like for 1/8) you can right click right there and choose "insert row above" ....it will keep the conditional formatting too
 
Viveca and Noah said:
Anyone have any experience with a diabetic cat on Zeniquin?
Click to expand...
My Ivana is on Zeniquin at the moment, also for a UTI. She's 4 days into a 7 day course. I have no idea how it's affected her numbers as she is unpredictable at the best of times, but something I have noticed is that she's not eating as much - likely feeling a bit nauseous, I guess.
 
Hi Viveca!
Does Noah get sub q fluids for his kidney disease? It may help his appetite and just make him feel better while slowing the disease even more…
I know there is lots to take in--just something to think about ;) You are getting great advice here.
 
Chris & China said:
One more thing....having an infection or inflammation of any kind can raise the Blood glucose, so it's possible that when the UTI is better, his blood glucose numbers will come down too

That makes testing more often than just doing an occasional curve even more important!

Let us know if there's anything we can do to help you with testing so we can keep your sweet kitty safe as well as hopefully getting some better numbers soon!
Click to expand...
T
 
HELP! First Hypoglycemic episode. Noah started the day at 445 BG, then 210 at +3 now 80 at +6. I just rubbed Karo syrup on his gums and gave him food. Now what?
 
Jumping in here - 80 is an OK number, especially so late in the cycle. Speaking from personal experience, it does freak you out the first time you see a low number.

80 is within the normal range for a non-diabetic. If you look at some of the titles of some of the better regulated kitties, they will be below 100 for a good part of the day. If they are this low in the early part of a cycle, you should feed a few teaspoons of low carb wet food and test again in 30 minutes. If they go below 50 at any point in the cycle, you should break out the high carb wet food that you have on hand for such emergencies.

You should probably test again in an hour to make sure that he is not still dropping.
 
We've all done it Viveca!!

When China first went low, I knew I could give her Karo/honey or syrup but hadn't learned how much yet....so I poured about a cup of maple syrup in a bowl and let her have it (she loved it!!)

It was only later that I learned I should have used a drop or two!!

Keeping some Fancy Feast Gravy Lovers foods around the house is a good idea too....the Gravy Lovers are high carb and we generally just pop the top off, and then "squeeze" the gravy into another bowl and feed a couple of teaspoons of gravy at a time.....Once they're above 50, we stop with the gravy and try to get them to stay in good numbers using low carb instead
 
Unless he drops below 50, you just hold the same dose (on the Tight Regulation Protocol)....below 90 if you do the Start Low, Go Slow method

Lantus craves consistency, so you hold the same dose both AM and PM

You need to read the "Stickys" at the top of the forum and decide whether you want to do TR or SLGS too so we can give you the best advice

TR (Tight Regulation) is a proven, published protocol that gives Noah the best chance at remission, but requires a little more testing and willingness on your part to hold the dose when you see those lower numbers. It's not for everyone, but we've had great success with it! China's on TR if you'd like to look at her spreadsheet...she's about as tightly regulated as any cat here!...that means keeping her between 50-120 the majority of the time
 
Crisis averted (I think). I tested his BG 2 hours and a mouth full of corn syrup after it was at 80 and it was up to 142 - I am going to go with the TR method.
I've now posted all of Noah's #'s so far in my ss (btw, on Jan 2,3 & 4, he was getting 10 hour cycles - HUGE MISTAKE). I did go down to 3.5u Lantus last night - boy is it confusing - I go down on the dose and BG goes right down. Is it possible Zeniquin could affect that?

One question - He does eat several meals throughout the day - gotta gain weight, so, do I need to adjust meal size by last BG # (ie. higher #, smaller meal and vice versa)? And, if he has a higher # pre shot, do I give him a smaller meal and vice versa?
 
Tara & Ivana said:
My Ivana is on Zeniquin at the moment, also for a UTI. She's 4 days into a 7 day course. I have no idea how it's affected her numbers as she is unpredictable at the best of times, but something I have noticed is that she's not eating as much - likely feeling a bit nauseous, I guess.
Click to expand...
Yes, you will definitely find that Ivana won't be as hungry as usual on Zeniquin. Noah's been on it before and he was less hungry and more lethargic - and nausea can be a problem. Good thing is that symptoms disappear as soon as the course is over.
 
I'd like to encourage you to read, bookmark, and/or print out the stick on Shooting & Handling Low Numbers. This will give you written information about what to do when numbers drop.

You do not adjust the amount of food you give Noah based on his numbers. Just like people, he needs a certain amount of calories per day. The only thing we recommend is that you pick up his food 2 hours prior to shot time.

 
jayla said:
Hi Viveca!
Does Noah get sub q fluids for his kidney disease? It may help his appetite and just make him feel better while slowing the disease even more…
I know there is lots to take in--just something to think about ;) You are getting great advice here.
Click to expand...
He doesn't get sub q fluids - he's not that far along. His appetite is generally pretty good, actually. He's always been a hardy eater. And he drinks a lot.
 
Viveca and Noah said:
I did go down to 3.5u Lantus last night - boy is it confusing - I go down on the dose and BG goes right down. Is it possible Zeniquin could affect that?
Click to expand...
It could be that any infection is going away. An infection can increase the numbers. Too high a dose can also make numbers go up - so reducing the dose could also help. But we don't have enough data yet to say whether he was on too high a dose. Since 80 is a good number, I'd encourage you to stick with the dose for tomorrow, unless he goes under 50. But you really should try to get some tests in at night. Many cats go lower at night. Even get a test a couple hours after the shot or before you go to bed will really help fill in the picture of how this dose is working for Noah.
 
This has helped me tons….someone sent it to me because I was terrified to shoot a lower number. It does get less nerve wracking:cat:
Now that I have TONS of data I can gauge how my boy responds/nadirs/if I can monitor and intervene if needed-etc..
I am pretty sure there are high calorie/low carb foods --


I'm quoting Julie&Punkin here from another thread. Whatever you choose will be the right choice.
I'll check in the morning and see how things went!

ok, more about shooting lower numbers.

This is a particular passion of mine, although I didn't really "get" it until punkin had been treated for his acromegaly and his dose was dropping unpredictably, so I didn't personally shoot low. However, in the past several years since he's passed away, I've seen over and over that the way to get control of blood sugar is to shoot the full dose into normal numbers.

Now I don't think you were ready to do that yet today! You don't have enough information (data) on Mocha just yet. But the way to GET to that point is to get a variety of tests in.

Lantus and Levemir are really good at holding blood sugar flat. But they are not so good at bringing down high numbers. So you get those crazy drops when you shoot a high number - maybe 300 points or more even, after you've shot a really high number. Then inevitably, the numbers shoot right back up before long. Now you've got another super high number to shoot. Eventually, as you get to a good dose, you'll end up with a lower number at preshot. Might only be 175. Shooting that number, with the full dose, can lower your whole range of blood sugar. Now obviously, you can't do that when you're going to leave. But if you're home, your kitty is not sick and eating normally, you have plenty of strips and high carb food - then GRAB the opportunity as a chance to flatten out your cat's blood sugar.

The first time, just shoot something like a 150 or above. The next time you have the chance, try lowering the number to something like 120. Then try a 90. Even for those following SLGS, you can learn to shoot lower - it is in the sticky. Since you're following SLGS, that would be your lower no-shoot number.

The important thing is to work up to it so you have DATA that shows what YOUR cat will do as you shoot lower.

It also helps to look at spreadsheets of people who have done this. You're looking for green amps - then looking across the row to see the results. Then notice as the person continues shooting green preshots, how the spreadsheet often will turn all green, or all green/blue. Here are a few - these were both following Tight Reg, but the principle is the same:

Davidson - start at February when Shawna began to shoot green preshots
Vyktor - start at Feb 12, 2012 (Australian style dating on the ss 12/2/2012) when Serryn shot a 110. His really significant changes started about a month later in March when his ss went all green.

Both of these kitties went OTJ. Not every cat does, but looking at their spreadsheets can help you see what is likely to happen when you do work up to shooting low.

Furball - look beginning July 9, 2015 - Carla has been following SLGS with her. She's on an OTJ trial right now!

Here's a post that Libby wrote about a variety of topics - shooting a dropping number is on post 6.

You also want to read the SLGS sticky on handing low preshots - there is an initial section for those new to this, then there is a second section for once you have a little more experience. Usually the first time people will suggest that you stall to let the blood sugar rise and then shoot. Some people get stuck on stalling as a strategy and keep doing it over and over. Or they always reduce the dose when they have a lower preshot. These are good strategies to use initially to see what your cat will do, but there are other options in that sticky that can also be tried, with the goal to getting comfortable shooting lower numbers.

I like to give the example of golfing & mini-golf. Both involve clubs, a course and a ball, but other than that they have little in common. Shooting low and shooting a high number are much the same way. The results you get are not very similar when you shoot high versus shooting lower. Shooting low is like mini-golf. the ball doesn't move much and it stays flat. Shooting high numbers, like playing regular golf, actually has the potential for huge drops and then huge bounces from it - it goes far, it's harder to know where it's going to land, too. I think shooting higher numbers is actually riskier than shooting low.

The caution with all of this is to know your cat, work up to this, read lots, don't do it when you can't monitor, and ask for help if you want someone experienced to see if it's a good time to try it. Experienced members following Tight Reg will shoot most everything over 50 if everything is normal with their cat. Experienced members following SLGS will shoot most everything over 90. We encourage new members to ask for guidance for anything under 150 - but the sooner you get enough data that you can shoot lower numbers, the greater the possibility of remission for your cat. Shooting lower numbers (50-120) is the path to going off of insulin - honestly, i haven't seen it happen any other way. If it does, it's unusual and it would only be in a very newly diagnosed cat.

You also don't have to do this! There's nothing that says you need to - I'm just explaining how it can work in cats so you know you have this option, IF you want to try it. You always hold the syringe and the choice is always yours.

i do want to encourage you without pressuring you - there's no way to understand the intricacies of this Sugar Dance if people don't explain it. Others certainly explained it to me until I got it, too. When you understand how things work, it's easier to step forward into unknown territory.
 
I think Noah's sugar is beginning to regulate. I know this isn't much data to go on, but after last night's debacle, when I way overreacted to a BG of 80 and gave him some corn syrup, his BG was predictably high pre shot this morning at 534. But I just tested at 4+ and it was down to 179 and his peak isn't usually until about 6+. Am I onto something here, or just lucky?
 
LOL--I think we all freak out at that first low number-(ok maybe the first few times :rolleyes:)
I will leave the others to answer as I am not that experienced ….looks good to me tho!
 
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