Returning member Lantus vs. Levemir

[KSAkitties]

Hello list members,

It's been over three years since my sweet boy Major had his last insulin shot. Unfortunately, his diabetes came back after moving to a stressful new environment (moved to Saudi Arabia at the end of Feb 2011) and being attacked by one of our rescued cats in April. Within two days of the attack, I noticed that he was lethargic and not quite himself so I tested his BG immediately. It was over 17 mmol/L(300 mg/dL). Prior to this incident, his BGs had been 3.6-4.6 mmol/L (65 - 83 mg/dL) consistently while he was in remission (without insulin).

Needless to say, I am very sad and angary with myself for not being more carefully watching over Major.

I have a spare bottle of PZI but it has expired on 11 June 2011 and have no way of getting PZI locally or from our previous vet in the UK (PZI has been discontinued). I just found out that I can purchase Levemir and Lantus without a prescription at one of my local pharmacies. I have two questions regarding switching Major to either Lantus or Levemir:

Question 1 – Lantus vs. Levemir:
I have read most of the info on Lantus and Levemir on this site but still can't decide whether I should switch Major to Lantus or Levemir. I noticed that some of you have experiences with both types of insulin and wonder if you could share with me on why you switched from Lantus to Levemir or vice versa.

Question 2 – Initial dose with Lantus or Levemir:
Major’s current’s AM and PM pre-shot values are around 7 to 9 mmol/L (130 – 160 mg/dL) on most days. I know these are quite low BG values but I have gathered a lot of readings on Major’s BG since he was first dx in 2008. I feel quite comfortable to give Major PZI at these values and always make sure that I am home to monitor him after each shot. Sometimes, I do have to delay his shot by an hour or two. He gets 05 to 0.75 IU twice a day. Nadir is around 3 to 4 mmol/L (54 – 72 mg/dL) about 3 to 5 hours after the shot. He weighs 6.7 kg (15 lb).

HOWEVER, I do not feel comfortable giving Major either Lantus or Levemir at these pre-shot values 7 to 9 mmol/L (130 – 160 mg/dL). If I use 0.25 IU /kg per The University of Queensland’s protocol, Major’s initial dose should be around 1.7 IU.
Should I reduce it to 1 unit as a starting dose if Major’s pre-shot BG is usually around 7 to 9 mmol/L (130 – 160 mg/dL)?
Any thoughts or suggestion is much appreciated.

Thanks,

 

[KarenRamboConan]

Given those preshots, I'd start at 0.25u or 0.5u, no more. It has a lovely, slow onset, so would hopefully be kicking in just as the BGs were starting up. I know the Queensland protocol wants us to dose by weight, but honestly, that doesn't seem to work well at all. "Start Low, Go Slow" still seems to be the best plan.

My personal choice would be Levemir, but that's simply because it seems to be a little "tougher". Lantus is fragile - it can be ruined by shaking, dropping, rolling, etc. And you can't prefill syringes with it. The action and onset are almost identical.

If you can, buy the cartridges, not the vials. Both Lantus and Lev have fairly short shelf lives, and there's often a lot of waste when you're only giving 0.5u a day! The cartridges are miuch smaller (meant for insulin pens) so the waste is far less.

Has Major been quickly checked to make sure there's no infection present? And was there any change in food since the move?

Other than that, you caught this fairly quickly, and here's hoping Major is OTJ again soon!

 

[Just-As-Appy]

I use Levemir and it comes in 5 - 3 ml cartridges in Canada. Some pharmacies will sell you one cartridge. I don't know about in Saudi Arabia, but it might be worth asking. Some people have found an out patient pharmacy at a hospital will ell one cartridge. I've attached the picture of what they look like here. I know they are different in the US, so this may not be what they look like in Saudi Arabia.

I would agree with the small starting dose. You may not see any effect for a day or two as both the L insulins need to build up in the body. I'm sure you've read about the shed.

 

[Larry and Kitties]

I also would start at 0.25 or 0.5 units. I currently have one kitty, Tonis, on Levemir and four on Lantus. I started Tonis on Lantus but got up to about 4 units with little improvement in BGs. Still has some HI preshot BGs. Tonis is not doing good on 7 units Levemir.

 

[KSAkitties]

Hi Karen,

Thank you for your reply.

-> Has Major been quickly checked to make sure there's no infection present?
## Due to the stressful situation Major was in, I did suspect that he might have UTI. The local vet did a basic unrine analysis using dipstick which indicated infection. We also did a culture test but the vet said it was sterile, and there is no medication for it. So I still can't be sure whether or not Major had or still has some infection.

->And was there any change in food since the move?
## There hasn't been any change to his diet. He is on raw rabbit and half can (5.5 oz) of Instinct Rabbit a day. I was lucky enough to find a food distributor in our neighbouring country (Bahrian) to bring in wild rabbits. We brought a year supply of Instinct Rabbit to Saudi Arabia when we moved here.

 

[KSAkitties]

Hello.

Sorry, I don't know your name.

Thanks for the image of Levemir.

It looks like the ones we have in Saudi Arabia. On the packaing, it says Levemir Penfill, 100 U/ml. It comes in a package of 5 - 3ml cartridges. I am not sure I can get buy a single cartridge.

I am planning to start Major on Levemir tomorrow with 0.5 IU as the starting dose. I believe I need to keep him on this dosage for three to five days before adjusting it. Is this correct? What happens if his nadir falls too low at 0.5 IU? Do I reduce it to 0.25 for the next shot?

 

[KSAkitties]

Larry,

Thanks for your reply. Kudos to you for taking care of five diabetic kitties.

I will start Major on 0.5u tomorrow. I am a bit nervous about starting a new type of insulin. Is it too early to do a full curve on the first day of giving Major Levemir?

 

[Just-As-Appy]

Doing a full curve the first day will probably not tell you much about the insulin action. However, am and pm preshot and then maybe first day a test around +6, then day 2 test at + 5 and + 7. The fourth day would be useful to do a curve.

 

[Maggies Mom Debby]

My Maggie was on Lev, and it's a good insulin. .5 units sounds like a good starting dose. I would do a spot check somewhere around +4 or +6 to see how low Major is going instead of a whole curve at this point. It will give you some peace of mind, especially since you're nervous.

You do know that with the cartridges, you still use U100 syringes, don't you? Just making sure.

 

[KSAkitties]

My Maggie was on Lev, and it's a good insulin. .5 units sounds like a good starting dose. I would do a spot check somewhere around +4 or +6 to see how low Major is going instead of a whole curve at this point. It will give you some peace of mind, especially since you're nervous.

You do know that with the cartridges, you still use U100 syringes, don't you? Just making sure.

Hi Debby,

Thank you for checking. I am using U100 syringes.

 

[Blue]

I have used Lantus and Levemir on both of my cats.
Oliver does not act/respond different on either, but dose is slightly less on Levemir.
Shadoe seems more tense on Lantus, but immediately seems more relaxed on Levemir. She also had her dose drop when switched to Levemir.
When cats are switching from Lantus to Levemir, it's usually advised to decrease dose by about 30%, so 10units of Lantus would switch to 7units of Levemir.
Starting low as already suggested is best; hopefully, Major's need for insulin help will be for a short time.
With the shed to be filled, a curve will not show much for a few days, so just a few tests on the first few shots should let you know how it's being received.

 

[KSAkitties]

I have used Lantus and Levemir on both of my cats.
Oliver does not act/respond different on either, but dose is slightly less on Levemir.
Shadoe seems more tense on Lantus, but immediately seems more relaxed on Levemir. She also had her dose drop when switched to Levemir.
When cats are switching from Lantus to Levemir, it's usually advised to decrease dose by about 30%, so 10units of Lantus would switch to 7units of Levemir.
Starting low as already suggested is best; hopefully, Major's need for insulin help will be for a short time.
With the shed to be filled, a curve will not show much for a few days, so just a few tests on the first few shots should let you know how it's being received.

Thanks, Gayle. I have a tendency to over test my poor Major. He is a such good and patient boy with me.

I am postponing to swtich Major from PZI to Levemir till after I have finished reading and absorbed everything I have found about Levemir from this site.

 

[Vicky & Gandalf (GA) & Murrlin]

Hi Ping,

You are welcome to post some specific questions about Levemir in the Levemir ISG.
I second the recommendation to start at only .25U or .5U. The way the longer acting insulins work is that you need to start at a dose which will be below their optimum dose and you increase dose based on how low the nadir goes. I would ere on the side of caution with the BG preshot values you're getting and use .25U to start.

You said you get lots of tests, that's good. You will be able to determine nadir time more easily than others. Nadir is important with Lantus or Levemir, so is the depth of the curve, meaning do they start high and drop fast or a lot.

I have not used Lantus, but I did use PZI for over 2 years. The differences in action are significant between PZI and Lev. I'm sure you've seen the graph in one of the stickies on Levemir ISG.

Good for you that you are doing your research first! Let us know if we can help.

 

[KSAkitties]

Hi Ping,

You are welcome to post some specific questions about Levemir in the Levemir ISG.
I second the recommendation to start at only .25U or .5U. The way the longer acting insulins work is that you need to start at a dose which will be below their optimum dose and you increase dose based on how low the nadir goes. I would ere on the side of caution with the BG preshot values you're getting and use .25U to start.

You said you get lots of tests, that's good. You will be able to determine nadir time more easily than others. Nadir is important with Lantus or Levemir, so is the depth of the curve, meaning do they start high and drop fast or a lot.

I have not used Lantus, but I did use PZI for over 2 years. The differences in action are significant between PZI and Lev. I'm sure you've seen the graph in one of the stickies on Levemir ISG.

Good for you that you are doing your research first! Let us know if we can help.

Many thanks, Vicky.

I intend to start low to see how Major will do on Levemir and will make sure I am home all day for a few days when I do make the switch. I have seen the difference between PZI and Lev. curves.