Simon's Insulin Switch (Lantus)

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Bruce & Simon

Bruce & Simon

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It was suggested in open this thread here about Simon.
Original thread in the Health forum is here
Simon recently relapsed after being OTJ since 2005.

I'm going to be switching insulin early next week, I'm really not happy with Caninsulin, or it's future availability.

From what I see, Lantus seems to be more used here, but from what I've read Levemir may have some
advantages (doesn't burn, slightly less likely to cause major hypo, etc.). Being in Canada I can get either w/o prescription.
My choice would be the Levemir, unless Lantus would be a better for reasons I haven't thought of/don't know.

Simon's 15 yrs old, and weighs 12.8 pounds (5.82kg) at present. He's lost weight the last few months. Years ago he was a 22-pounder
on vet-supplied "weight control" dry food. I think his ideal weight would be 14-15 lbs, he's a big boy. He's eating President's Choice
canned food, either chicken or turkey w/giblets.

Any suggestions would be greatly appreciated, especially to starting dose. His SS is linked in sig.

TIA
Bruce
 
Re: Simon's Insulin Switch

Welcome Bruce!

For all practical purposes, Lantus and Lev are very similar. Aside from burning, which it probably more relevant for a cat on a high dose of insulin, the biggest differences is that Lev lasts a little longer at least according to the manufacturere (45 days or thereabout vs. 28 days for Lantus) and the nadir is later with Lev. As far as hypo, they are both long acting insulin and the risks and issues are the same. If you've not already seen it, this is a link describing the differences between Lantus and Lev.

There are several people here who have switched from Lantus to Lev. They can probably give you a good sense of the differences.

In the mean time, when you have a chance, please look over the sticky notes at the top of the Board. Lev users post here regularly since dosing with both types of insulin is the same and this forum is very active. Below is an outline of what's contained in the sticky notes.
  • Tight Regulation Protocol: This sticky contains the dosing protocol that we use here. There are also links to the more formal versions -- the Tilly Protocol developed by the counterpart of this group in Germany and the Queensland/Rand protocol developed by Jacqui Rand, DVM and published in one of the top vet journals.
  • New to the Group: Everything you wanted to know about this forum and more. Info on our slang, FAQs, links to sites on feline nutrition and to food charts containing carb counts, how to do a curve and the components to look for, important aspects of diabetes such as ketones, DKA, and neuropathy, and most important, info on hypoglycemia.
  • Handling Lantus: how to get the maximum use from your insulin and what to not do with it!
  • Lantus depot/shed: This is an important concept for understanding how Lantus works.
  • Becoming Data Ready: What data you need in order to be able to work toward remission or tight regulation.
 
Re: Simon's Insulin Switch

hi bruce,

i can't answer your question but want to say welcome! hopefully you'll be able to get simon back under control again - wouldn't that be great?!

at least this will bump you up for some more experienced eyes.

julie
 
Re: Simon's Insulin Switch

Thanks for your replies!

I had read the stickies, along with some googling, and will re-read again.

I might just go with Lantus as it seems to be most popular here, and I doubt Simon
would be getting large enough doses to bring the burning issue into play. He's very
good-natured and tolerant of the pricking and poking, but all bets could be off if it hurt.

One quick question; I see a lot of the SS's show BG testing all through a 24-hour period.
How do people manage that? And some on what seems a regular basis?

TIA
Bruce
 
Re: Simon's Insulin Switch

Personally, I'm a big fan of sleep. That said, I'm a bit of a testaholic.

In some cases, there are 2 caregivers. For example, Marjorie/Gracie and her husband, Mike, will tag team if Gracie's numbers are running low. They work on different days and are both very invested in Gracie's care (as well as the care of their other kitties). Having 2 people definitely helps! Other people will set alarms to get up to test. I've arranged my schedule around Gabby's shots and testing. Because she tends to drop quickly and early in the cycle, I'm awake to test until she's past nadir. There are also nights when I'm having to stay up late to make sure she's in safe numbers. Safety is always the primary concern and may of us are a bit sleep deprived.
 
Re: Simon's Insulin Switch

different people do different things with the testing. some of it depends on our cat's needs, and honestly some of it depends on how addicted we humans get to getting the information! i probably test more than i need to on a daily basis. at first i think it was really important to see, in general, how punkin responded to insulin. but there's several of us that jokingly say we need to go to overtester's anonymous.

you need enough testing in to see what your cat is doing. you need tests throughout the day to see the patterns, and when your cat looks like it might be headed too low, you need to test more. some of the kitties seem to go lower at night - people either stay up, set an alarm and get up to test, or tag team if there's a partner to help. just depends, and thank goodness, it's never every night for anyone. but no one needs to test every few hours all day and all night every day. some people test every few hours on the weekend, and catch 2-4 tests on weekdays, if that's their work schedules. you really must get a pre-shot test to make sure it's safe to give the insulin, and you need to get one or more mid-cycle tests to see what the dose is doing.

that's not a very concrete answer because the answer is flexible, depending on your cat and your schedule.
 
Re: Simon's Insulin Switch

I suspected as much. I guess I'll just have to be a little more conservative in approach.
Middle of the night is not my peak for mental acuity ;-)
I stay up now until the Caninsulin peaks, which is at about +4 with Simon.
I make sure he eats, poke him, put some food out for through the night
(for him and 3 civies, which makes it nigh impossible to monitor his intake))
and go to bed. This would be a few hours later at least with Lantus I assume?
 
Re: Simon's Insulin Switch

I'm with Julie and Sienne....as much as I love my sleep, I'm even more of a testaholic. I didn't test as much when Trix was first diagnosed, until she suddenly threw me a 55 for one of my first random spot checks. That woke me up and made me realize that she could be going dangerously low, and without testing we might not find out until it was too late. Like Sienne, I've arranged my sleep schedule around Trixie's shot schedule; I now get up at 5:15 to get the ball rolling, so I'm able to get at least 2 post-shot testes in before I head to work. I also think that frequent testing has brought us to where we are now, with consistent BGs and a lowered dose that works well for her, not to mention it gives me peace of mind knowing that she'll never go hypo as long as we stay on top of monitoring her. It's daunting at first, but it has become part of my daily routine.

And welcome to Lantus Land!

Amy
 
Re: Simon's Insulin Switch

Hi Bruce,

Welcome! :-D
I switched Alex from Lantus to Levemir after about 8 months. I may be one of the few, but I didn't have great success on Lantus. At first it seemed to be going that way with Lev also, although in general Alex's numbers were much lower right off the bat. He just seemed to have a longevity problem meaning that it didn't seem to go the distance from preshot to preshot. Alex has lots of other problems that can get in the way of this though which I sometimes like to NOT take into consideration. I tried switching back to Lantus for a week because I thought I'd rather see yellow PS's and maybe not ever any greens as long as he was flat but this experiment went amok.For us it was disaster. All I saw was pink and red. When I switched back to Lev, right away lower nadirs with the same high preshots. I tried a number of things that most people thankfully don't have to and shouldn't resort to (I also work from home so monitoring is not a problem for me). As of March of this year, Alex has come back from a sickly 9 pound cat to a happy, cuddly and a little bit chubby 14 pound cat whose numbers are pretty darned good most of the time and he doesn't seem to have a longevity problem anymore (let me qualify by saying that when he does, it's because I don't shoot on time) ohmygod_smile . Would this have happened on Lantus? I don't know. But I know that when he gets his 3.5 units it doesn't sting him and the fact that it can go for 42 days certainly doesn't upset my pocketbook.

Just another 2 cents worth from the Levemir camp :)

Whatever you decide...good luck to you!

Caryl

ETA: last night Alex was low at PM+5. I set my alarm t wake up at 5:00AM to test him and make sure he was okay. Sometime ya just gotta do what ya gotta do :razz:
 
Re: Simon's Insulin Switch

hi bruce, welcome!

you've gotten some awesome advice so far. in terms of scheduling- i often found myself racing the clock (i have a day job and i'm an actor, so there go evenings)- what I tried to do was make adjustments or changes to dosing on days i worked from home or weekends when i could be home and play poke a kitty. since my bf worked from home, that did give us some day time flexibility, but he was still working so it's not like he could sit and stare at the cat all day (cat however, would often sit and stare at him), but he would grab a +6 or a +9, which did help keep a pulse on data.

after a few of those weekend/wfh day curves, i had a better idea of what cat's schedule was with his insulin, and what he was more incline to do at what time, and i was able to make decisions about adjusting my schedule from there.

I also tried to squeeze in a test whenever I could- home for 15 minutes to change- test a kitty!
up in the middle of the night to grab water- test a kitty! (i won't remember the number, but the meter did)
that actually helped fill out a huge amount of data on our sheet as well.
 
Re: Simon's Insulin Switch

Thanks everyone, great to hear all the advice. Probably going to go with Lev.

To quote from the protocol;
In many cases, the starting dose of Lantus or Levemir has been 0.25 IU per kg of the cat's ideal weight and is always dosed BID (two times a day, 12 hours apart). If the cat received another kind of insulin previously, the starting dose should be raised or lowered by taking this information into account.
Click to expand...
Based on this, Simon would start at 1.4-1.5u. However I couldn't find anything explaining HOW to "take into account" his previous Caninsulin dosage.
Especially because this time around I haven't arrived at a good one yet :oops: I also want to go "low and slow"... I prefer my drama to occur on TV :-D

Again, thanks for all this great input.

Bruce (& Simon)
 
Re: Simon's Insulin Switch

Hi Bruce....just want to welcome you and Simon to LL where we all take care of each other and watch out for each other. Glad to see you are making a switch to lantus or levemir. Sienne has already given you awesome information on the difference.

She told you that Mike and I tag team Gracie which does make life alot easier. I don't know how Sienne and others who are doing it alone manage. But I think it's also important to know your cat. For instance, our Gracie always seems to change her nadir and just when we think she might be up for the night, she may turn around and come back down. Other cats hit a lovely nadir and the caregivers know when that is so they can then go to bed. So you'll have to see how Simon is and what his needs are.

Tess is on lev...having moved from lantus in Jan.....and she's done very well on it but she onsets about +3 and nadirs about +11 so Ann and John (also tag teamers and testaholics like many of us) are usually up with her quite often during the night. I wouldn't mind trying lev but that late nadir just doesn't work for us with our schedules and Gracie is doing fairly well on lantus anti jinx.

We love questions here so we'll help out as much as possible. There are many people on both coasts of the US and in Canada and in between so there's usually someone around some time. Good luck!
 
Re: Simon's Insulin Switch

SO much to consider, LOL.

I'm bouncing between Lan & Lev with every post! Nadir @ +11 ! I know we won't know how Simon will
fare until I try one. Damn that ECID business.

Is there anything approaching a consensus as to which "L" is more likely to resemble a 12 hour cycle?
 
Re: Simon's Insulin Switch

Bruce & Simon said:
SO much to consider, LOL.

I'm bouncing between Lan & Lev with every post! Nadir @ +11 ! I know we won't know how Simon will
fare until I try one. Damn that ECID business.

Is there anything approaching a consensus as to which "L" is more likely to resemble a 12 hour cycle?
Click to expand...

My cat is on Levemir and pretty consistently nadirs between +5 and +7 hours. I do everything by myself as well and I rarely have any problems that high carb food won't fix pretty quickly.

If you want to look at Alex's chart, look at the second tab and start at May 11,2011. That's when I got him back to bid dosing. You can pretty plainly see where his nadirs are.

It's good to start at a low dose and go up as necessary(unfortunately I don't know the conversion from Caninsulin either), but as far as late nadirs with Lev, not all cats have them. ECID when it comes to that also. :razz:

Caryl
 
Re: Simon's Insulin Switch

Hi there!!! I wanted to add my 2 cents!!! Don't let the length the insulin lasts determine your ultimate decision. I bought my vial of Lantus and started using it on March 27 and I'm still using the same vial!!! If you look at Champ's spreadsheet, you can see the insulin is still very effect because I've had to reduce Champ's dose three times in the last six days! As long as you don't shake, rattle, or roll the insulin, keep it in the refrigerator religiously (and not on the door or where it will get knocked around), and don't inject air into the bottle (or any extra insulin you might draw up), it should last for a long, long time. I'm past the 60 day mark!!

Good luck on your decision!!
 
Re: Simon's Insulin Switch

Welcome from another 905er. I hope that when you purchased your U100 syringes, that you purchased the ones with 1/2 unit markings? You are in good hands with this group.
 
Re: Simon's Insulin Switch

Bruce & Simon said:
Is there anything approaching a consensus as to which "L" is more likely to resemble a 12 hour cycle?
Click to expand...
I'm not quite sure what you mean by a "12 hour cycle." With both Ls you will need to shoot every 12 hours. If you are asking about nadir, that's a different matter. Lantus does have an earlier nadir. However, that doesn't mean that there isn't variability. Gabby's nadir is typically around +4. But, she's had nadir's at +2 and at +10. (We are dealing with cats. They like to keep us guessing!) I suspect that the Lev users see similar variability.

The bottom line is that you won't make a bad choice. Both Lantus and Levemir are very good insulins. I've given a good deal of thought to switching to Lev. The only reason I haven't is the later nadir. A later nadir, given my cat's proclivity for nose diving into low numbers, would wreck havoc with my work schedule.
 
Re: Simon's Insulin Switch

Thanks again! This awesome group just as helpful as when Simon & I first joined in '05.

I did mean an approximate +6 nadir by 12 hour cycle. I want an exact 12 hour cycle, nadir at +6, give or take 5 minutes... OK? :lol:
Yep 905, got the short needle BD syringes 3/10cc, 31g with the half markings. Very handy even when using the U-40 juice as I am now.
And thanks for the tip to not keep on door, I would have probably done just that! That's where I keep the caninsulin, as it does need rolling anyway.
I checked pharmacy stock, and all the expiry dates are in 2013, so I understand refrigerated and unopened a pen is good till then.
Lev seems to be pens only, Lan some pharms carry vials too.

I will definitely be starting "low and slow"
 
Re: Simon's Insulin Switch

hi bruce. welcome to the group! as the action of lantus and levemir is similar, we have users of both insulins posting in this group.
i've used both lantus and levemir. i really don't have a preference. they're both wonderful insulins! don't let the manufacturer's guidelines for suggested use throw you. those guidelines (28 days for lantus and 42 days for levemir) are based on unrefrigerated insulin. most all of us keep both opened and unopened vials/pens refrigerated. this simple act extends the life of both lantus and levemir.

you asked about a starting dose. given simon's current dose of 1.4u, i would suggest starting out at 1u bid. we usually recommend starting about 30% less than the current dose. chances are the dose will have to be increased, but for some unknown reason many kitties show a marked response within the first few cycles. they'll often dip lower than we want them to. not every kitty does this, but it's why the protocol recommends careful monitoring the first few days. you'd want to hold that dose for a minimum of 3 days (6 cycles)... preferably 5 - 7 days (unless the numbers tell you otherwise). this is because lantus and levemir are depot insulins meaning the effects are cumulative. one dose can effect up to the next 3 days. one dose builds upon the previous dose. this is very different than caninsulin. lantus/lev dosing is based on the action of the insulin being cumulative and nadir with only some consideration given to preshot numbers.

take a look at the data i've collected on alex (link in my signature). click on the tabs at the top of the page to see her progress from one year to the next. she's had 2 honeymoon's, but has been back on insulin for over a year now due to other problems. note the 2006 lantus data was collected before the current TR protocol was widely accepted on the FDMB. when alex returned from the Falls in 2009 after an almost 3 year honeymoon i purposely tested her a lot to illustrate for others like yourself just how you can achieve the long flat curve lantus and levemir are known for. if you take a look at that 2009 spreadsheet in particular i think you'll get a good idea of how to use the L insulins... a lot different than what you're used to. don't be thrown off by the frequent testing. i had a specific purpose in mind. now that i know alex's response to her insulin and food (know thy cat), i usually test her 4 times a day... unless she's sick or i'm experimenting with feeding schedules or different foods.

alex did have an earlier onset (+2) & nadir (+6) with lantus. her lev onset is usually around +4 and nadir around +8 or +9... although that has recently shifted to almost +12 lately. yup. nadirs can and do shift... with both lantus and levemir.

you also asked about duration...
there was a time when i would have told you many levemir users noticed better duration from levemir than lantus. that was until i had one of those "ah-ha, you dummy moments". sure duration "looked" better with levemir only because onset and nadir are usually later than what you see with most kitties on lantus (not all - ECID).

to cut to the chase... i don't think you can go wrong no matter if you choose lantus or levemir. i will encourage you to post often because caregivers coming off another insulin often have a hard time forgetting what they learned about the insulin they used previously. we can help you with that! :lol:

good luck with whatever you decide!
 
Re: Simon's Insulin Switch

Hi and welcome to LL! Marjorie already mentioned Tess is on Levemir. We made the switch because she had been on Lantus for a year and seemed to be just sitting there, very low dose, but no change. We felt she had gotten too used to it and needed something to stimulate her pancreas again.

She also had a very early nadir, resulting in steep drops and lots of bouncing. We now get onset about +4 and although she can nadir very late it is usually about +8. I was told once that Levemir lets you know that the dose is high by giving later nadirs. Then you can start expecting time for a reduction. I think we are about there, hence the later nadirs that Marje noted. Tess has certainly leveled out w/ the switch.

Switching from caininsulin should be no problem as it doesn't form a shed (or reserve) the way Lantus and Levemir do. That is going to take some getting used to. Dosing decisions are always made by the nadir nor the preshot so you need to forget all you learned about that. And since they do form sheds we have to be patient and wait longer for that to stabilize before making adjustments.

I hope this clarifies rather than confuses things even more. :cool:
 
Re: Simon's Insulin Switch

Bruce, welcome to LL! My cat is also Simon! He is a pretty big boy (14.5 pounds) and is 14 years old. I work during the day but try to come home if I am able to check his bg. I don't always get home but leave food in the automatic feeder so I know that he is eating small meals throughout the day. I have another cat, so I'm not positive that Simon always gets to the food before her, but Simon has had pretty consistent numbers, so I think it must be working ok. I cannot stay up late at night and don't do well waking up and testing because I would never go back to sleep. I leave food again in the automatic feeder to go off at 1:30 in the morning and then i wake up at 6:00 to test, feed and shoot. This seems to be working well for Simon. Of course, if he tests low at the evening +4, I will stay up later and make sure his numbers are rising before i go to sleep. Good luck...such a lot of information to take in. Everyone is here to help, so ask any questions and you will get wonderful advice.
 
Re: Simon's Insulin Switch

Hi Everyone, and thanks again for all the support!

I'm going to go with Lantus. I was talking with our vet about having Simon's bloodwork done today (full geriatric panel),
and he agreed after reviewing Simon's SS, (which he thought was a great idea) that with Simon the caninsulin just doesn't
have the staying power.. decent nadirs but overall too long in "the damage zone" and he mentioned glargine before
I did! He has some patients on Lan, but none on Lev as yet.

I'll start the Lantus tomorrow AM, and at Jill's suggestion, and keeping with "low and slow" 1.0u BID (vet concurred).
 
I just wanted to pass along this info on how lantus & lev are constructed - not because it would make a difference in which one you use, just because i thought it was fascinating how they work within the body, especially the depot/shed part. so fwiw:

http://www.diabetesclinic.ca/en/diab/2treat/lantus_vs_levemir.htm

and while ecid - punkin seems to be the example of that long flat lantus curve. i love it. i feel some confidence that if i get a particular pre-shot value i won't have to worry about him zooming down. however, he might be like that on any insulin, i don't know. i have liked the lantus and don't have any complaints about it.
 
Hi there,
I switched Tray from caninsulin to lantus and a few months ago we switched to Levemir. Tray seems to do much better on the lev, not as many dramatic highs and lows. But lots of people have had great success with lantus here.

Good luck
 
Lantus in the fridge, ready for a.m. Starting at 1u bid.

I admit to being a little nervous :oops:
Thanks for all the great advice (and I'm looking forward to more)
 
:thumbup Welcome to the family, you're stuck w/ us now. Ok , how many times have you read the stickies? You know all about giving shots and doing tests, but really, the way Lantus is dosed is totally different. Be prepared to sit on your hands a lot. Hmmmm, I wonder if they make Patience Pants for men? :lol: :cool:
 
LOL

Read many times, one or the other of them usually open in another window.

I will not start messing with the dose immediately. I will not start messing with the dose immediately.
I will not start messing with the dose immediately. I will not start messing with the dose immediately.
 
Ann & Tess said:
:thumbup Welcome to the family, you're stuck w/ us now. Ok , how many times have you read the stickies? You know all about giving shots and doing tests, but really, the way Lantus is dosed is totally different. Be prepared to sit on your hands a lot. Hmmmm, I wonder if they make Patience Pants for men? :lol: :cool:
Click to expand...

LOL...I think Marje's yellow Patience Pants would look hot on any guy! (yikes...gives me the chills just thinking about it...and not in a good way!)

Welcome to Lantus Land, Bruce and Simon!
 
looking forward to see you open a condo tomorrow! and here's the thing, if you give lantus a significant try (gotta go for a while to be a real trial) and you don't like it, you can switcheroo. no divorce needed! :lol:
 
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