Some more questions about insulin choices

[KSAkitties]

I have been following the posts over the past few days over insulin choices by several concerned care takers. I was in the same situation less than two weeks ago.

I was under the impression that both Lantus and Levemir are very similar but I am starting to wonder why I have not found studies or papers on treating feline diabetes using Levemir like the ones published by Rand and her colleagues. Perhaps, Levemir is a newer type of insulin; therefore, there are few data and studies out there? Or I just haven’t come across these more scientific based studies on treating feline diabeteis using Levemir yet?

I have been reading most (if not all) of the papers/studies by Rand and on Lantus with great interests, and I am very pleased to see the positive remission rate in one of their studies. However, I have to remind myself, wait a minute, my boy Major is on Levemir, not on Lantus. Have I made the wrong choice (no offense to other Levemir users) even though he is responding well to Levemir? I must admit that I do often second guess myself when it comes to my kitties’ health.

So I have some questions:

1. I hope it is ok to ask this question. Between Lantus and Levemir, why are there so many more Lantus users than Levemir users on this board?
2. I know there are some minor differences between Lantus and Levemir (Lantus is acidic based so it may sting a little, and it has 28 day of guarantee shelf life at room temperature vs. 42 days for Levemir) but other than that, can I assume that Lantus and Levemir are so similar that the studies and papers by Rand are also applicable to Levemir?
3. I am wondering about the remission rate for sugar kitties on Levemir compared to kitties on Lantus. Does this board have some info or statistics on Levemir and Lantus remission rates among our FDMB members?

 

[Blue]

I can't really answer your questions, but I can say that both of my cats have acromegaly so remission is not in the picture for us.

As far as the differences between Lantus and Levemir, it could be that Levemir was not used much when past studies were done. I can say that one of my cats, Shadoe, reacts MUCH better to Levemir than Lantus - she is very tense and uncomfortable when on Lantus, she she immediately changes to a more relaxed cat when on Levemir.

 

[squeem3]

Between Lantus and Levemir, why are there so many more Lantus users than Levemir users on this board?

I think it's because few vets know about Levemir and are reluctant to prescribe an insulin they know nothing about. Lantus is quite well known because of the Rand study.

2. I know there are some minor differences between Lantus and Levemir (Lantus is acidic based so it may sting a little, and it has 28 day of guarantee shelf life at room temperature vs. 42 days for Levemir) but other than that, can I assume that Lantus and Levemir are so similar that the studies and papers by Rand are also applicable to Levemir?

I think you can. I followed the Rand protocol when my diabetic switched from Lantus to Levemir. For my weird cat, I didn't see any difference between the two insulins.

3. I am wondering about the remission rate for sugar kitties on Levemir compared to kitties on Lantus. Does this board have some info or statistics on Levemir and Lantus remission rates among our FDMB members?

There is a list of OTJ Lantus/Lev cats but it doesn't say which insulin the cat was on before going OTJ. I think knowing which insulin would be helpful. I can inquire if the list can add the insulin used but it might take awhile for the bean to get around to doing it.

 

[KSAkitties]

3. I am wondering about the remission rate for sugar kitties on Levemir compared to kitties on Lantus. Does this board have some info or statistics on Levemir and Lantus remission rates among our FDMB members?

There is a list of OTJ Lantus/Lev cats but it doesn't say which insulin the cat was on before going OTJ. I think knowing which insulin would be helpful. I can inquire if the list can add the insulin used but it might take awhile for the bean to get around to doing it.

Thank you very much.

 

[Lana & Yoyo]

The FDA approved Lantus for the American market in the year 2000. The FDA approved Levemir for the American market in the year 2005.

I have a paper titled, Management of Feline Diabetes Mellitus: Part 1. Which Insulin Do I Choose & How Do I Adjust the Dose? that was presented by Jacquie Rand to the AVCIM (American College of Veterinary Internal Medicine) in 2009. She does not note any differences between Lantus (Glargine) and Levemir(Detemer).

If you do not already have a copy of this, I can send it to you. I don't know how to attach the paper to an FDMB post, but I can send it to you if you email Lana dot H dot Nelson at gmail dot com.

Lana

 

[KSAkitties]

The FDA approved Lantus for the American market in the year 2000. The FDA approved Levemir for the American market in the year 2005.

I have a paper titled, Management of Feline Diabetes Mellitus: Part 1. Which Insulin Do I Choose & How Do I Adjust the Dose? that was presented by Jacquie Rand to the AVCIM (American College of Veterinary Internal Medicine) in 2009. She does not note any differences between Lantus (Glargine) and Levemir(Detemer).

If you do not already have a copy of this, I can send it to you. I don't know how to attach the paper to an FDMB post, but I can send it to you if you email Lana dot H dot Nelson at gmail dot com.

Lana

Thanks, Lana. Just emailed you.

 

[Vicky & Gandalf (GA) & Murrlin]

There have been studies done with Levemir, specifically at the University of IL. I don't know if there are any in Europe, but since the first user of Levemir in a cat was Steve's Jock and they were in Europe at the time, I assume it has been studied there. Steve has some great info in the Pet Diabetes Wiki on Levemir.

The first known USA study is presented in an abstract here http://images3.wikia.nocookie.net/petdiabetes/images/9/91/08Abstracts_OralPres.pdf
Abstract #96 (just hit Control F and enter Levemir)
Particularly interesting in this abstract is the conclusion:
"In young healthy cats, Lantus may have a more rapid onset than
Levemir, but the peak effect of Levemir is somewhat more predict-
able. The duration of Levemir may be greater in some cats. Investi-
gation of the clinical use of Levemir in diabetic cats is warranted."

That was 2008. So clinically, there was virtually no info on Levemir in cats in the USA until 2008. And as you can see it's very brief.

Also from the U of I was a dissertation done on the uses of Lantus and Levemir in cats https://www.ideals.illinois.edu/bitstream/handle/2142/16049/1_Gilor_Chen.pdf?sequence=3
The detail in this is remarkable and mostly shows Levemir to be longer acting than Lantus.

My conclusion, don't be concerned about the lack of clinical study on Levemir. That only affects the fact that vets aren't as willing to prescribe Levemir as they are Lantus. The proof is in the pudding, so to speak. And the proof is on this board! I don't know that we have statistics on how many cats have gone OTJ on Lev as compared to Lantus - by virtue of so many cats using Lantus, those statistics would be somewhat skewed in Lantus' favor anyway. The more experience on Lantus, the better users are able to achieve OTJ, for example.

It's 6 of 1/half dozen of another really. Why second guess yourself?

One aspect I have not seen mentioned much any more on the board is that Levemir may work better for cats who had been long-term diabetics, especially if they were on a fast acting insulin such as Vetsulin. Sheila's Beau is the perfect example for that argument. He was on Vetsulin for 2 years, started Levemir and because of Sheila's diligence was OTJ in 3 months on Levemir! Would the same thing have happened on Lantus? Probably, but the accepted view was if you had a newly diagnosed kitty either Lantus or Levemir had a great chance of getting them OTJ, whereas Levemir might give a slightly better advantage for the longer term diabetic perhaps because of the longer duration.

From my own experience - although Gandalf is nearing the end of his journey he will be 4 years on Levemir as of Sept. 26th. Levemir gave me 4 more years with him, PZI was hard on him because it did not have the duration he needed. His pancreas was burnt out from the use of steroids over 7 years, I never expected him to go OTJ, but I always had hope. My hope was answered by Levemir, because although he didn't go OTJ, he's been able to live over 6 1/2 years as a diabetic. Other disease processes are going to be his undoing, not diabetes. And I believe I have Levemir to thank for that.

OTJ should not be the goal - a healthy, happy diabetic should be the goal. Levemir will give your cat that life.

 

[KSAkitties]

From my own experience - although Gandalf is nearing the end of his journey he will be 4 years on Levemir as of Sept. 26th. Levemir gave me 4 more years with him, PZI was hard on him because it did not have the duration he needed. His pancreas was burnt out from the use of steroids over 7 years, I never expected him to go OTJ, but I always had hope. My hope was answered by Levemir, because although he didn't go OTJ, he's been able to live over 6 1/2 years as a diabetic. Other disease processes are going to be his undoing, not diabetes. And I believe I have Levemir to thank for that.

OTJ should not be the goal - a healthy, happy diabetic should be the goal. Levemir will give your cat that life.

Vicky,

Thank you very much for the links and info on Levemir. I never had the luxury of time before but now I do (one good thing about being in Saudi Arabia) so I want to learn and read as much as I can about insulin options and feline diabetes.

Since Major is a relative healthy (touch wood), very happy and currently regulated (touch wood, again) sugar kitty, I must admit that OTJ is my goal. And I know I may only have a small window of opportunity to achieve that. Whether or not I can get Major OTJ again, I want to give it my best shot.

 

[Larry and Kitties]

I find no real difference between the two. I started my untreated adopted, Tonis, on Lantus sinc y other four were using Lantus. I got up to 4 or 5 units BID of Lantus with little improvement with even some Hl. I then changed to Levemir with similar results. However, Tonis is doing good on about 7 units BID of Levemir. I suspect Tonis would have done similar on Lantus.

 

[KSAkitties]

I find no real difference between the two. I started my untreated adopted, Tonis, on Lantus sinc y other four were using Lantus. I got up to 4 or 5 units BID of Lantus with little improvement with even some Hl. I then changed to Levemir with similar results. However, Tonis is doing good on about 7 units BID of Levemir. I suspect Tonis would have done similar on Lantus.

Thanks, Larry. I don't know how you manage to look after five sugar babies. Every now and then I have to take a deep breath and remind myself to stay calm when dealing with Major's BG testings and injections. I am only taking care of one sugar kitty.

 

[julie & punkin (ga)]

i would agree with all the answers you've gotten. i think lantus is known better just because it's been around longer. there are people who start on one and switch to the other if they can't get their cat well regulated.

you've made a good choice - if you find that you can't get Major regulated on the levemir, don't hesitate to switch to lantus.

you do have to learn some different things about each of them, but people here will teach you. ask away!