Starting Levemir tonight....any suggestions or comments?

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Donna & Doogle

Donna & Doogle

Member Since 2011
So decided to change Doogle over to Levemir since after 2 years on Lantus he seems to have plateaued and bounces so much on Lantus. So is there any advice or suggestions on the switch? We will be starting at 2u tonight. Hoping for a more even numbers.
 
Hi Donna! How exciting! many cats do great on Lev - i'll be curious to see how Doogle does too.

The typical starting dose when you switch from Lantus to Lev is to start at 70% of the current dose. For Doogle that would be 1.75u (2.5 x .7 = 1.75). I'd probably start there. Although I can't see on his ss why you reduced his dose from 2.75 to 2.5u on 9/28. If you're going by the 2.75, (x .7 = 1.9) that would sugest you start at 2.0u.

Other than that, you just give the Lantus with one shot and give the Lev with the next shot. You'll want to monitor like you already do (hey, nice job with all that data!) to see how low it takes him and when his nadir ends up typically being.

It should go smoothly. Good luck! fingers and toes crossed here for you!
 
Well we dropped to 2.5u because we were running low on his last Lantus pen and didnt want to run out before the pens got here (long story with a problem ordering and my bank). Plus we just finished some Orbax ear drops and could tell it was getting out of his system. I just felt safer dropping it some that night. Ok, I had read the 70% and I guess we will do that and hold it for several days. Does going up or down on the dose change from .25u like with Lantus?
 
Hey Donna!!!

Great to see you and Doogle!!! The protocol for levemir is exactly the same as lantus. However, when you are switching from one insulin to the next, you don't necessarily need to hold the dose as long as you would when you started lantus. We start 70% lower on the dose just because of the overlapping depots and the differences in the cycles. Some cats drop on that first dose after the switch. Some, like Gracie, decided she was going to need more levemir than lantus.

From the Tilly webpage:
Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours).
Click to expand...
The bold is mine.

Gracie was on .75u of lantus and I started the lev at 0.5u and she was high and flat so I raised it after two cycles; she was still high and flat so I gave her four more cycles and then waited the customary six. You can check out her Levemir 2011 SS to see how ugly the numbers were at the beginning. I am hoping you will not need to be that aggressive because it really was quite aggressive but we got her into green within less than a week but the dose had to go up to 1.25u. You are an experienced caregiver so you should be able to easily handle any curve balls he throws you but hopefully it will be a lovely and smooth transition and you won't see any low numbers or high and flat numbers.

Levemir has a very different onset and nadir and I find it to be even more variable from cat to cat. Onset can be +4 or later and nadir generally anywhere from +8 to +12 but Gracie and Neko will sometimes even nadir at +15. Levemir can also get second dips at the end of the cycle.

I think you will like it. We've been very happy with it even though Gracie still bounces but she doesn't bounce nearly as high as on lantus and she can get some really nice, flat, long duration curves.

Good luck and let us know if you need any help :-D
 
Thank you Marje for the info! We just gave him a shot so I will start a condo and try and keep it up (so hard to do with working now and cant get the DH to post, he hates the internet...lol). I may only post once a day with numbers but I will try and post.

Thank you everyone and I am hoping to see great things with the change.
 
Just stopping by to wish you good luck Donna!

I'll be watching to see how Doogle does with the Lev...I know you've really been looking forward to trying it, so I hope it does the trick for him!
 
If it wasn't completely obvious from Marje's post, other than getting Doogle switched over, the dosing protocol is exactly the same. You give a dose 3 days/6 cycles to stabilize and then raise by 0.25u. Reductions work the same, as well. If you've not noticed before, the TR protocol is titled to include both Lantus and Lev.

Good luck with the switch. It will be good to hear from you and Doogle on a regular basis for at least a bit!
 
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