Switch from Lantus to Levemir

Peeps Dad

Peeps Dad

Member Since 2021
I am seriously considering a switch from Lantus to Levemir. My vet will support the switch but said he knows nothing about Levemir. Actually he was surprised that I check Peep's BG at all. Peep's clinical signs have been terrible. He is very weak. Walks a few steps and lays down. This is how he was diagnosed last year and its back. His BG's are all over the board. One day he will appear regulated and the next he will spike over 300 and then the next he will stall at 80 for 6 hours without giving him his shot.

I've searched this forum and have not seen anyone say that they regretted the switch from Lantus to Levemir. It was said that the BG's were more flat and longer lasting over Lantus.

Peep's dose varies from 4.25 to 5 units. He started out on 1u June of 21 and did well on it. His body is changing, he is getting weaker and is requiring higher and higher doses. He is my buddy and I don't want to give up on him. Any help is appreciated.

More info here: http://www.diabeticcatinternational.com/knowledge/insulin-information-scales/

Looking to see who has made the switch and what you saw? How long do you wait from the last Lantus injection to the first Levemir injection?
 
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I have a couple of thoughts.

First, I don't trust the carbohydrate/nutritional information for the Meat Mates food. When I plugged the numbers into a carb calculator, it didn't make sense. You may want to contact the manufacturer and see if you can get the "as fed" values. While the ingredients look OK, it's not a brand I'm overly familiar with and like I said, the numbers don't calculate out which may simply be a matter of what's on their website are the guaranteed analysis numbers.

Have you taken a look at the information on dosing for Lantus and Levemir that's on that section of the board? How we approach dosing with a long-acting insulin is different than what you've been doing. I suspect this may be at least one reason you're not getting the results you're looking for with Lantus and the results would be much the same with Levemir other than the nadir being later in the cycle. With a long-acting insulin, changing doses with less than 6 cycles between those dose changes can result in wonky numbers. Lantus and Lev are "depot" insulins -- a small amount of every dose is stored and slowly released over the course of the cycle and into the next cycle. This gives the insulin it's long duration and overlap between cycles. If you make a change in dose from one cycle to the next, it has an effect on the depot since the dose doesn't have a chance to stabilize.

It may also help to keep in mind that insulin dosing varies. A dose that was good 2 weeks ago, may be too much or too little this week. Insulin is a hormone and it's dosing is influenced by a number of metabolic factors. It doesn't act like an antibiotic where there is a much narrower effective range. Insulin dosing isn't a "set it and forget it" approach.

One other factor is that you will really need to get at least one test during the PM cycle. Many cats experience lower numbers at night. Without any PM tests, you could easily be missing low numbers that warrant a dose reduction and without any PM tests, you're missing half of your data. We strongly encourage at minimum, a test before you go to bed every night.

Levemir is a good insulin for cats. The biggest difference between Lantus and Lev is that its onset and nadir are later than with Lantus. If a cat's nadir is at +6 with Lantus, nadir with Lev could be a couple of hours later. This may be a consideration for your schedule. I stuck with Lantus because of the timing of the cycle and my cat's time of onset and nadir. Other than the timing, Lantus and Lev act in a very similar way. All of the dosing information (what I linked) is the same. In making a switch, you will want to reduce your dose by 30% to account for any action from the depot.

Just a word of caution.... The DCI board was founded by a vet, Elizabeth Hodgkins, who took the research regarding Tight Regulation which was developed by Roomp & Rand (2009) for Lantus and Levemir and applied it to cats that were prescribed PZI (now Prozinc). They are very different pharmacologically. In addition, Hodgkins took the position that NO high carbohydrates were to be used with a diabetic cat. While on the surface, this makes sense. However, it's dangerous if your cat is in very low numbers (e.g., like the 42 you saw on 3/2). The people who developed the DCI board are quite adamant about these issues and they note that their board is not affiliated with Dr. Hodgekins. Cat's have died following the instructions on their board. Needless to say, I'm not a fan.

Please let us know how we can help.
 
Thanks for the response. Peep's clinical signs are terrible. He can barely walk now and it's heartbreaking. I don't know what to do for him. He is still eating great and drinking but having accidents outside of the litter box because he struggles to get in and out. This is not new but much worse in the last few days. I can take him off of the Meat Mates but the stall yesterday was on this food. I have been feeding him this for about 5 days now. Oddly, he seemed much better clinically on the FF fish flavors but it gave him bad diarrhea. I'll take any help at this point. If I hold the dose at 4u which I was hoping to do then he has a day like yesterday where his BG never came up what do I do?
 
Sienne highlighted a lot of the things that came to my mind so I'll just add a couple of comments, having made the switch from Lantus to Levemir a few years ago.

I found that I had to relearn Maverick's patterns and it felt like I was new all over again :). As Sienne noted, you often get later onsets and nadirs with Levemir. As a matter of fact, with Levemir you may often find that the preshot is the lowest in the cycle, so you may need to get more comfortable with shooting (I see that you've skipped a lot with Lantus). In those cases, it is helpful to remember that while you may be shooting a lower number, onset is likely 4-5 hours from then, which means with food and time the last dose duration will have waned. But it does take some getting used to. In fact, I've even had some cycles where Maverick actually nadirs at +13 or +14.

I also second the suggestion for those night time tests, and getting into the habit of a before bed test. It really is important to get those night time tests in, since at the moment you really only have half the picture. I have had instances back on Lantus where Maverick was actually dropping at night, then bouncing during the day. Had I not gotten those night time tests in, I would have presumed that he would need an increase in dose, where he actually earned a reduction. Perhaps if you give that a try for a couple of weeks, you may find if you do that you're assessment of whether Lantus is actually working for Peep may change.

The only other thought I had is whether you've had a senior health panel done for Peep lately. I think for his age, there may be some other reasons or explanations for his weakness that may have nothing to do with diabetes. A couple of things that come to mind are low potassium and anemia, so if you haven't had blood tests done within 6 months or so, that would be something I would recommend at least to rule out any other possible causes for his weakness. Arthritis is also quite common when kitties get to be older, so there may be some things your vet might suggest in terms of pain management.
 
I would like to add about the arthritis possibility. I also have a maine coon. They are quite large not just weight but bones joints etc. They tend to develop arthritis maybe sooner than we think they should for age. Your Peep has 3 years on my LM and my guy already gets stiff if he sleeps a long period of time.

You've gotten a lot of information which can be overwhelming so here is a hug:bighug:. One step at a time. Make appt with vet for full on check up and get some nighttime tests.

I did look at your ss and noticed just recently you gave insulin at +10 after a skip instead of just waiting till pmps. I would suggest not doing that. It's normal for bg to start to rise in second half of cycle. :)
 
He had a panel done late December and the vet said it was not bad. I can share it but note sure how to post it. I just did a +5 on him and it barley changed from this morning. Yesterday he was cruising. :banghead::(
 
Peeps Dad said:
Peep's clinical signs are terrible. He can barely walk now and it's heartbreaking. I don't know what to do for him. He is still eating great and drinking but having accidents outside of the litter box because he struggles to get in and out. This is not new but much worse in the last few days. I can take him off of the Meat Mates but the stall yesterday was on this food. I have been feeding him this for about 5 days now. Oddly, he seemed much better clinically on the FF fish flavors but it gave him bad diarrhea. I'll take any help at this point. If I hold the dose at 4u which I was hoping to do then he has a day like yesterday where his BG never came up what do I do?
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Please read the information on dosing that Sienne linked to in her response above.

In the interest of getting Peeps stabilized and on the right track, if the food is agreeing with him continue with that food while you research the true carbs percentage before making any further dietary changes

With food stabilized and for the time being not a variable, focus on finding a dose you can safely shoot, consistently, every 12 hours, with the goal of stringing together 6-10 consecutive cycles at the same dose.
However if at any time you catch a number under 50 that is a signal to reduce by .25u at the very next shot. Then you carry on with the reduced dose for another 6-10 consecutive cycles and re-evaluate.
Make sure and always get a PS test before shooting (I'm seeing a shot with no ps number on 03/05/pm)

Get some random spot checks in during the PM cycles. You need the whole picture in order to make the best dose decisions. Set an alarm if needed. you don't have to stay up all night every night. A before bed check and perhaps one more at a random time for example a PM+4 one night, a PM+9 another night, a PM+5 on yet another night etc. The results are likely to be eye opening.

If you are going to go with 4u please monitor as closely as you can, based on the 42 on 3/2/AM+3 be on the lookout for any numbers under 50. Resist the temptation to increase based on a PS value, no matter what.

Post daily following the posting guidelines

Lastly, hang in there and hang in here. Its the very best place to learn how to care for your diabetic cat.:cool:
 
Peeps Dad said:
He had a panel done late December and the vet said it was not bad. I can share it but note sure how to post it. I just did a +5 on him and it barley changed from this morning. Yesterday he was cruising. :banghead::(
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Definitely put the results in the lab tab of your ss. A vet that says it's not bad doesnt mean there could be some flags for why he is feeling so sluggish even if just small changes.

I would start with night time tests minimal a +2 and then a before bed for sure...check out others ss on this board to and just get a feel for how others test and when. Give Peeps some loving he is more than his numbers and tbh his numbers arent that bad overall...
 
Just a thought but have you had him checked for pancreatitis? When Taz has a flare up, one of his first signs (besides elevated glucose) is only taking a few steps, then laying down. When he lays down, he does so slowly and carefully, tucking his legs in under him into a meatloaf position. Or he'll stretch his hind legs way back when in a sitting position, to relieve pressure on his stomach. You can also see in his eyes and ears that he doesn't feel well, and his tail will get really fidgety. I could tell that my vet thought I was over reacting and saying it was a flare up, because Taz shows no discomfort at all when being examined. He'll be full on pancreatitis, and still be alert and acting like he's fine at the vet's. My vet did the pancreas blood test last weekend to see if his behavior is due to his pancreas, and it came back positive.
 
I posted lab results to the tab. These are what I have. @SaraMV he does exactly what you described when laying down. Very slow and cautious. Walks a few steps and lays down. It's worse now thought as he is stumbling and acting drunk. He did this last year and it's how we found out he was diabetic. He has a history of pancreatitis but as I understand there is no cure, only manage the symptoms. How do you manage the flare ups? The vet did say that he thought this was an issue but did not offer anything. It has been frustrating to find a vet the cares honestly. I feel like I have to tell them what to do.

I will continue the same food. He has a great appetite and will eat anything but has a sensitive stomach and battles loose stools. It is the reason I stopped the FF fish. Did that and the loose stools were gone. He gets tired of a flavor quickly though so it's a challenge there.
 
I still want to know what to do in the case of 3/5. If I would have given him his 4u AM, he would have tanked no? He was 107 AMPS, +3:81, +5:81, +8:117. This is not normal and never saw this happen. I will take the great advise and not panic and hold him at a dose for 6 cycles, but what if a cycle like 3/5 happens.
 
Peeps Dad said:
I posted lab results to the tab. These are what I have. @SaraMV he does exactly what you described when laying down. Very slow and cautious. Walks a few steps and lays down. It's worse now thought as he is stumbling and acting drunk. He did this last year and it's how we found out he was diabetic. He has a history of pancreatitis but as I understand there is no cure, only manage the symptoms. How do you manage the flare ups? The vet did say that he thought this was an issue but did not offer anything. It has been frustrating to find a vet the cares honestly. I feel like I have to tell them what to do.

I will continue the same food. He has a great appetite and will eat anything but has a sensitive stomach and battles loose stools. It is the reason I stopped the FF fish. Did that and the loose stools were gone. He gets tired of a flavor quickly though so it's a challenge there.
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Taz occasionally loses interest in a flavor, but I think it has to do with him associating the flavor with his not feeling well.

I'm sorry your guy is feeling so bad. Taz's appetite is the last sign of him not feeling well. He'll eat clear up until he doesn't anymore. I do notice that as his pancreas starts bothering him more, he increases his water consumption. I'm not really sure why, but I associated it with the increase in glucose.

When I start noticing the signs, I immediately give him pain medication (Bupe seems to work well for him) and cerenia. If his appetite also starts to change, I start him on syringe feeding. The extra fluids in the blended food is good for the pancreas. I.V. fluids are better but my vet doesn't feel like Taz needs that kind of support. You definately want to keep them hydrated to help the pancreas. From there, I pray. His first episode of pancreatitis had him hospitalized at the beginning of January, for 4 days. I try to catch his off behavior quickly, and give him relief before it gets that bad again.
 
Peeps Dad said:
I still want to know what to do in the case of 3/5. If I would have given him his 4u AM, he would have tanked no? He was 107 AMPS, +3:81, +5:81, +8:117. This is not normal and never saw this happen. I will take the great advise and not panic and hold him at a dose for 6 cycles, but what if a cycle like 3/5 happens.
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It is possible he may have dropped low...that's when testing and medium and high carb food become tools to use.

Check out my ss. LM hovered in the 50s for quite awhile yesterday. I used mc food and testing to keep him surfing above 50. It is possible that the dose Peep is on is too much and he needs a reduction. But you need to test and see where and what his nadir is so you know if it's taking him too low or not.

Those numbers with a skip shot were probably his depot keeping him in normal numbers and not getting too high
 
How would a higher fat food affect his numbers? H&G is a higher fat (8.5%) food then what we have been feeding.
 
Going to try to get a blood panel done Monday. Are there any specific tests I should ask for?
 
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Peeps Dad said:
Going to try to get a blood panel done Monday. Are there any specific tests I should ask for?
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Sorry, didn't see the edit. I would ask for a senior blood panel and urinalysis, that should give you some good info. The senior blood panel should include measure of thyroid (T4) and the SDMA which will give you an indication of early kidney issues. I'd sure like to see that phosphorus go down.
 
Christie & Maverick said:
Sorry, didn't see the edit. I would ask for a senior blood panel and urinalysis, that should give you some good info. The senior blood panel should include measure of thyroid (T4) and the SDMA which will give you an indication of early kidney issues. I'd sure like to see that phosphorus go down.
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He did have an SDMA done in December and it was a little high at 19 so there probably is some kidney disease. Is there a good low carb, low phosphorous food?
 
Peeps Dad said:
He did have an SDMA done in December and it was a little high at 19 so there probably is some kidney disease. Is there a good low carb, low phosphorous food?
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Here is a list of foods , I did a search on our forum and found these


Here is a list of some of the food
As far as the food goes
For kitties with kidney disease and diabetes



. First number is carb percentage, second is mgs of phosphorus/100 cals, all less than 10% carb and less than 250 mg phos:

Weruva Truluxe Steak Frites can 6% 118
Weruva Cats in the Kitchen La Isla Bonita can 3% 166
Weruva Cats in the Kitchen Pates Meowiss Bueller pouch 7% 174
Weruva Truluxe Glam 'N Punk can 0.6% 180
Weruva Cats in the Kitchen Fowl Ball can 4% 180
Weruva Classic Pates Jeopurrdy Licious pouch 4% 187
Weruva Classic Pates Family Food pouch 0% 191
Weruva Cats in the Kitchen Pates Cattyshack pouch 9% 211
BFF PLAY Tuna & Salmon Shhh... pouch 3% 223
BFF PLAY Tuna & Turkey Totes! pouch 2% 226
BFF PLAY Tuna & Chicken Chill Out pouch 2% 226
Weruva Cats in the Kitchen Pates Cat to the Future pouch 8% 235
Weruva Cats in the Kitchen Pates The Breakfast Cat pouch 9.7% 235
Weruva Classic Pates Meal of Fortune pouch 8% 236
Weruva Cats in the Kitchen Lamburgini can 8% 236
Weruva Cats in the Kitchen Double Dip can 8% 248

YOU WANT CARBS UNDER 10% AND PHOSPHORUS IDEALLY LOW 200's OR LESS


Also go to the Weruva site
You want the metabolizable energy profile percentage of carbs to be less than 10%, and the phosphorus which Weruva lists in Minerals to be less than 250 mg per 100 cals. So you have to look at two different places in the Weruva charts
WCC_PATES_NUTRITION_V1R8-pdf.jpg
 
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https://weruva.com
You can look at all the cat foods here other than the pates,
When you click on each can of cat food click in
Detailed Nutrition Information that's in the left hand side
And it will give you all the information like I posted above
 
One other thought is if your kitty is experiencing diabetic neuropathy. Adding a form of B12, methylcobalamin, can help enormously. It takes a couple of months to work and it works best if blood glucose numbers are in a reasonable range. You can purchase Zobaline from Amazon -- it's formulated specifically for diabetic cats.
 
You guys are amazing. Thanks for the help. He is a bit better this morning. Not as unstable. BG was 243.
 
Diane Tyler's Mom said:
https://weruva.com
You can look at all the cat foods here other than the pates,
When you click on each can of cat food click in
Detailed Nutrition Information that's in the left hand side
And it will give you all the information like I posted above
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All of their foods seem to have xanthan gum and guar gum. I was told a while ago by a holistic vet to stay away from those. I guess we have to pick our battles.
 
Peeps Dad said:
All of their foods seem to have xanthan gum and guar gum. I was told a while ago by a holistic vet to stay away from those. I guess we have to pick our battles.
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Hi The only thing I can tell you is that most members feed weruva whose cats have kidney problems and have no problem with them.
I see you aren't following one of the dosing methods for lantus
https://www.felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/
Post daily following the posting guidelines
 
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Peep is having another episode where it looks like he is going to stall tonight. I need help. I picked a dose of 4.5 and planned to stick with it but here I am again with the same issue I had 3/5. Don't know what to do.
 
Peeps Dad said:
Peep is having another episode where it looks like he is going to stall tonight. I need help. I picked a dose of 4.5 and planned to stick with it but here I am again with the same issue I had 3/5. Don't know what to do.
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Can you stay up and test? Donyou have mc and hc food and karo or honey if needed? (Not likely) donyou have plenty of testing supplies?

If answer is yes to all questions I say shoot the 105.
 
Rainbow Conti said:
Can you stay up and test? Donyou have mc and hc food and karo or honey if needed? (Not likely) donyou have plenty of testing supplies?

If answer is yes to all questions I say shoot the 105.
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I have some Hills A/D 13.3% carbs dry matter basis. Plenty of testing supplies, karo and honey. I guess my concern is the same as 3/5. I don't know that he has hit his nadir yet. I tested PMPS at 7 and will test again at 8.
 
Peeps Dad said:
I have some Hills A/D 13.3% carbs dry matter basis. Plenty of testing supplies, karo and honey. I guess my concern is the same as 3/5. I don't know that he has hit his nadir yet. I tested PMPS at 7 and will test again at 8.
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So keep in mind that whatever he is at time of preshot wont be same when insulin onsets because he will have eaten. Lantus typically (and I've not seen it on this board personally) doesnt nadir past the 12 hour mark. Levemir I've heard can but not lantus
 
Unfortunately by moving his shot time around so much you could be messing with his depot which is what will give you more wonky numbers...if you've delayed it an hour tonight you would logically have to delay ay least 45 mins tomorrow morning...if you dont it's can act like a dose increase. By delaying it can act as a dose decrease
 
Rainbow Conti said:
Unfortunately by moving his shot time around so much you could be messing with his depot which is what will give you more wonky numbers...if you've delayed it an hour tonight you would logically have to delay ay least 45 mins tomorrow morning...if you dont it's can act like a dose increase. By delaying it can act as a dose decrease
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Just tested at 8p. 93 so he is still dropping at +13
 
I will say and maybe other members can chime in if I'm wrong but if you do decide to skip feed him but dont give insulin at all until AMPS tomorrow morning.
 
He's been eating like a pig. He always does lol. His clinical signs are great tonight as well. Very calm and snuggly. I am inclined to skip and deal with it in the morning but I'll wait for replies. I know I've been doing it all wrong and wanted to set a dose and stick with it. Best laid plans...
 
Depot is rather messed up at this point - I don't have time to catch up on all history, but I suspect (hope) it's been mentioned that you really need to stick to a consistent dose for a few days at a time.

Have you fed him at all in the last 3 hours?

If yes - wait for my next.reply.

If no -

93 is within meter variance, and when you stall so long without food they can naturally drop.

If you can monitor and be off schedule, I would shoot 4U and stick to it unless he earns a reduction. Take whatever Elise advises over my advice though
 
FrostD said:
Depot is rather messed up at this point - I don't have time to catch up on all history, but I suspect (hope) it's been mentioned that you really need to stick to a consistent dose for a few days at a time.

Have you fed him at all in the last 3 hours?

If yes - wait for my next.reply.

If no -

93 is within meter variance, and when you stall so long without food they can naturally drop.

If you can monitor and be off schedule, I would shoot 4U and stick to it unless he earns a reduction. Take whatever Elise advises over my advice though
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Yes, he's eaten multiple times in the past 3 hours. It does not seem to affect the number.
 
tiffmaxee said:
Would it be possible to get you to follow one of our dosing methods? Have you read them?
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Yes, like I said, I know I've been doing it all wrong and wanted to start today with a set dose. Then this happens and I don't know what to do. Maybe call it a night and start with a lower dose in the morning, hold it for 6 cycles and see what it does? His baseline dose according to his weight would be around 2.5units. Should I basically start from scratch?
 
The bg is food influenced. He would likely be lower if he had not eaten. I would skip tonight and give 3.5 in the morning and hold that dose for three days. The day you gave 3.9 he went down to 42. You skipped and then gave 5 units. That is way too much.
 
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