Switching from Prozinc--Lantus or Levemir?

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beclt

beclt

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Hi all,

We aren't happy with the results we've gotten (or haven't gotten) on ProZinc. We'd like to move to either Lantus or Levemir, but I am not sure of the pro/cons or preferences. Has anyone recently switched to either and see results?
 
The dosing protocol for Lantus and Lev are the same since they are both long-acting, depot types of insulin. The biggest difference between the two is that the nadir for Lev is later in the cycle. Where you typically see a Lantus nadir somewhere around 6 hours (give or take an hour or two) after you give a shot, with Lev, the nadir is around +8 (give or take an hour or two).

In terms of the technical difference between the two, this link explaining the differences may be helpful.
 
What I liked about ProZinc was the ability to shoot what I saw. What I didn't like was the steep daily curve and high preshot levels.

What I like about Lantus is the daily curve is flatter. What I don't like is having to wait 3-7 days to figure out if a dose increase or decrease is definitely needed. The doses are measured accurately to half units; anything else is your best estimate. You cannot dilute Lantus.

I haven't used Levemir. It also builds up over time. A recent post in that forum suggested the doses were often very small - if you have vision issues, that could be tough to measure.
 
BJM said:
I haven't used Levemir. It also builds up over time. A recent post in that forum suggested the doses were often very small - if you have vision issues, that could be tough to measure.
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I don't know that Levemir "often" has smaller doses than other insulins, since any insulin should be started at no more than 1U and some cats do well on less than 2U of either Lantus or Levemir. Levemir may need finer dose adjustments for some cats, such as .1U increments rather than .25U or .5U, especially if the cat is getting less than 1.5U, but until making that determination, Levemir can be adjusted in .25U increments, just like Lantus. It's when you run in to the scenario that 1.5U seems too much, but 1.25U seems too little that finer dose adjustments may need considered. That may well be true with Lantus as well for some cats though.

Keep in mind that Every Cat Is Different when it comes to insulin dosing. Start low and go slow applies to the longer acting insulins, so they do take patience to work most effectively but the rewards are worth it.

Here are my recommended sites for learning about Levemir:

http://www.felinediabetes.com/phorum5/read.php?15,1778958
You will read in the above link that the median dose for Levemir was found to be somewhat lower than Lantus. Although I don't consider 18 cats to be a very large study, there may then be some credence to those of us on the Levemir ISG seeing our cats do well on less than 1.5U and our general approach that small dose increases work better.

Dissertation comparing Lantus and Levemir use in cats:
https://www.ideals.illinois.edu/bitstream/handle/2142/16049/1_Gilor_Chen.pdf?sequence=3

If you are considering Levemir (ISG sticky):
http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=681

Jock's Levemir Journey (Pet Diabetes Wiki case study, Jock was the first cat known to use Levemir):
http://petdiabetes.wikia.com/wiki/Case:Jock
 
I had to make this same decision about a month ago. Lantus and Levemir, seem to have an equitable pros/cons list. That in mind, the deciding factor between the two was price. While Levemir is about 10% or so more than Lantus, it last 50% longer (42 days as opposed to 28), and thus is cheaper in the long run. Of course, this will mean nothing if your cat doesn't respond well to it (Andy's BG has stabilized nicely) but as a starting point I went with the more frugal Levemir.
 
Andy and Cale said:
I had to make this same decision about a month ago. Lantus and Levemir, seem to have an equitable pros/cons list. That in mind, the deciding factor between the two was price. While Levemir is about 10% or so more than Lantus, it last 50% longer (42 days as opposed to 28), and thus is cheaper in the long run. Of course, this will mean nothing if your cat doesn't respond well to it (Andy's BG has stabilized nicely) but as a starting point I went with the more frugal Levemir.
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If kept in the fridge, open Levemir pens will last until the insulin is gone. Possibly more than 3 months, depending on how much is used for each dose. I never had a pen "go bad," every time I thought "it must be the insulin," and I started a new pen, the results were the same, until I tweaked the dose.

Lantus also lasts longer than 28 days - those efficacy recommendations regard the insulin's use for humans - the whole idea of the pens is that they are portable and can be kept at room temperature. Also, human doses are so much higher, the insulin is used up much quicker.

Refrigerate, refrigerate, refrigerate!
 
some people have reported using lantus for up to 6 months. the important thing with it is to take care of it. here is the sticky on Care of Lantus/Levemir, including a video that punkin & I did on it. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=151

i don't have experience with Levemir, but lots of people on the Lantus Tight Reg forum use it and it seems to need much the same care and dosing as Lantus. not sure there's a significant difference. i use the Lantus on Punkin and really like it.
 
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