switching Lantus to Levemir

[koolkat66]

Hi everybody. I have a 16 (nearly 17) year old diabetic (6+) , always well regulated on 0.5 U Lantus twice daily, now has developed peripheral neuropathy, which we (vet and I) initially mistook for arthritis.
I use to test regularly but hadn't done it for quite a while, as she was always so well regulated and hates having her ear pricked, so it was a bad surprise when 4 days ago the vet found out her blood sugar was 522 mg (29)! I increased the dose of Lantus to 1 and 1.5 U but to no effect. She stays very high, and I am wandering whether the vial is off (always in the fridge and newly opened), or has she became resistant to Lantus or is she simply to skinny to assimilate it (she has gone down to 2.2 K). I am considering switching to a brand new vial of levimir, and I would like to know is there is anything I should know about switching, or shall I just switch like for like?

Any advice appreciated.

Cristina

 

[Larry and Kitties]

- I would just change. That is what I did when I changed Tonis to Levemir. I changed because he was getting little response from the Lantus. However, the Levemir was not really any better. He finally got good BGs when on about 8 units Levemir and 4 units N.
- After Tonis passed I changed Thunder to Levemir to use up the Levemir. I found he need less Leve ir than Lantus. However, at the same time he has dental and had many bad teeth extracted.

 

[Vicky & Gandalf (GA) & Murrlin]

Hi Christina,

Has your kitty been on Lantus for 6 years? That's a very good track record, but without testing it's difficult to know truly how well regulated kitty was on .5U.

Did the vet run any diagnostic tests to look for an infection? Infections, even poor dental hygiene, can cause high BGs. The weight loss is probably also a sign of the poor regulation.

Have you changed her diet at all? What food does she eat?

It would probably be best to have further diagnostics done before switching insulins. Something like infection is not going to be helped by changing insulins.

 

[Sheila & Beau GA & Jeddie GA]

I agree with Vicky that there are things that would help you with her regulation, such as more testing and checking for infections. Has she been tested for hyperthyroid? And with numbers that high you should probably test for ketones daily or at least every other day until she gets some numbers below renal threshold (about 180-220 or 10-12).

For testing, my experience (only two cats!) is that making it a routine that is rewarded with treats gets them to where they accept it pretty well. Jeddie still sometimes complained, but sat through it. He started off as a fighter though and I got bit pretty badly in the first few days. I had to "burrito" him in a blanket for several weeks - and show him I was not going to back down. Ever. Beau, on the other hand, purred through the whole process every time after getting up on the table to be tested while I got everything ready. It's the pieces of boiled chicken that do it.

It would be good to have tests in the middle of the cycle so you know how low she is going. Dose should not be changed without those mid-cycle (nadir) numbers. Again, my experience, but numbers in the 500s are either from high carb food or rebound so you want to make sure her diet is low carb and then get those mid cycle numbers over several days/weeks to see if she is high and flat with sudden dips to low numbers (which is probably rebound from too much insulin) or just staying high with a little drop lower numbers (which is probably not enough insulin).

Lev is a great insulin and many who are switching from lantus to lev lately are finding that their cats "like" it better - meaning they have better moods and more even numbers. If you have the lev already, I would go ahead and switch, but all the other things need to be addressed as well or you may not see improvement. And you want to be testing to see how she is doing on the new insulin. I always tested before every shot. There were too many times when there would suddenly be a low preshot number, like 5-8 that warranted a wait and retest or slight dose reduction.

ETA: I see that she had a symptomatic hypo about a year ago. It is possible that her high numbers are because she is getting too much insulin - and has been for a long time, but you will only know with more testing, I'm afraid.

I saw on that thread that you said you would have trouble giving less than .5u because even that amount was barely visible in the syringe. What syringes are you using? You want to get u100 insulin syringes, 3/10cc with half unit markings. With those you can pretty easily get .25u and with some practice, you can dose in .1u increments (actually, even in .05u increments). For more info on that, go to the Lev 101 info and look for the "drop method" instructions and photos here: http://www.felinediabetes.com/FDMB/viewtopic.php?f=10&t=682
The links to those posts (instructions and photos) are between the two charts.