How to safely change from Lantus to Levemir.

My cat Leo has been diabetic for over 2 years and the Vet recommended Lantus. Leo's BG was about 275 mg/dl. Even though his daily insulin has increased from 2+2 units up to today's 6+5 units it still fluctuates and remains similar to 2 yeas ago with fluctuations. Some days BG at 6 hours after his first shot can be as low as 6.4 and the next day it could be 15.4. I read that Lantus can create these type of fluctuations and that Levemir is much more stable for some cats. My problem is how to change over to Levemir in a safe manner. I would appreciate any help you can offer. Thank you.

 

I do think you start at a lower dose, but I’ll tag @Wendy&Neko for specific advice

 

Thank you for responding.
I was thinking of starting at 3+3 for 3 to 5 days then increasing slowly if needed.

 

It sounds like you are home testing. Are you testing before each shot? Will you consider using our spreadsheet to record the numbers? That will help us to better help you. Here are the instructions to set it up, but if you need help, we can do it for you! http://www.felinediabetes.com/FDMB/threads/fdmb-spreadsheet-instructions.130337/

 

My cat is super sensitive and does not like me pricking his ear so I have to be careful when and how often I check.
I check several times in a day but then would leave it for days before checking again.
Sometimes I will only check once in a day for several days then stop.
He is a stray that came to my back door in the winter starving and after several days of staying in my home and leaving the next morning he decided to stay and has done now for 51/2 years.
He will not go outside and freaks out if I open the back door when he is nearby.
He has had a lot of health issues and gets sick if we have people in the house at times.

 

It would be really helpful if you could complete the spreadsheet, even for the last couple of weeks of data you do have. We really like to see data before we give any suggestions on dosing. Having said that, some cats show a strong reaction to the switch between Lantus and Levemir, so we typically take the dose down to 70% of the Lantus dose. I might modify that if I can see your data. You will find that the onset and nadir are later with Levemir, sometimes the nadir can be at or near preshot times. We are very strong advocates of testing before each shot, to make sure it's safe to give insulin.

 

Okay thank you for your help. I will work on the spreadsheet and get back to you.

 

I have posted the spreadsheet, I hope. I am a little lost with Forums so I am not sure if I should be posting here.
i would appreciate any help you have to offer in regards to Leo's glucose levels and changing to Levemir. Thank you.

 

Spreadsheet looks good! Have you read the stickies in the Lantus/levemir forum? There is some great info in them. Here’s the link to that forum. http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
The stickies are in yellow at the top of the page. Can I ask why you are giving 6u in the AM and only 4 PM? What are you feeding Leo? You stated he has other health issues, is he on any other meds?

 

Great job getting the spreadsheet done. A question for you, I notice you are reporting some blood sugars with decimal points. If you are using the mmol/L for blood glucose, our World version of the spreadsheet will do the conversions for you.

A couple comments on the spreadsheet. First, since Lantus (and Levemir) are depot insulins, we find it's much better to give the same dose in the AM and the PM. But you have no data in the PM cycle, so we'd don't know what's happening then. The "fluctuations" you are seeing could be in part because of the different doses given AM and PM. A "before bed" test is always a good one to get, as many cats go lower then.

Since you are giving 10 units a day total, 70% of that would work out to a starting dose of 3.5 units in the AM and the PM as your starting dose of Levemir. This may or may not be too low, but is a safe place to start. Note that the nadir time in Levemir is typically later than in Lantus. We determine how to change the dose in Lantus and Levemir, based on those nadirs or how low the dose takes the cat.

 

Thank you for the information. I will check the link today. The vet had me increase slowly from 2+2 over 2 years up to 5+4. The glucose started to increase in April so I went up to 6+5 which seemed to work bringing the sugar down so I thought I would start decreasing slowly because my vet moved to the States recently and I don't have a new Vet as yet.

 

I was just multiplying the blood glucose reading by 18 to get those results but I will use your chart in the future if I can find it.
Leo likes to eat small frequent meals sometimes as late as 10pm.
I do leave any leftover food for him overnight. If he eats close to the morning the BG is a lot higher.
He eats about 5 ounces of wet food daily and 4 to 6 treats around his injections.
Until quite recently he was given only all protein food which was usually the best I could find such as Merrrick, Weruva and K9 from New Zealand but he would go off of these foods and recently the only food he would eat consistently is not the best. Purina Fancy Feast. I have a cupboard full of good food but he won't eat it.
Another problem is that he likes milk a lot and will want it for a few months and then stop for a long period.
He really wails for it in the early morning and I break down and give him mostly skim milk and water, about 2 ounces.

I will check his blood before I go to bed but how long after he consumes anything should I take it?

 

Fancy Feast is fine as long as it is the pate type and not the gravy lovers which is high carb. Be sure to have a few cans around along with honey or Karo syrup, in case Leo’s blood sugar ever goes too low.
You want to withhold food for 2 hours before you test Leo AM and PM then if the number is high enough to give a shot, you can feed and shoot. If the number is low, don’t feed and recheck in 20 minutes or so to see if it has gone up. He can nibble his food the rest of the day

 

It is the Fancy Feast pate and I always have maple syrup or honey available.

 

If you are anywhere other than the US, please click on this link for the World Spreadsheet Template for HUMAN METERS:
World Spreadsheet Template

You might want to see if you can get an auto-feeder like the PetSafe 5. It's programmable and you can set it to open to offer meals when you want him to have them and then you leave one slot empty. Set it to open to the empty slot at least 2 hours before testing/shooting times.

It may not all be food related though. The AM number is usually the last one to come down due to something called The Dawn Phenomenon

You might want to see if he likes goat milk...it contains less sugar (lactose)

 

The Petsafe 2 or 5 is not recommended for use with wet food by the manufacturer.
I did not know about the Dawn Phenomenon, thank you.
I have been thinking about using goats milk so I will buy some today and see what happens.

 

A large number of us here use the Petsafe 5. There is a small spot underneath the rotating disk where you can put a small freezer gel pack to help keep food cold. Or you could add an ice cube to the food, it'll melt and add water and keep food cold in the mean time. Extra water is always good for diabetics.

 

Thank you Wendy I will check it out. I add extra water to all his meals because he rarely drinks from the bowl. He is a strange boy but I love him.

 

I've only seen my Zoe drink maybe 5 times in the 10 years we've been together.

 

i have given Leo his first day of Levemir at 3+3. Even though the PM BG is 189 he has been drinking more than usual.
I wanted to test at +10 but he managed to find some food an hour before that time.
He does seem very quiet today so I assume it is the new insulin.
Should i stay at 3+3 or increase to 4+3 or 4+4?

 

i meant to add that he has not been eating as well recently especially his first meal and his evening meal.
He seems to enjoy eating after 10 am and before 6pm. I give him 4 small meals a day one every 4 hours.

 

Leo's BG is 214 this morning so I will stay at 3 units of Levemir for now.
I am not sure if Leo's spreadsheet is available to everyone or not so could someone please tell me if they can see the latest BG test. Thank you.

 

I can see it. Some nice yellows. I would stay at 3u BID for now. As @Wendy&Neko said, levemir is best dosed consistently, so the same amount every 12 hours. If you don’t see any lower numbers, then you increase to 3.25u BID. I know he’s difficult to test, but is there any way you could get a test at night once in awhile? Some cats go lower at night, so it’s good to at least occasionally get one during the PM cycle.

 

Could you mark you spreadsheet with the day you started Levemir? I would out in a blank line between last day of Lantus and first day of Levemir. Then mark it as “start Levemir”, so we can see at a glance what happened.

Remember that Levemir nadirs are typically later, meaning you will see lower preshot numbers. At some point soon you should do a curve to see when Leo’s onset and nadir are on Lev.

If his numbers are all high on this dose, you could safely go to 3.5 units,s in every you started even lower than 70% of the Lantus dose, which is what 3.5 units is.

 

I took Leo's BG at +8 and it is low at 9.2. I think it will be lower at +12. If the reading is around 7 should I give only 2 units?
I am using a Novopen so cannot use half units. Novopen Echo does give half units but I can't find one at the moment. Thank you

 

Sorry used wrong BG readings +8 is 166.

 

I am using the Novopen 5 which is in whole units only. The Novopen Echo does have half units but difficult to find here in Canada.
I assume you mean after 8PM which is when I give him his shot and sometime early in the morning, 5AM perhaps.

 

Most of us use syringes to draw the insulin. I am in Canada too. I bought the Levemir (originally Lantus) cartridges and the BD Ultrafine II syringes from the pharmacy.

Based on numbers you are seeing so far, I would hold the same 3 unit dose a couple more days, so a proper depot can be built. One thing to keep in mind, even though the "typical" Levemir nadir is +8, not all cat like being typical. My girl nadired from +9 to +12 most of the time on Lev, some cat are earlier. When you get a chance, a curve will help you determine when the Levemir onset and nadir are for Leo.