Is Levemir worth a try?

I wanted to thank the people who responded to my post about Nomad.he has been on Lantus for almost a year.His dose varies from one to two units daily.I usually give him 1.5 once a day. If he is near 300 or above, I will give him 2 units. I don't want to go above that beause of the rebound effect.if he was very high I might give a small .5 to 1 unit dose at night.His avaeage is good at 212 over the past ninety days.the issue that alarms me are three or four times a month his level will spike drastically. I have tried to identify other factors such as stress,infections, etc that may account for it. So far there is no pattern. I feed all of my cats grain free dry food. Nomad gets boiled chicken or pureed baked fish as his "wet" food.

My vet doesn't seem very concerned about these spikes stating that he is generally being managed well.she even suggested it might be an error with my meter. Three meters later I am still getting the same results. I am glad Nomad is still with me but I feel he could be doing better on a different insulin.

 

I used Lantus for years, and recently switched to Levemir. I asked my vet for a prescription and he asked me "how do you spell that?" :lol: He's a "PZI Man" he says.
I am very very happy with the switch. J.D. has been a bouncy boy for a long time. I find the Levemir to give me more predictable BGs and the bounces are shorter.
Good luck with whatever you do.

 

I switched from Lantus to Levemir but my reason as hearing that with large doses there could be a stinging issue with the shots.
I can't really say if you should switch without knowing what doses you have been giving and what BG numbers you have had for the doses. If you are home testing, do you have numbers from your testing?
some info on the difference:
Lantus and Levemir: What’s the Difference?

If you could give a bit more info like what you are feeding as diet is very important, what dose you are giving now and how you reached to that dose, and also any other medical issues that may be contributing to the troubles.

I really like Lev for my two, but I did not have a problem with Lantus, so maybe you could make some changes or adjustments and you could see improvements and not need to switch insulins.

 

I love levemir. We have been on Lantus, PZI and now levemir. It has been by far the most stable and gentle insulin. Do you hometest?

 

I really like levemir too. My first diabetic, Beau, went into remission 3 months after switching to lev. He was on vetsulin for over two years before that. My second diabetic is on lev. He wa also started in vetsulin by his former owner and vet, but I feel lev is immensely better than vetsulin.

But it is also true that to determine if lantus isn't working it would really be helpful to know what his numbers are, what his sport check numbers are, etc. and the dose and his diet.

I will say that Beau had numbers like that after switching to lev. I had hear wonderful tings about lev so I was frustrated and how erratic his numbers were. He'd have high numbers so I would increase the dose and then he would drop too low (30s) and I would decrease the dose. Sometimes he's have 100s, but other times 300s (at preshot). He turned out to be rebounding. When I started slowly reducing the dose the numbers got better and better and I just reduced him down to nothing. I did it in .1u increments and then to .05u, and then shot that as needed, which would sometimes be twice a day and sometimes once a day. I only tell you this so you know all the possibilities. I would want to see Nomad's numbers and know the other stuff (dose, food) before suggesting he might be rebounding.

Here is a good article on rebound:
http://petdiabetes.wikia.com/wiki/Somogyi_rebound

 

My personal experience is that Levemir is more flexible than lantus.

PK was on lantus for awhile, the we switched to lev. I find I can shoot an hour+ either side of the 12 hour mark without much difference in regularity, also that the lev is less fragile in that I can use every single cart to the very last drop without BG fluxuations (outside normal ones).

PK does better on the lev than the lantus, but that may be in partial b/c I ws new to long duration insulins with the lantus where by the time I switched to lev, I understood how to use it better. Could just be coincidence?

In any case, I like the levemir.

 

If you are not satisfied with the performance of Lantus why not try Levemir? It wold be nice if someone nearby could sell you a 3 ml disposable pen so that if Levemir does not work better not much is lost.

 

I switched to Levemir after being on Vetsulin, then PZI, then Lantus. I know now that I bounced around more with the dosage on the Lantus than it likes, but, even though we're nowhere near regulated, I have seen better numbers longer on the Lev than I did on Lantus.

 

Although I have not used Lantus my understanding is that it works best with a stable dose. Levemir definitely works best on a stable dose and if you decide to switch, you would need to determine that dose and stick with it. So why not try to achieve the optimum dose on Lantus, instead of switching, is my question to you?

The longer acting insulins Lantus & Levemir work by maintaining blood glucose at fairly stable levels, their curves should be flatter rather than curved. So changing doses using a scale based on the blood glucose level defeats the proper action of these insulins. That is most likely why you're seeing high spikes of BG, you've built up too much shed because of excess insulin and the bottom dropped out, resulting in a surge of glucagon from the liver and extremely high numbers. http://petdiabetes.wikia.com/wiki/Somogyi_rebound

I think Levemir would serve you very well, but my concern when members broach this question about switching for the reason "I can't seem to regulate my cat on Lantus," is that they may have the same problems on Levemir that they have on Lantus because they are simply not at the optimum dose or are changing doses too much.

 

Ijust wanted to add a comment without editing my orginal post again.Besides just wanting some feedback from people who have used Levemir, I also want to get some comments on vets who are relunctant to switch insulin.I know each vet or human MD has their "first line" drugs they are the most familiar with or have had the most success with.That's fine. The problem comes when they are resistent to changing if the patient (animal or human) is having difficulty after a reasonable time frame on the Rx. There should be a number of second or third line treatments available.

Nomad has been on Lantus for a year now. I believe that is a reasonable time period. I have one refill of Lantus left and then I am going to request trying Nomad on Levemir again.If he doesn't respond well to it, I can always go back to Lantus.

 

If you are having trouble with switching insulins with your current vet, maybe it's time to switch to a more flexible vet? You are the customer, yes?
Take the vet info on the two insulins and tell your vet that you want to switch, none of this asking business.

Best of luck on the switch. While Lantus and Levemir may be similar, they are not identical, and some cats do seem to do better on the Lev.

 

Definitely worth a try....however, as Vicky mentioned, Lantus and Lev work best with very, very consistent dosing - sliding scales do not work with these insulins. Have you read the German Tight Regulation Protocol? Or, have you considered posting in the Lantus group for daily help on the dosing?

http://www.tillydiabetes.net/en_6_protocol2.htm
viewtopic.php?f=9&t=1581

Many vets seem to be resistant to things they don't know. However, I think there's been some discussion on Levemir on VIN this year. I know there's been some discussion and links posted in "Think Tank" on this board, but you might have to hunt.

 

Your vet should be willing to listen to your reasons and concerns. If they are not familiar with a treatment or drug or an insulin in this case, they should be willing to "look in to it." That's what my vet did and she came back with a positive recommendation on Levemir, after finding the right resources, which would be a University Vet teaching Hospital, such as the one at University of IL, where a study on Levemir's use in cats was conducted in 2008. My vet spoke to them prior to the study being published, but they already knew enough to advise her about it.

A good vet should be willing to do that, especially if you can make a convincing case as to why you should change to it - why you believe it would work better than Lantus. I was able to do that given that Gandalf had been on PZI insulin for over 2 1/2 years and had done OK on it, but was declining in his activity level because his blood glucose was going from 300s to 80s within 5 hours. I wanted an insulin which lasted longer for him.

Be specific about why you need to switch and offer up as much information about Levemir as you can. It is a reasonable request.

 

My vet calls himself a PZI man. He said J.D. was his only patient using Lantus. When I wasn't getting good results, I mentioned maybe switching insulins. He thought I meant to PZI. I told him I wanted a prescription for Levemir. He said "how do you spell that?" and wrote me the prescription.
Re-iterating what everyone else has said, the doses need to be as consistant as possible.