Levemir Info

hi all and thank you all for everything you have done for us in our sugar dance this far. Little just has her 1yr anniversary of being diagnosed with this awful disease. We spent 8 months on Prozinc with no regulation and we are now at 4 months on Lantus. I try to stick to the protocols as much as possible but my work travel/ using pet sitters makes me have to adjust/hold doses more than I care to. That said she is doing much better on Lantus but still not where I want her to be numbers wise although clinically she is awesome. Like a new cat!! I have held 1.75 for extended periods and she has dropped into the 50s and even the 40s a few times but the rest of her numbers would indicate a dose Increase. My fear in raising her to 2U is that she will go too low. That said , anyone have any advice on yet another insulin switch? Levemir perhaps? I hate the thought of switching again but I’d really like to see good numbers more consistently. And thought and advice appreciated!!

 

Is there anything different on the days when she goes low? My Badger had similar occurrences and I switched insulins (Lantus>Levemir>ProZinc with no) change. The cause was due to a chronic ear infection caused by polyps in one ear. Antibiotics would only resolve the problem temporary. Ithe problem was finally resolved by removing the polyps surgically.

 

No but since I travel so much I reduce the dose down for sitter and work my way back up. I THINK if I were to keep the dose consistent for 2 weeks I may start to see her level off but I can’t take that chance with a sitter that doesn’t test. I see a huge difference from prozinc to Lantus but she still bounces regularly. Just wondering if maybe Levemir would help remedy that although I hate to change. Vet says don’t change that her numbers are good for a “diabetic cat” but in the end it’s up to me not him. Thanks for replying.!!

 

I think I would stick with Lantus for the time being. I used Lantus and levemir insulins. I liked Lev as it had a later onset and often a lower Preshot.
I don’t think it stopped Sheba bouncing though.
Littles numbers are pretty good really considering you have to juggle them with a sitter. She does bounce a bit after low numbers but that’s normal until she gets used to the low numbers again.
If she’s clinically great then I think that is great.
I think it looks as if you are doing a really good job with her, especially with work , travelling etc.

She’s getting into the low greens(40s) with the 1.75 and looks as if she goes into the higher numbers with bounces.
If you get a low number always try and test again to ensure she is coming up and not dropping further.
I think I would stick with the 1.75 too at the moment.

 

WHen you run of of your existing stock of Lantus I would give Levemir a try. Except for Wiggles, I get a very flat and low curve with Levemir. Wiggles is very sensitive, he only get 0.1-0.2 units

 

Thank you all for responding. It is a juggling act when you have to lower doses for travel which unfortunately my job requires. I so want her low blue to green all the time but I guess we all do. My Lantus won’t be out till 6 more months as I ordered 5 pens that seem to last 2 months each. Do you think I should wait that long if I am going to make a change? Although I am not sure I will change. She is so sensitive to changes I’m sad as its looking like little will be a “lifer” regardless since it’s been a year since diagnosis and all I can think of is that Levemir is the only thing I haven’t tried. Anyone ever seen a long term kitty go into remission?

 

I would use up the insulin you already have, before considering a change of insulin.
Looking at the SS Little is doing well.
You have mostly blues and greens with a sprinkling of yellow.
I wouldn't increase the dose with those greens in the picture at the moment..
The AMPS is almost always the last to come down.
Do you have an autofeeder? Sometimes if you give some food around +9 overnight, it can help bring down the AMPS.
That would be worth a try.

 

My Alice hit a year this month too. It’s frustrating because I would love to give her the gift of a break from pokes.... but if it doesn’t happen, that’s okay, because to me it’s still pretty amazing that she is alive. I think about the fact that insulin was not introduced into medicine all that long ago, historically. But it is still frustrating. A little disappointing to think about it being “forever.” Statistically though, it is not impossible for a cat to still go OTJ.


“Treatment and monitoring
The aim of therapy in newly diagnosed diabetic cats is to maximize the chance of remission by strict glycemic control (72 to <180 mg/dL; 4 to <10 mmol/L), while avoiding hypoglycemia. Diabetic remission is defined as persistent euglycemia without the requirement for exogenous insulin or oral hypoglycemic therapy in cats previously requiring treatment to control diabetic signs.13,38,44 For long-term diabetic cats that do not achieve remission (≥6 months), the aim is to control clinical signs and avoid clinical hypoglycemia. Remission may occur in a small proportion even after 2 years of insulin treatment, if rigorous glycemic control is maintained.

In newly diabetic cats, early effective glycemic control can resolve glucotoxicity before there is permanent loss of sufficient β cells to maintain euglycemia, which increases the probability of remission. A protocol aimed at strict glycemic control within 6 months of diagnosis showed that 84% of cats achieved diabetic remission compared with 35% (p<0.001) when strict glycemic control was not instituted for ≥6 months after diagnosis.45

Besides early institution of tight glycemic control, factors associated with remission include a low-carbohydrate diet (12% versus 26% of energy from carbohydrate), long-acting insulin (glargine versus PZI or lente), higher age (suggesting possible slower disease progression), lower maximum dose of insulin (mean maximum dose of glargine of 0.4 U/kg versus 0.7 U/kg or <3 U/cat versus >3 U/cat), lower mean blood glucose after treatment with insulin, and lower cholesterol concentrations.13,44–47 Corticosteroid administration in the 6 months before diagnosis of diabetes is associated with significantly higher remission rates.45 Peripheral neuropathy at diagnosis is associated with decreased probability of remission. This is likely because diabetic neuropathy presents later in the course of disease, so these cats have been diabetic for longer period of time and have greater β-cell damage.45”
From: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6053045/accessed 10/7/19 17:40CST.

 

Again thank you all for responding. I could not have gotten this far without all the advice and help. Good thing here is her neuropathy is all but gone. She jumped on something so high this week that I don’t think she ever jumped on before diagnosis. So back legs are good! I wish I could leave a feeder out but with multiple cats and Little attacking all food always..( you should see the games we play at feeding time. Kinda like block and tackle!) I have been hesitant to leave a timed feeder or feeders for fear one would get all or there would be a feline fiasco! Again thank you from the bottom of my heart to all of you I am truly grateful.
PS. Anyone think zero carbs is detrimental? She’s literally getting no carbs and I wonder if that is freakng out her system. Usually I know eliminating something totally is no good long term. But changing anything scares me.