? Levermir in the UK - want to change from Prozinc

Hi all,

I hope you don't mind me posting in this group.

Toby has been really struggling to get regulated on Prozinc, my vet thinks he has somogyi overswing, she has suggested we switch to Glargine, having done some research I think that Levemir might be a better option.

Do any UK users have any experience in getting it in the UK?

Will the transition be OK from Prozinc?

What else should I consider before deciding to make the switch.

Thank you all in advance for any advice you can offer me.

 

Welcome to the group!

I don't recall any Lev users in the UK but that could be my memory. There are differences between Lantus and Lev but from the standpoint of a long-acting, depot insulin, they are similar. Lantus onset and nadir are earlier, at approximately 2 and 6 hours post-shot than Lev (at around 4 hours and 8 hours or later). Some Lantus users who have switched to Lev find that cycles are a bit flatter but that's not always the case.

As for Somogyi, your vet needs to do a bit of reading. There is no such thing as Somogyi rebound in cats. The term was coined by Michael Sonogyi in 1938 using a very small sample of humans (8 total) using a shorter acting insulin. The results have never been replicated in humans. Further, I don't think you can generalize from a short acting insulin to a depot type of insulin that is long-acting. More recently, Roomp & Rand published a paper using Lantus and did not find evidence of Somogyi.

 

I found that Levemir had better duration, in my cat. That led to the flatter cycles. Been trying to remember who in the UK was on Levemir. Most of the cats with acromegaly end up on Levemir, partly for the better duration, and partly because Lantus’s acid base can sting at higher doses. I do remember one acromegalic cat in Scotland, but it’s been a while, and at that time they might have been in Caninsulin first. We have had a number of people here switch from Prozinc to Levemir. Maybe some of them will pop in, but most are in the US.

 

Thank you Sienne, I actually found the paper from Roomp and Rand in a post from about 4 years ago whilst doing my research and so I too had questions over the validity of my vets diagnosis. That being said, I have noticed that Toby's numbers have come down a bit since reducing his dose, meaning that there might be some truth, certainly for him, about the impact of over dosing, I have said to my vet I will consistently stay at a reduced dose of Prozinc for 10 days (we are on day 4) before making the switch to Lev.

Some further research has indicated that Lev is available in the UK under the British Veterinary Society Cascade System which means that as long as they have tried another non human insulin first they are licenced to prescribe lev and it is widely available in pharmacies here in the UK, so good news on that front.

I am more nervous about getting my head around the depot and what it means for dosing, and what dose do I start with? I trust you all so much more on this forum than I do my own vet, what does testing look like in the early days? Am I to do daily curves for a few days? Toby has a history of DKA recurring fairly regularly so I am keen to get his numbers down as a matter of some urgency.

Sorry for all my questions and thanks again for your input.

 

Thanks Wendy, I really value your input. I had read about the acid base, and Toby is getting more sensitive to his injections so this was another befit of Lev for me. As I have said above, I am keen to switch but want to get my head around what is involved from a testing and monitoring point of view. Toby doesn't have acro but is definitely struggling to regulate to any sort of normal numbers yet despite being on a 100% low carb diet and being on insulin for 3 months now (which I know is still early days!). Thanks again.

 

Hello! We switched from Lantus to Levemir and I really like the flatter curves. Although our case is a bit different from yours as we aren't switching from Prozinc...but you're welcome to look at Luci's SS to see the difference from the Lantus curves to the Levemir curves. Overall I think it's been a better insulin for Luci.

Best of luck to you on your decision as you move forward

 

If you are starting with Lantus or Lev as your first insulin, the initial dose is calibrated on a weight based formula (initial dose = 0.25 x ideal weight in kilograms). However, when a cat has already been using another insulin such as Prozinc, you can start at the same dose. (When switching between Lantus and Lev, the switch dose is slightly less.)

One reminder, you will need U100 syringes. I believe that Prozinc requires a U40 syringe. We encourage people to get syringes with half unit increments since that's the typical amount that you will be increasing or decreasing doses. I'm not sure if you have the same variety of brands of syringes that have half unit dosing in the UK. I believe Monoject is available there. I'm tagging one of our members who's in the EU: @Gill & George.

 

You can probably get BD brand syringes at the chemist. I found the U-100 syringes had thinner needles than the U-40 I used for Caninsulin, another reason to switch. Neko barely noticed the shot..

 

Sorry have been of line for a few days.
@Wendy&Neko is correct BD syringes are widely available, I've seen them for sale @Vetuk
https://www.vetuk.co.uk/veterinary-...-0-3ml-u100-insulin-syringes-box-of-100-p-296
These are the ones with the half unit markings.