Starting insulin degludec (Tresiba)

Discussion in 'Lantus (Glargine) / Levemir (Detemir)' started by Jessica & Conan, Apr 6, 2018.

  1. Jessica & Conan

    Jessica & Conan Member

    Joined:
    Jan 16, 2016
    I haven't posted on these forums for a while, and I'm not sure where to post this, but I thought I'd start by putting it here after seeing this post: http://www.felinediabetes.com/FDMB/threads/insulin-degludec-for-cats.187673/

    I am starting Conan on Triseba tomorrow morning. If anyone is interested in following this experiment, I'd be happy to update as we go along - my vet is very supportive and we've talked a lot about it, but we're definitely going to be in unknown territory to a large extent.

    His case is not necessarily typical, as his diabetes was steroid-induced and he remains on steroids, making blood sugar regulation extremely challenging (and remission an impossibility). For the first six months after his January 2016 diagnosis he was on Lantus, but his numbers were all over the place and very unpredictable. Then we switched to Levemir. This was much more predictable (and effective) for him - but it lasted a much shorter time, generally 7 hours or less. He was on a 3x/day dosing schedule whenever I could manage it (which was not every day), but even then he often didn't make a full 8 hours on a dose.

    3x/day dosing is very challenging, and so two weeks ago we decided to try the Lantus again. Right after that, I read about Triseba, and after discussing it with the vet at length, we decided it was worth a try. His current Lantus dose is 2.75, and he is not well regulated (yet?) on that dose. I'm going to begin the Tresiba at 1.5U 1x/day (in the Zurich studies, it lasted close to 24 hours for many cats; in people it can last up to 40-42 hours). The nature of this insulin seems to be that it can take a number of days to see the true effect of dose changes, so it will probably take a while to figure it out.

    If 1x/day dosing works, that could be great for pet owners - especially since the dosage timing for Tresiba, at least in humans, is supposed to be much more flexible. So I just thought it was worth a mention in case anyone is interested! :)
     
  2. LizzieInTexas

    LizzieInTexas Well-Known Member

    Joined:
    Jul 25, 2016
    I am very interested in your experiences, but also terrified for you and Conan. I hope that you are available to monitor and keep him safe.

    Please keep us posted or put a link here if you are documenting elsewhere. :bighug:
     
  3. Chubba

    Chubba Well-Known Member

    Joined:
    Apr 30, 2017
    Good luck. It will be interesting to see the results.
     
  4. Ter and Sally

    Ter and Sally Member

    Joined:
    Jan 9, 2018
    Definitely interested and wish you good luck. I'm with LizzieinTexas, please keep us updated or let us know where/how to follow you.
     
  5. Stacy & Asia

    Stacy & Asia Well-Known Member

    Joined:
    Oct 2, 2017
    Jessica! :woot:

    Please, please, please post every day here if you can. :) I’m so interested to follow your journey, you are trailblazing here. I’m so glad you have the support of your vet. I really, really hope that the once a day dosing works out, wouldn’t that be amazing?

    I’m having a similar issue with Levemir, I really like the action profile, like you, but the duration is still an issue and I just don’t think I could dose 3 times a day (though I’ve considered it). I wish you all the success in the world and will be following with great interest.

    ETA: this is absolutely the right forum to post in, Tresiba is a long acting basal insulin like Lantus and Levemir, you just happen to be the first person to try it, here.

    ETA: Just kidding, Jill will let you know where to post. :p
     
    Last edited: Apr 6, 2018
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  6. Jessica & Conan

    Jessica & Conan Member

    Joined:
    Jan 16, 2016
    Okay I will keep up with updates then! I'm not quite sure where, since obviously there is no deguludec forum. Is it okay to just post here? It seems most like Lantus/Levemir in that it is a long-lasting basal insulin. Also my spreadsheet is in my sig, and I'll just continue the 2018 sheet with the Tresiba starting tomorrow (it's a little weird, because I adjusted it to allow for 3x/day dosing for the Levemir; then switched to 2x/day dosing a few weeks ago when we tried Lantus again - but it's basically the same as the standard).

    I definitely will be monitoring him quite closely for quite a while.

    Humans generally seem to start Triseba on a dose about 80% of the Lantus dose. His current Lantus dose of 2.75 is definitely not high enough - if I were to keep him on Lantus I'd definitely have to keep going up. But 80% of 2.75 is 2.2. Also, the Zurich experiments (referenced in the thread I linked to in my first post) used doses of .1, .2, and .3U/kg for non-diabetic cats - most of us dose at much higher ratios that that. .3U/kg for Conan would be 1.25U. So a 1.5U starting dose seems safe.

    The Zurich studies are reassuring in the sense that they seem at least to show that insulin degludec isn't harmful for cats and that it works on cats as insulin should. So I'm not so much worried about somehow poisoning Conan or something! The problem is that there is no body of practical information out there about how to use it with diabetic cats, as there is for the other insulins. So it will be more a matter of figuring out dosages, figuring out "how it works" (duration, how long it takes dosage changes to take effect, sensitivity to timing of dosing, that sort of thing), and of course monitoring curves and keeping an eye out for low BG, etc. Conan is one of those cats who is for whatever reason quite tolerant of low BG - he has never had a hypo episode even on the (very rare) occasion his BG has dropped below 30 (on a Relion Micro). Obviously those numbers aren't good for him, and I am not blase about it, but it makes me more relaxed about experimenting (I never would have done this when he'd just been diagnosed and I didn't know his patterns so well!). And Degludec is supposed to have a flatter curve - though who knows how it will work in cats in general, and him in particular!

    Stacy, 3x/day dosing is a huge pain. I'm able to do it many days, but not all days, which means there's a lot of inconsistency. And the problem is that it's still really not enough - he really needs Levemir to be dosed every 7 hours or so, not every 8. So while Levemir works for him, there are a lot more spikes and valleys than I am happy with (some of that I know is attributable to the steroids, which create great variability in his BG levels, but some is not - he has less variation on Lantus, but Lantus is less effective for him).

    Anyway, I will continue to report back as I learn more!
     
  7. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Hi Jessica. I'm glad you're willing to take us on this journey with you! I think many of us are interested in following along. As far as where you should post, since we don't have a forum for degludec, I've sent a PM to our board administrator for direction. As soon as I hear from him I'll let you know.

     
  8. Stacy & Asia

    Stacy & Asia Well-Known Member

    Joined:
    Oct 2, 2017
    Very exciting! I’m sure you won’t be alone for long, others will use it eventually, but you are paving the way!
     
  9. StephG

    StephG Well-Known Member

    Joined:
    Sep 8, 2016
    I'll be following too. Good luck!
     
  10. Sandy and Black Kitty

    Sandy and Black Kitty Well-Known Member

    Joined:
    Dec 31, 2009
  11. Tracey&Jones

    Tracey&Jones Well-Known Member

    Joined:
    Dec 12, 2016
    Very cool. I know for us with kitties that use steriods and have FD induced by that usage...I can understand the difficulty with stabilizing the BG numbers. Watching with great interest. Thank you for sharing!
     
  12. Chris & China

    Chris & China Well-Known Member

    Joined:
    May 10, 2013
    Another one watching!!

    Best of luck to you!!!
     
  13. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    @Jessica & Conan

    Just wanted to let you know...
    I heard from Robert. We'd love to have you begin documenting your use of Tresiba/degludec with Conan in the Think Tank Forum.
    Initially, start with a single thread... updating daily or as often as you can. Depending on how things go, we can then set up a new forum for degludec users.

    If you have any questions, let me know.
    Looking forward to watching with great interest! Good luck!!!
     
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  14. Camille and Cyclone

    Camille and Cyclone Member

    Joined:
    Dec 29, 2009
    Quick question, are you using the 100U/mL formulation? That would be easiest to measure since it's the same as Lantus. IMO it's important to specify the concentration since dosing the 200U/mL version as if it was 100 could be potentially diasterous.
     
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  15. Jessica & Conan

    Jessica & Conan Member

    Joined:
    Jan 16, 2016
    Yes I am using the 100U/ml formulation! And you are right, that's very important. For a while Tresiba was only available in 200U/ml, but now you can get it in either strength. It comes in 3ml pens, packs of 5 pens. I was unable to get the pharmacist to split up a pack for me so had to buy all 5 pens, unfortunately. The cost seemed much higher than the other insulins, but I don't think it's as much a difference as I thought - depending on dosage and usage of course. It cost me about $460 for 15mL. Levemir has always cost me about $280-$300 for 10mL, which would be $420 for 15mL. In my specific case, since I was dosing Levemir 3x/day (as much as possible at least!), I should end up using the Tresiba more slowly even if I have to dose 2x/day instead of once (looking likely). It will depend on the Tresiba dose too.

    Since most of the people who are interested in following this are here, and since the insulin-specific forums are the place where people post daily updates, it doesn't seem like Think Tank is the forum best suited for daily or frequent update posts on this issue. But if that's what the mods want, that's what I'll do! I will probably end up putting corresponding posts here as well, linking to the posts over there, since there are so many interested people here.

    I will start now - my first update post for today is here: http://www.felinediabetes.com/FDMB/...first-day-on-insulin-degludec-tresiba.193815/
     
  16. Jill & Alex (GA)

    Jill & Alex (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    The decision to start degludec users in the Think Tank Forum was an executive decision made by the board administrator. He would like Tresiba posts in that forum, not mixed in with those in the L & L ISG. If all goes well we will create a forum for those using degludec insulin. We can easily transfer threads from TT to the new Tresiba/Degludec Forum since they'll be separate.

    People who are interested in watching your progress are only a click away from Think Tank. Trust me, those who are truly interested will follow you over there! I'm sure there will be quite a few of us over there with you. :)
     
  17. Stephanie & Quintus

    Stephanie & Quintus Well-Known Member

    Joined:
    Dec 9, 2017
    Following with extreme interest!
     
  18. Jessica & Conan

    Jessica & Conan Member

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    Jan 16, 2016
  19. Jessica & Conan

    Jessica & Conan Member

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    Jan 16, 2016
  20. Jessica & Conan

    Jessica & Conan Member

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