Switch from Lantus to Levemir

Wow, it's been a long time since I've posted in this section.

Lantus has proven to be a failure for Blackie as he can't even get into the yellow ranges much these days. We've increased his doses by .25 units (except for the last increase) but it has proven useless. I have no more hope in Lantus so I've been thinking of switching to Levemir.

A while ago we thought Blackie was regulated but I guess not. We've become really frustrated with his recent numbers and as well we're stressed out due to our busy lives.

If theres anyone who made the switch to Levemir from Lantus, is there anything I should be concerned about? Any feedback you can provide me? My question is whether I can continue using the BD 31-guage syringes for Levemir.

Other than that, Blackie is still doing great these days. However, hes lost quite a bit of hair on his back legs and around his bum hole.

Thanks guys.

 

Well. I don't know if I am the first to ask but here goes:
Have you thought about having Blackie tested for acro or IAA?

I ask because if your dose just keeps rising and you just don't seem to be finding Blackie getting results, there has to be a reason.

I would guess that you could start with the cheaper checking - get full b/w done to ensure all his levels are within range and no problems jump out. Also, when I don't know what's going on, I get the urine checked as well - u/a and ask for C&S-culture and sensitivity - just to be sure that nothing is happening in that dept.

Teeth are another thing that can be a problem and affecting their numbers. I had never taken Shadoe in for dental but when she went for a clean and what was needed, she had 4 iffy teeth with one bad canine pulled and the others were just cleaned up. Her numbers improved and the dose dropped right after that too. If you have the vet do a look-see (you can't tell all that much from visual if there are issues below the gums, but it's a starting spot).

Next is food - what food is Blackie eating as food is a major factor in regulation.

I switched to Lev from Lantus after my two tested positive for acro, and Oliver positive for IAA as well, and Lev was said to be gentler on higher doses.

It could be that Blackie is just a thirsty fella and needs more insulin but I don't know if switching from one to the other will do anything to regulate Blackie. They are pretty similar, so if you can't get him regulated on one, then the other is not going to be any different.
There are differences though:
Lantus and Levemir: What’s the Difference?

About the syringes, I just use the BD ones with the 1/2 unit markings. What you could try to see if it makes a difference for Blackie is to split his shots - give half on the left side of scruff and half on the other side. When you get to higher doses, it seems that some people feel they get better results by this method. If I give Oliver his shot, I split it into left, center, and right with about 2inches between spots.

Talk to your vet about it all, and if you have ruled out all the above, except for the tests, here are the sheets with info where to have the blood draws sent.
IAA Test
IGF-1 (Acro) Test

Cushings is another condition, since you mentioned the coat, but it's pretty rare though possible.
Cushings Info

I can't comment on issues with thyroid, etc, but others here have that knowledge. Others can suggest what you should have your vet test for, and which test result numbers to watch closely.

I do like using Lev, but wish we could get vials in Canada. Why they are not available here, I don't understand, but the 5-pack cartridges are just fine.

It seems like there are lots of ups and downs with Blackie; he is getting some greens, so I don't think you are looking at acro, but it's tough to say as you don't have all that many tests in the evening and lots of cats go low then.
It looks like he's lower at amps but then ends up high at his pmps.
With a couple missed shots, you may need longer to fill the shed so holding the 7u for only 4 shots might have been too fast to see results, and upping to 7.25 made for NDW and more shed to top up. Then, toss in a couple of green amps to cause a few bounces, and Blackie is all over the place.
I wonder what he's doing in the pm that is giving you better numbers for his amps?

I am totally not one to know about dosing info; my method is to fly by the seat of my pants, so my words are just observations.
The others here will be able to see more in Blackie's ss than I can.

If you do switch to Lev I am sure you will be satisfied as most people like it.

 

I don't have experience with acro or IAA.

I also see a lot of greens when he was on 4 and 5 units between March and May. And I also, was wondering if he is going lower at night time, and don't see many middle of the night spot checks.
Also, when you were giving the 6 units in August, he had some low green AMPS on 08/19 and 08/20 and then increased the dose on 08/22. Maybe, you increased the dose too fast and missed his optimum dose and he is now bouncing all over the place? I'm not saying you did anything wrong, that's just my observations from looking at your spreadsheet.

When/If you start Levemir, I believe you will start off at a lower dose. I was told to give a 30% lower dose of Levemir than I did of Lantus. I was giving 2.50 of Lantus, so 2.50x.70 was 1.75 of Levemir. I was given the option by Jill, of starting at either 2.00 or 1.75 units and I chose to start Levemir at 2.00 units. Very quickly we were down to the 1.75, and now are at 1.50. J.D. still has low AMPS and high PMPS, and I'm not really sure what that is all about.
Since you're are now giving 7.5 units, you might want to start Levemir with 5.25 units (7.5x.70=5.25) or even 5 units. I'd send a PM to Jill to ask her opinion, I think she'll agree.

The syringes are the same for both insulins.

 

I want to say Lantus just plain began to fail for Pearl too after about 1 year and a half. We switched to PZI and did IDexx, then BCP (which was did not work that great for her) and back to Idexx. Switched to Lev when they stopped making that. Wow. It has been so much better. Use it like Lantus, yup, same syringes. It has worked like a dream. I wouldn't be afraid to change.

 

We went right to Lev after 6 weeks on Vetsulin. Many people in LL have switched from Lantus to Lev....
I don't think you have anything to loose by trying it yourself. But I agree with Dyana that more spot tests would be good to have. Even a before bed time check would help fill in the picture. It is difficult to test often with a busy schedule but still with that amount of insulin, the extra tests would be helpful. Weekends for a curve perhaps?
Maybe if you post in LL too there will be others who will tell you of their experience with the switch...I wish you well with it if that is what you decide to do! :mrgreen:

 

hi team blackie, i think but am not positive that 'venita and the boyz' made that switch.

 

Get the acro testing done before you make a switch.

As far as the BD syringes go, I do not recommend them for low doses and neither does a study that was done and posted on the original FDMB a while back: http://www.felinediabetes.com/phorum5/r ... 22,1462377

They are probably fine with higher doses though, so if you get a confirmed acro diagnosis, they should be fine with Levemir.

 

I have to ask my usual dumb question, and please forgive me, I have not kept up on your history.

Is your lantus still good? I ask because a cat I'm helping here in CT, his Lantus was not good at all, we switched him to Lev and he's doing great, but I don't know how he would be if his Lantus was any good.

I switched my cats from PZI to Lev and love the Lev. I used Lantus for only a few days before Bean went off insulin, so I cannot say whether I prefer Lev or Lantus, but I do prefer Lev over PZI.

 

Yeah our Lantus is still good. We usually use each cartridge up before the 28 days are up but with the higher doses we finish way before the 28 days. In fact I just opened a new one a few days ago.

Awesome, thanks for the feedback guys!