Switched from Lantus to Levemir - how long should it take to get better?

We switched from Lantus to Levamir with the hopes hat Pumpkin would be able to go lower. We are doing a full curve today but so far it isn't better than Lantus. How long should it take? We will probably use up this pen and go back if it doesn't get better. He is still happy, playful, cuddly. After today we may try to go to another unit. Does it matter if we inject in stomach or IM? We tried to do IM at the Vet's suggestion but didn't see a difference and it was way scarier. He didn't like it much either.

 

I'm pretty new here, and I'm sure others with more experience will chime in with advice. But looking at your SS, I'd say it's hard to tell if the Lantus or Levemir is working because you essentially have zero data for the PM cycles and very sparse data elsewhere. It's really hard to see what a dose is doing if you don't know what it is doing. Asia often has lower numbers in the pm cycle than in the am and I have seen that in other cats as well. Almost every dose reduction Asia has earned was in a pm cycle.

Especially with such large doses, I would at least try to get AMPS, PMPS and at least one in the middle of each of those cycles to see what is happening, that is scary! The little stretch of curves you did is great, but the pm data is still missing and that could tell you so much more. I'm confused as to what information the dose increases are based on if you don't know how low each dose is taking Pumpkin. That's how both Lantus and Levemir are dosed, based on how low it takes the cat in a cycle, not preshot numbers.

It also helps to put some info in your signature like which meter you are using, if you are following a particular protocol or method (which one), the food you are feeding, any other medical issues/what high dose condition your cat has. That will help others to be able to help you, and probably the number one thing for others to help you is getting more tests.

 

I understand what you are saying, but the medicine is 12-hour so it should be close. Unfortunately/fortunately, Pumpkin is not low enough to worry about him crashing in the PM. We are giving him shots now at 10A/10P. We are doing a Levemir curve today, but even based on what we see so far, it is higher than Lantus. I just wondered if it took a few weeks to regulate after switching. If it stays this way, we will go back to Lantus, which he was lower on.

 

I agree with the need for data. The data you do have says he needs more insulin. I see a few "zeroes" for dose (Lantus section) even when the PS is very high. Were those fur shots?

I switched my kitty from Lantus to Lev 7 weeks ago. I can tell you that, for him, it acts like an in and out insulin, not a depot insulin - ECID. I'm sticking with it because he feels so much better on it. Lantus gave me more stretches of low numbers but it made him lethargic and generally unhappy a lot of the time.

 

It's impossible to say, last January, you hit a high blue and some low/mid yellows on 5 units (and who knows what in the pm cycle). You could easily have skipped over a workable dose because you are missing the data. And yes, he could go low at night even though the numbers you have during the day are high. It definitely happens. As far as Levemir goes, I don't think 6 days is enough to say if it's working or not. With either insulin, you need to find the dose that brings him to the lowest (safest) numbers consistently. You're going to have the same problems with Lev (I suspect) that you've had with Lantus because the dosing decisions are not based on nadir data. I'm not sure where you go from there.

If your vet has their own way of doing things, and that what you're following and you're comfortable with that, great. But if you get frustrated and want to try something else, you can look at the TR protocol on this board. It's a published study in a peer reviewed feline medical journal for FD cats on these depot insulins. As far as I know, there aren't any others with the science to back them up. I'm here because I've seen a couple vets since this diagnosis and I wasn't keen on how little they understood these insulins (compared to my zero knowledge but a couple days worth of reasearch).

Unfortunately, the only person who can advise you on your vets own method of handling FD is probably your vet. The beauty of this board is the wealth of knowledge and information comes from the fact that we are all following the same protocol or method and adding to that data with our own experiences (many with our vet's support). Dosing advice is shared based on the data you offer when you are following the protocol or method.

 

I shoot Girlie's left flank in the AM and her right flank in the PM, and try not to shoot in the same place: I picture a clock, and each shot is at a different hour. Here's some info on injection sites for cats that I found very helpful from this wonderful sticky on Lantus & Levemir - Syringe & Insulin Info: Handling, Drawing, & Fine Doses. Just click on the picture to make it bigger or go to the link.


I second the advice from the others re: the need for more data. Data is everything! It clears up so many mysteries...

This is just day 2 of Levemir for me with Girlie, but you can see from her SS that - already - Levemir has a different onset and nadir. In order to figure this out and know when to feed her and when to watch her in case she goes low, I have to get the data to tell me what her body is doing and when.

I'm not an experienced person, so I look forward to what others have to say. But I'd love to see more data!

I might have missed this, but what kind of food are you feeding and what carb level? Does beautiful Pumpkin have any other conditions or take any other meds? I'm so curious now!

 

Link to your last post (it helps people help you to have info from previous condos):

http://www.felinediabetes.com/FDMB/...amps-375-per-usual-range.184088/#post-2044049

 

Wow - that answers a lot of questions I had; thanks for posting that link, Stacy.

In that link to your previous post, you got some really good advice from people who are really experienced; who know what they are talking about; whose advice I have really learned to trust over the last few months; and who have guided me carefully to learn how to do this sugar dance and best help my beloved Girlie.

I know this can be hard and confusing, especially at first. And it's hard at first because the natural assumption is that your vet knows best. I'm not the only one who realised that my vet knew very little about feline diabetes. It's a complicated subject. Just an example: before I switched to Levemir, I contacted THREE vets in my area about getting a prescription for Levemir. Guess what? None of them had even heard of Levemir! One very conscientious vet said that Girlie was complicated with her diabetes and other conditions and she wouldn't feel comfortable advising me on feline diabetes, but she was happy for me to go to a specialist vet at the University and - when Girlie was better regulated - to come see her for just the everyday cat things. I really respected her for being so honest.

I wish you luck; I look forward to seeing more data so you know what's actually going on with Pumpkin; and I hope she stays safe.

 

Thanks for that pic Darrah, it helped me see we are doing it ok. We usually shoot the side of his belly. I was hoping to see a change for the better with the Levemir. My vet is very experienced with diabetic cats, but Pumpkin is acting differently than they have seen. They also consulted with a university that has a department that studies feline diabetes. Pumpkin has been all the way to 14 units of Lantus. His numbers stayed around the same and he threw up a lot more. We took him down over a long period to try the Levemir.

Amazingly, Pumpkin is acting fine. He does best around 2-3 units of Lantus - no throwing up like he did on the high dose. He is happy and has no issue. He always drank a lot of water, even when he was a kitten. The vet said some cats do well around 300, but we haven't been there yet. We use the Freestyle Nero human meter. We tested our other cat and ourselves and it is working appropriately.

He did lose weight when we switched his diet and portioned his food. He runs around and wrastles with our 4yo cat. He is playful. No indication that he is feeling bad at all. If it weren't for the numbers, we would never have known.

 

Are you able to do more testing throughout the day and in the evening? Right now you're a bit blind with only having the AMPS: that number could be a reaction to so many different things that are going on throughout the day and the night. The AMPS or PMPS alone just doesn't give you the information you need, does it? Are you working full-time?

 

Yes, we work full time. We are trying to test some more today. He got his shot at 10AM. We tested at +4. It was higher.

 

That's great that you got a +4 test! Nadir is usually later on levemir, from what I understand; can you get a +6 test?

 

+7 test - over 500 We will go to 3 tonight. Looking like we will probably head back to Lantus if the Levemir isn't staying in his system.

 

I am not sure where to begin. My comments from before on not enough testing still hold true. The biggest problem I see is that you have gone back to the beginning on your Lev dose. Often kitties need around the same Lev dose as they do Lantus, so we suggest starting around 70% of the Lantus dose when you switch. The reason Levemir isn't looking good is that you are on way too low a dose. I also don't know why you reduced the Lantus dose before the switch. It looks like his numbers are dangerously high all the time. I hope you are testing daily for ketones.

To answer other questions, we inject subq, not IM here. I shot Neko most of the time below the shoulders.

As for how long to try Levenir, it can take done kitties up to three months to really work Lev, Neko was faster at one month. But I also started her a Lev dose just below her Lantus dose. Starting back at one unit, you have a long way to go to get near a good Levemir dose.

 

+ 11 at 480, came down some. Wendy, thanks for the timeline - I was ready to give up on Levemir. I will move to 3 Levemir tonight and see what that does. As you can see from my spreadsheet, Pumpkin was pretty much is the same at 14 Lantus as he was at 3. The vet told us to reduce the dose before changing insulin. The numbers are very interesting, especially since all along my sweet kitty is doing well.

 

375 this AM, going to curve today