Transitioning from Lantus to Levemir

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MrWorfMen's Mom

MrWorfMen's Mom

Member Since 2015
I have received blessings from my vet to switch Menace from Lantus to Levemir :cat::D due to the painful injections she is now experiencing with the Lantus as well as the less than stellar level of control we've achieved thus far.

I would love to hear about other's experiences and any opinions as to how to go about making the transition.

My looming questions are:

Should we start back at square one...ie. 0.5u? (Menace is currently up to 6 units of Lantus)

Should we start at perhaps 3 units and work from there? Any other suggestions?

I've noticed Menace is often very sleepy/lethargic for a few hours after her injections of Lantus. Don't know if others have experienced that but definitely wondering if this occurs with Levemir?

Is there anything else I should be aware of to make this transition as smooth as possible?

NOTE: This is also posted on the general Health Board.
 
Generally you don't start over with the dose. It's a waste of time to do so.

Some cats have an initially impressive response to switching between Lantus and Lev. You want to reduce your current dose by 30% as a margin for safety. If your current dose is 6.0u, then I'd suggest starting the Lev at 4.25u.
 
@Sienne and Gabby Thank you. I saw your other post. I figured I'd have to decrease the dose to some extent but wasn't sure just how much.

My vet, bless her heart, had never heard of Levemir the first time I mentioned it to her a couple of months ago. When I revisited the idea a few days ago, she embraced it with enthusiasm. I think perhaps she's done a little research since we first spoke, for her own edification, but she did indicate she wanted to research how to transition first which is why I wanted to tap into the experience of folks here. I want to be prepared for that discussion.
 
Hi Linda - good to hear your vet is on board with the transition to Levemir. :) I made the switch a couple of years ago and am much happier with the results. For Neko (at least until a month ago), she was much flatter and more predictable on Levemir. She didn't seem to be bothered too much by Lantus (got up to 8.75U) but she never purred through her injections like she'll sometimes do now. The way I did it was to shoot Lantus one cycle and just start Levemir the next. You'll want to do it when you have a couple of days you can monitor a bit more closely, just in case Menace is one of those kitties that have a markedly better reaction to Levemir.

Transitioning to Levemir is usually recommended when kitties get to higher doses, as it seems to keep them more even and potentially last a bit longer. I don't know if anyone has mentioned it to you yet, but when kitties get up to 6 units bid of insulin, we suggest they might want to get tested for some of the high dose conditions, acromegaly and IAA being the first two to test for. Neko has both. The latest research from RVC in London has shown that 1 in 4 diabetic cats has acromegaly.
 
I already had a discussion with my vet about the possibility of acromegaly and/or IAA when I saw no improvement at all in Menace's numbers at 3u. It was at that point she consulted with a specialist in Texas. The specialist thought Menace might have some asymptomatic pancreatitis and wanted us to keep increasing up to 7u. Then if no joy, he wanted me to change to PZI. Frankly, I thought he was nuts and everything I could find about PZI suggested it would mean ProZinc. I helped out with a cat on that insulin and was not impressed with the severe ups and downs that poor cat was enduring and I'm certainly not going to subject Menace to that. It may have just been that particular cat but it left me gun shy!

My plan at this point is to change over to Levemir to remove the painful injection from the picture first and foremost. (Menace used to sometimes sleep through her injections!) My vet is going on vacation until the end of September so that gives me time to get Levemir started and get a feel for whether it is more/less/equally effective. If no improvement, I plan to revisit the high dose condition possibility when the vet gets back. She told me yesterday that she is getting nervous because she has never had a cat require more than 4u doses of Lantus so I doubt I'll have any problem convincing her to run the appropriate tests if need be.
 
Glad you think your vet will be on board re the testing. My vet consulted the local IM specialist and then told me we didn't need to test until Neko got to 10 units - which she never did. But she eventually agreed to humor me. I was less surprised than the vet at the positive results. Since then she's identified another acrocat at her practice. Wonder what specialist vet your vet consulted in Texas - I don't know of any high dose expert there. The blood for the tests goes to Michigan State University.
 
I don't think the specialist was picked for his expertise in high dose conditions. Quite frankly I found it interesting my vet took the case to a Texas specialist when we have specialists close to home...I saw one when Menace was diagnosed. I never bothered to ask the guy's name because what we got back struck me like it came from some old geezer who follows a certain protocol no matter the facts. He came up with what I thought was nothing short of crap. Don't use scruff for shots....use flanks because scruff has poor blood supply, possible chronic pancreatitis but asymptomatic and the real kicker....get her off EVO.... the calorie count is too high like I couldn't control that!
 
I asked my vet about iaa/acro and he said "what?". :( "you want us to test her for insulin?" (asked about IAA).
 
Thanks Julie. I will definitely be around to monitor Menace for a few days when we switch (likely start Sunday). Little scamp has recently had a habit of showing signs of improved numbers day one of increases and then she goes back up to near her previous numbers the following day. Every time I'd think she was bouncing but it would never clear. Even tried backing up her dose and that made no difference so it wasn't Somogyi. I think I have a little zebra who has not read the rule book so I am currently negotiating with my vet to start at a 50% reduction. Vet suggested starting back at square one and I really don't think it's necessary to lose all that ground but my vet has never used Levemir and probably is just being extra cautious even though she repeatedly tells me she has never had anyone test as much as I do! :rolleyes:
 
It may be that your vet consulted with someone at Texas A & M (TAMU). Their vet school is well recognized for their expertise in GI-related conditions such as pancreatitis and hepatic lipidosis. If there was a concern about chronic pancreatitis, that may have been why. Of course, it may also be that it's where your vet trained or where s/he knows someone. When I had a question my vet couldn't answer, she contacted someone at U of Wisconsin where she trained. (I call U of IL which was closer to Chicago where I lived and where I was on faculty and it was easier for me to get answers!)
 
My vet trained here in Canada (OVC at Guelph U) so either she knows somebody or was thinking pancreatitis because of Menace's history of some inappetence when first diagnosed. An ultrasound and blood work at Dx however were inconclusive for either condition so who knows.
 
I wouldn't want to drop by 50% - look at his spreadsheet on how he was doing at 3.0u. There is nothing happy there. Usually people drop to 70% of their dose on the previous insulin and then increase fairly quickly if it's clear that's not enough insulin. You won't want to hold the dose too long in this case, after you've made the switch. You've held the 6.0u about 3 weeks, and even following Start Low Go Slow the suggestion is to evaluate and increase if needed once a week. Since the 6.0u is only getting him into the 130's AT (you're still using AT, right?) you could probably even round up the 70% - 6.0x70%=4.2, so you could very reasonably round up to 4.5u for a starting dose on Lev.

If the 6.0u was getting him consistently into lower green numbers, then i'd suggest rounding down. The point is to lower it enough that you don't have an immediate low number crisis, while not lowering it so much that your cat is sitting in high numbers for any longer than necessary.
 
Thanks to one and all for your input. Tomorrow is the big day and I feel armed to make to this transition confidently thanks to your help!

My vet is now recommending I start at 2u and increase every 2-3 days until at 4u and then do
0.5 u increases from there once weekly.

I think my vet is just being extra cautious because she seems to think Levemir is more potent than Lantus and Menace's reaction to insulin thus far has her as puzzled as it does me.o_O

I'm running both pet and human meters. So in human meter numbers, on the first day of 6u of Lantus Menace went from AMPS 264 down to 91 @ +9 (lowest reading ever) and then her numbers jumped up again. Two weeks later with no dose change, out of the blue, all things being equal, she had an AMPS of 149 and surfed through the day @ +6,7,8 between 88 & 90.(new lowest readings). Her numbers on the 26th had me elated but they too didn't stick.:banghead:

I admit whole heartedly to being a little timid about moving too fast with Menace because of what I see as her bizarre lack with response along with those 2 surprising blips. With the suggested transition I can still get her up to 4.5u within a week and faster if her numbers are really bad. The sad truth is that her numbers at 2u were not that much higher than they are now at 6u although they look further apart in your US mg than in my mmol.:)

Menace has proven to be an impossible kibble addict (not that I'm not still trying but after almost 5yrs, I'm not hopeful) so having her go hypo scares the daylights out of me because I can't just put some higher carb canned food down to steer her if I see her going low and kibble takes longer to click in and will fill her up. She will take nothing but kibble/Temptations willingly so a fight will ensue should karo become necessary.

For that reason I'd rather be a little extra cautious knowing she has thrown me those more delightful numbers just recently. The 70% mark gives me the confidence to move her up quickly depending on her initial reaction so I shouldn't lose much if any ground.

Here's my sign.... CHICKEN!:woot::D
 
I think most vets err on the side of caution. Mine for instance got pretty mad at me when I told him Luna was going under 100 periodically, telling me it's too dangerous to let her get that low. Kind of odd seeing my civvie cats avg BG is around 60.
 
By the way, because of the dry food you need to adjust doses per the Start Low Go Slow method. Tight Regulation requires only canned low carb.

It would be good to put SLGS into you signature block so people don't keep asking you what you are doing.
 
MrWorfMen's Mom said:
Don't use scruff for shots.
Click to expand...

Actually Linda that "old geezer vet" might be right on this one point, my vet mentioned to me a while back that the protocol now with vets giving injections or vaccines is not to use the scruff as constant injecting in this site can possibly cause sarcomas (see discussion in my recent post here) so in this case flank shots are better. This was also the advice given by Dr Lisa on her site. Unfortunately I have to use the scruff for Crystal's daily dose of R because of the absorption rate, but I know I am running a risk with this.

We also transitioned from Lantus to Levemir on January 27 this year when Crystal was on 16.50 Lantus and we were advised by this forum to reduce to 12.00 Levemir (she has acromegaly, and possibly IAA, hence the very high doses, do not follow). Crystal is the first cat my vet has seen with acromegaly so she doesn't know anything other than what's in the textbook, so I take all my guidance regarding dosing from this forum. We increased roughly every 4 cycles by 1u under watchful eyes in order to try to find a dose that would eventually bring her numbers down (don't be horrified at her latest dose, it works and I have been told on more than one occasion that a cat needs as much insulin as it needs, contrary to what my vet thinks!)

I certainly hope Menace turns out not to be a high dose kitty or to have acromegaly and/or IAA. Good luck with the transition and hope Menace soon feels the benefit.
 
@suki & crystal Thank for for bringing your experience to my attention. I looked at Crystal's SS. All I can say is WOW! It takes a lot of bravery to deal with those high doses. My hat is off to you!:nailbiting:

I can only hope that I am not dealing with Acro or IAA with Menace but I see a worrying similarity between Crystal and Menace's patterns. I have however seen a few more encouraging numbers at 6u of late so fingers crossed she won't get up to any extremely high double digit dose requirements.

Because of Menace's extraordinaryly stubborn refusal to entertain any food that does not crunch, I have also been told I will just need to dose up to her diet and as you say, a cat needs as much insulin as the cat needs.

Your point about the sarcoma risk is good to know. I was told not to use the scruff due to poor blood supply in that area rather than any risk of sarcoma. The "old geezer" seemed to think Menace might not be getting the full effect from the Lantus because of poor absorption. That has proven to not be the case.

Menace does not like anyone fussing with her flanks but it was my observation that she was becoming increasingly distressed when the insulin was being injected. Some areas of the body are a little more sensitive so I am pretty sure any sting from the Lantus was just magnified in her flank region. Scruff shots the last few days have actually been a breeze for both of us.

Thank you for the good wishes!
 
Ah, thanks for pointing out the SLGS. Without the ability to bold or color things in the signature, and some people have a lot of text, it can get lost, and from my perspective at least, it's one of the most important things to have in the signature.

I wouldn't worry about high dose conditions for Menace - i suspect her larger dose is directly related to the dry food. We had a kitty on here, Scooter, who was getting 5.5u of insulin daily. They had 13 cats in the family, and while Linda thought that Scooter was not eating any dry food, apparently he was finding little bits on the floor. The other cats were fed up high and he couldn't get to it. When the whole household of kitties went to low carb canned food, Scooter's insulin dose went from 5.5u to zero in one and a half very, very long days. You can see the action here on Feb. 18-19, 2014. Dry food is powerful stuff, and if you can't get her to accept canned low carb you'll just have to give the amount of insulin she needs. But I wouldn't worry about acro or iaa at all in your case.
 
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