Intro to Little One & ??Levemir

Hello Everyone!

Recently, I adopted my very elderly neighbor's FD kitty, Little One. Other than FD she's healthy, 8 yro, about 8 lbs, & has been on ProZinc for 1 year. I kept her on ProZinc, but due to the recent shortage of PZ I purchased Levemir pens. All kitties eat canned LC Before Grain, Wellness, & FF classics (like this best). Bayer Contour meter (at times, ReliOn mini or Micro). I've written a bit about her on the Levemir forum (see link below) I'd like now to switch her & have some questions.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=10&t=76368

My pharmacist insists that Levemir should be stored in an upside down position in the original box to protect it from the light, deep on a shelf in the fridge. True? What's the best method? No shaking, swirling, twirling, etc.

She's been on 1.6u of ProZinc (to clarify, I use U-100 so that converts to 4.0 on U-100). Her BGs have been all over except reds & blacks. Over the past month or so, I've taken her down from 2.6 ProZinc to the current 1.6. She nadirs early +4 or +5, lowest at 1.6 was 83.

I plan to start her at 0.5 unit of Levemir for about 5 days unless she goes really low, keep a close eye on her nadirs, as well as test for ketones 2X daily. Increase to 0.75 if she stays flat. All comments are very welcome. My goal is remission! Better late than never...

I may not be able to respond to comments quickly because I divide my time between two locations - one has no internet connection.

My Pudge has been in remission, Pro Zinc user, for several months & is going great (BGs in 40s, same as his two litter mates). All thanks to you guys & PZI forum, in particular.

Greetings to everyone & thanks in advance for all suggestions.

Sophie

Hi guys, how sweet of you to take on another sugar kitty!

I don't have any experience with prozinc or levemir (used lantus) but with lantus it should never be shaken or twirled, anything of that sort. We always bought the lantus solostar pens and kept them in the fridge, in the box they came in. We always laid the box on it's flat side and was never told otherwise. I hope others with levemir knowledge can stop by and help you out more!

I think you will like lev - and, hopefully, so will Little One!

Not sure about the upside down part (??), but do keep the pens in the fridge on a shelf (not the door) and not the top shelf or way back on a shelf where the really cold air is coming in. I kept mine on the shelf under the meat tray - in that little space there. The ones you are not using you can keep in the box, but the open one you are using you can just place on the shelf. The pen casing itself will protect it. Yes, no shaking, rolling, stirring, folding, or any other "ing". Just uncap, draw dose from the tiny stopper at the end, recap and place back in fridge. The pen has a plug on the other end (that you can't see inside the pen) it moves by vacuum action as yo draw the doses an that keeps the bulk of the air out of the insulin as you use up the pen. Maybe your vet doesn't know that and hence the "upside down" part of the instructions (never heard that one before, btw).

.5u seems like a good starting dose. I would suggest starting on Sat morning, or when you will basically be around to monitor during the first 3 cycles. If she is going to drop low that is when it will happen. Beau had a significant response to his first dose and was into the 30s on the 3rd shot.

Good luck!

Levemir should ideally be stored in the refrigerator and, if it is unopened, can be used up until the date printed on the carton. Never freeze Levemir or use it after it has been frozen. If you are unable to refrigerate this medication, keep it out of sunlight and at room temperature. Do not use Levemir if it has been exposed to extreme heat and do not store it in a hot car. Vials, cartridges, and pens can be used for up to 42 days when not refrigerated.

I'm not sure why the recommendation to store it in any direction. The pens are in a negative pressure system container. There's a plug/plunger that moves down the pen as you take the insulin out so it keeps the insulin from sloshing around. This is a link on the Lantus board to information on how to care for Lantus and Lev.

shelby33 said:

Levemir should ideally be stored in the refrigerator and, if it is unopened, can be used up until the date printed on the carton. Never freeze Levemir or use it after it has been frozen. If you are unable to refrigerate this medication, keep it out of sunlight and at room temperature. Do not use Levemir if it has been exposed to extreme heat and do not store it in a hot car. Vials, cartridges, and pens can be used for up to 42 days when not refrigerated.

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That information from the manufacturer about being used up to 42 days is irrelevant as long as Levemir is kept refrigerated and sometimes causes confusion for people that use Levemir for cats. Humans generally use insulin up much faster than we use it for cats. There is no reason anyone using Levemir for cats would not keep it refrigerated. That unrefrigerated aspect of Levemir was developed so humans could have portable, warm insulin that did not need constant refrigeration. Relatively small doses for cats generally make a pen last upwards of 90 days and even longer in cases where doses are less than 1U (each 3ml pen contains 300U). This makes Levemir exceptionally economical, but it must remain refrigerated, except to draw doses. Occasionally leaving it out on the counter for 12 hours or more does not seem to harm it either. Just pop it back in the fridge!