What are the differences between Lantus and Levemir? Considering a switch.

Tink's been on Lantus awhile and we're still struggling to get him into any sort of consistently decent numbers. He's one of those bouncy cats. Lately I'm noticing very high preshots even after a smooth surf the cycle before. Last night he surfed very flat (still higher than I'd like though) up till at least +10 - but was up to 379 just two hours later at AMPS. I'm wondering if Levemir might work better on him - we haven't tried that yet. He was initially on ProZinc, but it wasn't lasting long enough. Tried TID dosing, which probably would have worked... but it was super tough on my schedule (I'd like to maintain at least SOME semblance of a social life).

Seems I remember reading on a post somewhere along the way that Levemir sometimes hangs out longer in the system (for some kitties at least). Is that accurate? Are there other things to take into consideration?

Also... with him being on a fairly high dose of Lantus (4u) currently, would I still start low with Lev or would I start with maybe 3u or??? I haven't talked to my vet about switching yet - I know he generally prescribes Lantus... but he's always been very open to discussion.

Appreciate any insight from those who know anything about Lev. Thanks!

 

We switched back in August and are very happy with the switch. Cobb was also a little bouncy on Lantus. He has a much smoother curve on Lev.

If you switch, yes, you would start at a lower dose...about 70% of your current dose. Some people find their dose stays lower, some don't. That frustrating ECID rule.

I've found cost is about the same between the two, so that isn't really a pro for Lev.

I took info that I had found here to my vet to convince her to switch. Didn't take much convincing on my part.

 

Hi Jen - as Suzanne said, we start about 70% of you Lantus dose when you switch. Some cats are more sensitive so it's a safety thing. Some cats end up on less Levemir, some don't.

The biggest difference between the two is that generally, the onset and nadir is later. I've seen cats onset from +3 to +5.5ish and nadirs are also a couple hours later. With Neko, she's often at her lowest around +9 to PS. She's not into consistent nadirs. The beauty for me, of a nadir at PS, is that I'm always home then. Plus I'm usually safe for quite a few hours after PS. I've been able to go out a lot more for dinner I switched. The down side is going to bed and not having onset yet, so not having a perfect idea what the cycle will look like. Often I have to get up at 4AM for a test. It's fine for me during rowing season cause I get up at 4:30 anyway. Not so much this time of year.

Not all cats go flatter on Lev, but some do. Cobb and Neko are two examples that did go flatter.

 

I switched from Lantus to Levemir end of August and Bruno took the change very good, so good he went into remission after a month or so. You can go to the think tank section and read about switching from Lantus to Levemir: http://felinediabetes.com/FDMB/threads/attention-lantus-to-levemir-users.122941/

Does this mean you do SID on Lantus?

Lantus and Levemir need TID dosing, Levemir is more forgiving when you have to shot out of schedule but you do need to shoot twice a day, and be ready to shoot low, because some cats have their nadir at shot time.

What to expect, will depend on different factors. Some cats that have used insulin for a long time, take more time to settle on Levemir and they can still bounce every now and then. My cat was on Lantus for 6 months and the change was smooth and amazing but not all cats are the same.

So, all I can say is good luck¡

 

Correction Lantus and Levemir need BID dosing not TID dosing, TID is three times a day. BID is twice a day. SID is once a day. There are several differences between Lantus and Levemir, besides just onset and nadir. Lantus is an acidic base, Lev is a neutral base. Lantus forms crystals under the skin, Lev binds and unbinds to a protein in the body. Because of the difference in how the depot is formed some cats will have a more immediate reaction to a dose change on Levemir than they do on Lantus. Autumn's numbers were great on Lantus but her personality was not. She was tense and downright vicious on Lantus, switched her over to Levemir and she is the sweetest cat you will ever know.

Mel and The Fur Gang

 

Jen:

I don't think the issue is necessarily Lantus. I think you may be holding your dose for too long. If you opt to switch to Lev, you'll run into the same problem since the dosing protocol is the same. I'd encourage you to evaluate how effective your dose is after 3 days (unless a reduction is warranted). What may be going on is that glucose toxicity is building up. This is the fancy way of saying that Tink's body gets used to being in higher numbers and treats those higher numbers as his new "normal." This is why the TR protocol pushes for a dose increase after 3 days/6 cycles if you're not seeing numbers in the range you want them to fall.

 

Yes, sorry you need BID, Mel is right. My bad.

 

Yes, he's getting Lantus BID. He was originally on ProZinc BID, but it was wearing off after about 8hrs, so we went with TID dosing (3x/day). It looked like it was starting to work for HIM... but it didn't work for ME.

Unfortunately I can't really increase any more often than once/week because I work during the week. I do my increases on Friday evening so I can monitor through Sunday night. The rest of the week I can't get anything other than a +2 on the AM cycle and I'm not comfortable increasing without being able to monitor. That said, I DO have 4 days off starting tonight. He saw ONE cycle of nice (normal/green) numbers - but otherwise not. Should I increase to 4.25 tonight?

Thank you all for the info. I'm thinking it might be worth a shot. Tink's personality has been ok on Lantus - though every once in awhile he does "PMS" for a few days, usually resulting in spontaneous fights with our lone female. For some reason any time any cat is in a bad mood, she's the one that gets beat up. Poor thing. He's only had two bouts of that though... first one lasted several weeks (with the fights being every few days or so), but the most recent one only lasted a day or two. I HAVE noticed though that he does flinch a bit (some days a LOT - or he'll try to squirm out of it altogether) when I inject the Lantus. Though he's also been flinching on the ear pricks... so I think he's just getting sick of it all. Can't say I blame him. There's been a LOT of ear pokes with his numbers being all wonky. I'm going through test strips like mad. Only other thing temperament wise is that his "PICA" has gotten worse - though I think that's just because he's convinced I'm starving him. He has always enjoyed eating the handles off of plastic grocery bags and other random items... but the past few months he's been actively seeking out random non-food items. Particularly plastic bags and the fluff from inside dog toys (which my dog LOVES to destroy). If he sees me coming to take it from him, he wolfs it down even faster. Doubt that's related... but it's weird.

The later onset/nadir may be a really good thing for us. I usually get home around +10 - and getting up through the night isn't a huge deal for me. I've been getting at least one test in after bedtime more often than not anyway.

I'll try to talk to the vet over the phone next week and see if he'll switch the rx.

 

If you look at the sticky on Lantus/Lev & the insulin depot, near the top is a link to the differences in how the two insulins work.

 

FWIW, I work, as well. I get a +2 and sometimes a +3 on weekdays. If you think it may be helpful, take a look at Gabby's SS. Since she is a long term diabetic and it's highly unlikely that she will go into remission, I'm holding doses for a while. However, she's mostly in numbers that are below 200.

To be honest, I felt the same way as you early on in this process. I'd encourage you to take advantage of every long weekend, times when you're home, etc. to understand Tink's numbers. That will give more confidence about how the cycle plays out and how often you can increase. It may be that how you're doing things is the right way given the limitations of your schedule and Tink's numbers. But, if not, then becoming an expert on Tink may allow you to manage his numbers differently.