Lantus & Levemir Question

Status
Not open for further replies.
Tracy0504 and Zarley

Tracy0504 and Zarley

Member
Please forgive the stupid questions. I've read and re-read the Lantus & Levemir info here several times. And, just as a background on my situation, Zarley, my 12-year old cat, has been pretty well regulated on Vetsulin for the past year except for the past month when his numbers have gone sky high. I only found out tonight (via this board) that Vetsulin was discontinued.

Tomorrow is Friday - my only opportunity to have my vet get me something else or go to another vet altogether (my vet wants nothing to do with FD). So, for that reason, I feel this is urgent.

My questions:

Just like Vetsulin and Catsulin (sp) are the same thing, are Lantus and Levimir the same thing?

Are Lantus and Levimir 12-hour-apart dosages just like Vetsulin? (I don't mind a 24-hour dose but I'd need to arrange an every-6-hour-dose).

How do I know what dosage to give? Zarley has been fine (well until recently) on 1 unit of Vetsulin. If my vet won't help or claims that Lantus and Levimir are just for humans how do I determine dosage?

I don't understand the vials and pens stuff. I mean, I understand what a vial is, but others on here have recommended the pens because they last longer and are less expensive. I don't understand what they are. Are pens the insulin and the needle all in one? I mean, will I still be using syringes if I get the pens? I was paying $40 for Vetsulin. I saw on another website that Lantus (I think) is $100 per MONTH? Is that true? *trying to breathe*

For example I don't know what this means,"Lantus is available in a box of five 3ml cartridges designed for the refillable OptiClick Pen, or in a box of five 3ml prefilled SoloStar Pens."

Again please forgive what may be stupid questions. I just need to get Zarley on something else and fast. I have to do it in a few hours and I have NO IDEA what I'm asking for.

Thank you thank you thank you from both of us.
 
1. Lantus and Levemir are two different insulins with pretty much the same action and responses and the same protocol is used for both. They need to be dosed every 12 hours.

2. The vials are like what you used for Vetsulin. But most people buy the pens or cartridges because they will last longer since the insulin once opened is usually recommended by the respective manufacturers to be used for about 28 days for Lantus and 42 days for Levemir. So if you have the pens, you'd only be using one of them for a month or so and there is less waste. If you used the vial for a month, you would end up throwing away a lot more insulin.

3. Pens vs cartridges... some people like the pens because they sort of protect the insulin a little better if you drop it or something. But the cartridges can be used too. You do NOT need to get the pen needles that a pharmacy may try to sell you. You take a syringe and stick it in the rubber end of the cartridge or pen to get the insulin out. This way you can fine tune the dose. The pen needles have full unit dosing only, but like I said you don't need to buy the pen needle.

Here is a photo of the pen (Levemir) I didn't have a photo handy of Lantus pen, but probably the same idea. http://i5.photobucket.com/albums/y161/F ... MG0579.jpg

Here is a photo of using a syringe with the pen.
http://i5.photobucket.com/albums/y161/F ... MG0583.jpg

4. The dosage... well, usually kitties start low.. around 1.0 unit or less. If you've been using Vetsulin at 1 unit, then you'd probably start on Lantus or Levemir at 1.0 or 0.75 unit and work your way slowly up as needed. We go slowly so the correct dose doesn't get passed by.

5. Convincing your vet to use Lantus or Levemir. Many vets do use these insulins because they are gentle and the remission rate is higher than on Vetsulin.

Let me try to find an article that you can print out and take with you. I'll be right back.
 
Oh you are very welcome. Please come back and post here everyday, there are so many helpful people to guide, support, and encourage you and Zarley. We'll be looking for you real soon, Ok?
 
Hi Tracy! I'm glad CD was still on line to answer your questions. I'm fairly new to all of this too, but Mally, my cat, has been doing very well on Lantus.

I'm not sure what type of syringes are used with Vetsulin, so you may need to get different ones if you go with Lantus.

I started with the vial of Lantus and even though it's only good for one month for humans, you can use it longer for cats. I believe, however, you get more for your money if you go with the pens or cartridges. A little bit more of an initial layout moneywise, but in the long run it works out to be cheaper than the vials.
 
I was up almost all night.

I called the vet this morning. No apology. No concern. Just telling me I need to call back at 9:30 when the vet is there (the office opens at 8am).

No one seems to be able to tell me - how much money are we talking here? I keep hearing "value" and "more for my money." Are we talking $100 or $200 or ....?
 
Tracy0504 said:
No one seems to be able to tell me - how much money are we talking here? I keep hearing "value" and "more for my money." Are we talking $100 or $200 or ....?
Click to expand...


For that, you might want to call around to your local pharmacies and ask them how much it costs. It should be less then $200 for 5 cartridges or pens, that will be a 5 month (or longer) supply.
 
Where are you located, Tracy? I went to my local Walmart and bought a vial of Lantus for $103. I called around to some local pharmacies to price the vials, pens, and cartridges. My vet wrote a script for the vial and I went with that for now. Next time I'll go with the pens or cartridges.

Your best bet is to call around and price out the insulin. See what kind of prices you get. :smile:
 
I believe the one vial (10ml Chris?) is about $100

however the more economical would be the 5 pack/3ml cartridge/pens - good for 5 months

someone was here asking that a few days ago, and she had just called her local pharmacies, that would be ur best bet too.
 
Unfortunately, you will need a prescription in order to buy either Lantus or Levemir, unless you are in Canada, where no script is needed. You will also need U-100 insulin syringes, which you can purchase at the drugstore. You need the ones that are marked in 1/2 units.

The cartridges are the better buy by a long shot. A vial will cost you somewhere around $100-$120 and the initial outlay for 5 cartridges will be around $200 (unless you buy from an online Canadian pharmacy, in which case around $110). But those 5 cartridges will last you at least 5 months, maybe more. So about $40 a month or less. Call around to the local pharmacies and get prices...first off, a lot of them will need to order it and second, there is a BIG variance in price from one to the other. I believe it has been reported that Costco is the cheapest and that you don't have to be a member to buy drugs there.

Hope this helps...I believe you will need to find a new vet STAT! The news about Vetsulin is not new news and your vet should have been discussing this with you eons ago. How irresponsible!
 
Oh, and I forgot to say that the vet has to write the script specifically for the cartridge if that's the way you go. My prescription for Levemir reads like this:

Detemir - Cartridge formulation. 2u SQ BID. Adjust dose PRN based on blood guciose concentration.
 
Brenda and Morris said:
The cartridges are the better buy by a long shot. A vial will cost you somewhere around $100-$120 and the initial outlay for 5 cartridges will be around $200. But those 5 cartridges will last you at least 5 months, maybe more. So about $40 a month or less. Call around to the local pharmacies and get prices...first off, a lot of them will need to order it and second, there is a BIG variance in price from one to the other. I believe it has been reported that Costco is the cheapest and that you don't have to be a member to buy drugs there.

!
Click to expand...

I'm in the U.S. I'm sorry to keep asking (and now on no sleep). Is a cartridge the same as a pen? I need to tell the vet what I want. Her advice at this point means nothing. And yes, I'm switching vets after this (although if she argues with me or refuses to help I'll switch vets today).

THANK YOU all of you.
 
Here is a price comparison for Rx drugs http://www.edrugsearch.com/web.php?q=lantus&butSearch.x=0&butSearch.y=0&st=7 I didn't read it too closely but it shows there is a wide price range for Lantus.

For example America Pharmacy (online orders) has a discount price Lantus Brand Cartridges 100IU/ ml 15 mL (that's 1500U) retail price $191.09 Online discount price$146.99

I used Levemir and was able to use 1 cartridge for about 5 months (it was almost empty) Many people have used thier Lantus for several months. Unless your dose is more than 10U per day you won't use a whole pen/cartridge in 30 days, but you should be able to use it for several months, and have very little waste. Even if a pen only lasts 1 month for $150 you would have 5 months worth of insulin which is then $30 a month, I think Vetsulin and others cost at least that much. While a 10 ml vial of insulin (1000 units) costs about $80 if it only lasts one month it costs more. Plus a glass vial is breakable, should you drop it on the first day you are out $80 worth of insulin (and have none at home) If you drop a pen, first of all it is surrounded in plastic so less likely to break and if it does it's only a $30 loss and you have 4 more on hand. It's like the saying "don't put all your eggs in one basket".

The cartridges cost $10 per 100 units of insulin
A vial costs $8 per 100 units

The savings is $2 per 100 units, not much!
 
We are using levemir....and i want you to be sure to come back to LL and post so we can
talk to you about dosing, etc...k? we also started out on Vetsulin. If you think you were well regulated
at one time on that, you will LOVE either Lev of Lantus....The longer duration insulins stay with the kitty during the entire day
instead of leaving them with nothing as the Vetsulin Bid dose did.
I look forward to hearing back from you!! good luck! :-D
 
I called two local pharmacies. As some of you noted, Wal Mart is the least expensive. I got estimates on the vials ($110 or so) and the pens ($230).

I just talked to the vet. HUGE argument. She said the press release from November said only 1% of pets have had issues with Vetsulin and she finds it very hard to believe MY cat would be in that 1%. I then informed her that Vetsulin was discontinued by the manufacturer since last week. Stunned silence from her. She then verbally attacked me and said she just doesn't have the time to keep uptdated on things like feline diabetes and if I'm looking for top of the line diabetes treatment, I need to go elsewhere. OMG

I told her that at this point I can switch vets but I need her to help me help my cat NOW. I told her I needed even Lantus or Levimir (she said she'd never heard of either). I told her what pharmacy I needed and that I needed pens. She said something like, "Well I can't call something in right now because I need to research this more."

I said, "Well, it's Friday and his numbers are through the roof. I need something done today."

She also said knowing nothing about dosages, she can't legally prescribe it (but it was okay for her to give me insulin that had an FDA warning). I told her the pharmacy stated the cartridges or pens only come in 3ml vials. She then asked me how many units per milliliter (or something like that). I didn't know the answer. She told me to sit by the phone and she'll call me back.

I so badly want to call another vet right now but THEN we'd be looking at an office visit charge, stress on the cat AND the cost of the insulin.
 
Lantus is a human insulin all human insulin are U100 that means 100 units per millileter.

Your Rx should be for something like this

Lantus SoloStar insulin pens 5x 3ml each 100unit/ml 15 mL
Manufacturer: Aventis
 
Your vet is right -- she does not take continuing veterinary education seriously.

If you want pens, you need to ask her to write the Rx for Lantus Solostar pens, 100 units/ml (or U-100), 5 x 3ml.
For the benefit of your vet, the dose should read: 1.0 units subcutaneously twice daily. (We can help you sort out the dose issue.)

The units/ml is the concentration of the insulin. Some are U-40; Lantus/Lev are U-100. You need to make sure you have U-100 syringes. The 5 x 3ml in the Rx indicates that there are 5 pens each containing 3 ml of insulin.

You vet is not incorrect -- Lantus has not been FDA approved for animal use. It's use in FD is off-label. That doesn't mean it shouldn't be used that way. There are a sufficient number of articles in highly regarded veterinary journals that she should be familiar with and that support the use of Lantus and Levemir.

If you post your city and state both here and on the Health board, people may be able to recommend a vet who is better informed about FD. If you have a vet who is ill informed but will learn with you, that's a good thing. A vet who doesn't want to learn -- I'd encourage you to find a new vet.
 
oh my goodness! Very irresponsible vet.

I will tell you something - I had bad vet issues with my 2nd vet, I couldn't take it anymore, bit the bullet and paid for a consult with a new vet.
Was it worth the basic fee? yes. very much.

Dont let this vet push u around. You do what u feel is right - because this vet has clearly shown a complete disregard for ur pet.

And if ur up for it later, definitely report her.
 
Tracey I can see you've got more stressed as the day has worn on.

Yes your vet hasn't kept up to date and of course she's been caught out and therefore defensive.
I appreciate what you've said about another vet and associated costs. Why don't you write down what it is you need to ask her to write on script (so the 5x 3ml pens/cartridges) that others have quoted. Either wait for her to ring or you ring her and 'smooth' her ego.

' Iknow it must be terribly hard for you to keep up to date with all the changes in medications,progress and research, not for just one species but a multitude...blah blah' I think we could do this together and it would really work for Zarley....blah blah'

Get her on your side, regardless how you feel inside, if it's going to save stress to you and Zarley but get you that script, bite your lip and go for it!

Hocks.com seems to be a good on-line source for syringes.
You need 1/2 unit 30g something u100 syringes (sorry on work computer so haven't got the exact details you need)
You can get relion ones from Walmart-anyone else from USA assist here?

There cheap (and I really liked the box Heather bought back for us, so smooth)

I'd say we're looking at 1u as I said on your other thread, 12 hours after Zarley's vetsulin shot. (assuming he's still in the 400's)
LL (Here) is a fantastic ISG with lots of support, help and advice. You just need your vet for other stuff and the script!!! :lol:


Hang in there, you'll find a way I'm sure.

Be watching for you :-D
 
Hi and welcome. I hope this gets straightened out soon. People can be so difficult!

I just wanted to say that we have been using the same vial of Lantus for 3 months with no problem.

I hate to see a vet (or anyone) behave like that. So defensive! And most vets, in my experience, really want to help your animal. I'm sorry you have a clunker!!
 
THE VET IS REFUSING to let me have Lantus or Levimir.

She said she called the doctor at Vetsulin (!!!!) who assured her the product is still safe but to transition the pet to another insulin in the next 30-60 days !!!)

She then told me the stuff about Lantus or Levimir for cats on the web is all URBAN LEGEND. She said she can order something called Prozine that will be in her office on Monday or Tuesday and I can start him on that. She said if I put him on Lantus or Levimir, I will either kill him or he will be at an emergency vets office before I know it.

She also told me to ignore Zarley's high numbers. That if he's not sitting in front of his water bowl drinking like crazy then that's when I should worry.
 
UPDATE TO THE UPDATE

The vet just called back and said she is calling in the Lantus to the pharmacy. When I asked why she'd changed her mind, she said she found the dosage information and then added sarcastically, "And it's not MY cat."
 
WooHoooo :mrgreen:

There's somebody who knows they overstepped the mark!!!!

Just let us know when you have the insulin and the 1/2 unit syringes (you can manage with whole unit, but really quite difficult to guesstimate .25u or a .75u measure)

You don't use your vetsulin syringes as they are for u40 insulin (you'd be way overdosing your cat using them with a u100 insulin, by about 2 1/2 times)

Do you have a spread sheet?
Not to worry if not, just post the last few days numbers, get a preshot reading with a 30 minute window to check advice here for dose you should give.

Is there anything else we can help with right now?

Ooooo soooo pleased for you :mrgreen:
 
Well she's refusing to call in the pens. She said they MUST be used with a special gun you can only get from your doctor. She at least called in a vial. I guess I'll pick my battles.

I'll take a vial to start. I'll argue about the pens later (and talk to the pharmacists when I pick up the script from the pharmacy).

I had a spreadsheet at one point but I need to see if it's still there. At some point I stopped using the online one in favor of an electronic one.

By the way, I don't think Zarley is peeing enough for his numbers being so high. But he is peeing. I'm just concerned since he usually pees a LOT when his numbers are up. Seeing only a large circle instead of a puddle is a concern.

I will definitely get the syringes today and will defintely post a pre-shot.

For now I need to lay down. Now way I can drive on a few hours of sleep.

THANK YOU THANK YOU THANK YOU ALL OF YOU!!!
 
chair.gif
insane.gif
throwrock.gif
slapsense.gif


:shock: Seriously.
 
What a day you've had!

FWIW, your vet is an idiot. Well, maybe not an idiot but certainly at a loss for common sense. (Sorry. That's totally tactless.) She could have called any vet school in the country and spoken to a veterinary pharmacist or pharmacologist and they would have generously given her more information that she knew what to do with about the ins and outs of Lantus and/or Levemir. I've called the vet school pharmacy at Univ. of IL which is the vet school closest to me. Just like the pharmacist at any medical center or even Walgreens, the staff there were eager to help and answer questions. That's what pharmacists do. They advise doctors and patients on the safe use of the medications they are dispensing. When I needed a bit more info about a particular issue, they connected me with a faculty member who specialized in feline dermatology. The pharmacy folks LOVE to help.

When you feel up to it, if you post the city and state where you live both here and on the Health board, people may be able to recommend a vet to you who is more up to speed on feline diabetes and the use of long acting insulins like Lantus and Levemir.

Congrats to you for doing your homework. And while it is certainly possible for any of us to acquire more expertise on a single illness than a vet who is in general practice and dealing with a wide variety of species and illnesses, this vet's behavior is considerably less than admirable.
 
Sounds like your vet is worse than mine and he's a goner. You don't need that extra stress right now. At least you have a script for the next month and can do a little vet research. Seriously, a lot of vets just don't know that much about FD. Give your city & state and there may be someone near who can advise on a good vet.

Tess just started Lantus last week so I am no expert, but her numbers really came down with it. What I do know is a lot of the research I've done on resources. Costco was the cheapest place I've found for Lantus, $182 for 5 cartridges w/ a member discount. They included a flier in the bag stating that Levemir was on their preferred formulary and would be considerably cheaper. I'm happy with Lantus and am sticking with it, but for people with real budget concerns that might be the way to go. From what I've read here, the two insulins are pretty equivalent. Someone who knows more here can advise.

As for syringes, you need the 100U ones. The half unit ones are difficult to find retail, If you are starting out shooting a full unit no problem. You can usually get a 10 count package or 2 to hold you over until a mail order of the half unit arrive. Some Walmarts have them, but apparently not all.
 
You guys make me want to cry just out of gratitude alone.

To answer the city/state question, I live in a rural area. I mean so rural my town has no traffic lights. The vets are all in the closest town over. There are only three vets here. One is the one I go to, the second one is friendly but incompetent (!!!) and the third one is more professional but I had a falling out with him years and years ago. At the time, my cat, Ranger, went there for a upper respiratory infection - he'd had them since he was younger. They decided to give him a shot and there were like two techs and the vet's wife holding the cat down (Ranger was a sweetheart normally but really stressed out at the vet's office). The vet's wife (who I'm pretty sure at the time wasn't a vet tech), administered the shot in Ranger's throat (!!!). At the time, I still trusted doctors and said nothing.

I brought Ranger home and he refused to eat or drink. The vet called and asked how the cat was doing. When I said he wasn't eating or drinking, the vet got very defensive and told me he didn't appreciate my "accusatory remarks." ???? I ended up taking Ranger to my current vet who ran a bunch of tests, said nothing was wrong and (in her usual sarcastic way) said that it's not like the cat was going to starve to death. He never ate or drank again. It was agonizing to watch and I wanted to do the humane thing. The morning he was scheuduled to be euthanized, I found him in my spare bedroom. He'd already died.

SO! Those are my choices. I've heard that the "accusatory" vet now has a partner who specializes in cat health. I think that's my best bet.

I got the Lantus and the syringes. As a few of you said, the pharmacists were all too happy to help and provide information today. The one pharmacist said I CAN get the cartridges next time but she said she's not sure if you can easily extract insulin using them (it sounds like from a lot of your posts here, you CAN do it).

I have my caro syrup, my ketone strips, a whole box of diabetic test strips. I'm going to get Zarley's spreadsheet going again and will be back on here tomorrow (in a new thread) posting pre-shot info. I don't want to give him his first shot tonight. I'll do it tomorrow so I can monitor him. I'm terrified. I almost feel like I'm starting all over again. And to be honest, my vet this morning scared the hell out of me and I'm afraid I'm going to kill him. New insulin, new syringes. I feel overwhelmed. I'm going to spend time tonight reading the Lantus info on here again (for example, I was surprised it's not refrigerated when its sold like Vetsulin). THANK YOU THANK YOU THANK YOU all of you, again. Wow.
 
I wish I had more time. I didn't get to read all of this thread but it is a story I have heard and lived before. I sure hope all goes well for you guys and stick around here -- you can't get more up-to-date info on Lantus and FD anywhere else.

I just want to throw out a quick note on my experience.
I had a vet that was overdosing Noisy (22u a day and wanted to keep raising it). Once I got the Lantus in my hands I never went to a vet for Noisy's diabetes again. We did great here in Lantus and Noisy went into remission here (OTJ.) I AM NOT ADVOCATING THAT PEOPLE DO NOT GO TO A VET -- I only mention my brief story because I have a feeling this vet isn't up-to-date on FD and all vets are not great. Noisy and I went to vets, just not for his FD.

Here is a list of kitties, from this forum, who went into remission on Lantus and Lev.

103 OTJ kitties since February 2008
:-D Pelusa :-D Raja :-D Bruce :-D Scruffy :-D Noisy :-D Cyrano :-D Chuck :-D Cosmo :-D Tobias :-D Flamie :-D Thomas :-D Brutus :-D Abby :-D Alex :-D Lexie :-D Tom :-D Smokie :-D Friday :-D Chloe :-D Calliope :-D Natasha :-D Gracie :-D Alex :-D Shadow :-D Grover :-D Fluffy :-D Mary :-D Rocket :-D Petie :-D Harley :-D Karre :-D Venice :-D Butcher :-D BigMac :-D Ti-Mi :-D Zoe :-D Devo :-D Tuxedo :-D Pumpkin :-D Oscar :-D Morrie :-D Olivia :-D Fuzzy :-D Riggs :-D Cobra :-D Chip :-D Rosco :-D Emo :-D Jake :-D Peepee :-D Nosey :-D Lucy :-D Kato :-D Tom :-D Rascal :-D Cream :-D Chico :-D Casper :-D Maui :-D Crash :-D Blackjack :-D Joey :-D Arlene :-D Tom :-D Kahuna :-D Big :-D Boy :-D Mika :-D Buster :-D Grey :-D Boy :-D Smokie :-D Spooky :-D Cruiser :-D Sparky :-D Miss :-D Kitty :-D Raistlin :-D Boo :-D Seamus :-D Marco :-D Tizon :-D Scar :-D Alex* :-D Black Kitty :-D Guinness :-D Beethoven :-D Jesse :-D Moon :-D Barry :-D Beeker :-D Raja :-D Nefeli :-D Rocky :-D Tummy :-D Callie :-D Milo :-D Grace :-D Matty :-D Porky :-D Scruffy :-D Luna :-D MEL :-D Tommy :-D Indy :-D Jasper :-D Velcro :-D
 
Ummmm.... Tracy, it should be refrigerated.

From our proper use sticky above:

* In-use and unopened Lantus and Levemir should be stored in the refrigerator between 36 to 46 degrees F (2 to 8 degrees C).
Be careful your refrigerator is not so cold that the insulin freezes. Do NOT use Lantus or Levemir if it has been frozen.

Please call your pharmacy and ask why they did not refrigerate.
 
Sienne and Gabby said:
Ummmm.... Tracy, it should be refrigerated.

From our proper use sticky above:

* In-use and unopened Lantus and Levemir should be stored in the refrigerator between 36 to 46 degrees F (2 to 8 degrees C).
Be careful your refrigerator is not so cold that the insulin freezes. Do NOT use Lantus or Levemir if it has been frozen.

Please call your pharmacy and ask why they did not refrigerate.
Click to expand...

Not arguing, but just want to state that when my order from Canada arrived in Florida with the ice packs melted, I spoke to the Canadian pharmacist about it. He said that unopened Levemir can be unrefrigerated up to 28 days with no damage but to refrigerate after opening of course.

I'm still using it 4 months later and seems OK...I have changed carts every 30 days or so just in case.
 
Hi Tracy,

Hope you're still reading this post. I'm so sorry you've had such a difficult time with the vet. Too many of us have dealt with ______________ vets (you choose the adjective) and have had to make the tough decision to go it alone.

Well actually you aren't alone. You are part of this community and while yes, you are trusting strangers on the internet. I can tell you from being here almost one year, that for Maui - it was a blessing! I trusted the strangers and she benefited.

What a horrible story about Ranger, I am so sorry that you both had to deal with that. It's a shame that you have very limited vet options where you are. I'm wondering, how far is another large town with more vet options? It may be worth calling some of these further out places and talking with the vets there. Just asking some general FD questions about insulin choice, home testing and method of treatment.

While the folks here will do everything possible to guide you through this process, it is important to have a competent vet that you can rely on when needed. We are not vets and sometimes situations arise where you need a vet and one that you can feel comfortable with.

Regarding the vial vs. cartridge/pen. Honestly, at this point, you have the Lantus and that is what is important. When you have a moment, check out the starred posts above, so that you better understand how to use, store and work with lantus, as well as see the pics of how to use the syringe with the pens.

the good part of having the vial, you don't have to worry about running out of insulin anytime soon. ;-) And disregard what the label says about it only lasting 28 days. That is the manufacturer recommendation, however, there have been many discussions that Lantus will last much longer than that. I used one vial for the entire time Maui needed it, then gave the leftover to my mom for her use.

So, hope you had a good night sleep and are fresh and ready to start your journey on Lantus.

Welcome to the group!
 
Status
Not open for further replies.
Back
Top