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-   -   Sissy became an Angel December 29, 2016 (http://k9diabetes.com/forum/showthread.php?t=5557)

stylynjm 07-19-2013 04:02 PM

Re: Sissy's Mom
thanks Jessegirl,
I am worried about the cost of levemir. I can't do 175.00 every month. Does R work the same???:confused::eek:

momofdecker 07-19-2013 04:17 PM

Re: Sissy's Mom
Levemir comes in a 10ml vial - same as NPH. Same needles can be used too. We last bought a vial in Oct. 2012 and paid 136.00. Believe it has gone up quite a bit since then. It also comes in 3ml pens, which you can use the needle to withdraw the insulin from, then inject as you normally would. The cost for the pens is higher but you get several pens.

The data sheets says to only use the insulin for 42 days. We used nearly the entire vial each time. Think we went through three vials. The last vial lasted from Oct. 2012 to about a week before Decker passed away (mid Jan 2013). His insulin needs ranged from 3.5u to 5.5u during that time frame. We kept it refrigerated and being a clear insulin, we never noticed a problem with potency. We did keep several doses worth in each vial to have on hand as emergency back up, given that it was costly and required a prescription.

Decker's initial script was written for 5u. He went up to 10u and we ran into a challenge trying to refill it, because according to the pharmacy records, at 5u, he should not have been due for a refill for another 40 some odd days. If you go that route I'd have the vet write it for something along the lines of, 'use as directed.'

Sissy's wobbles do remind me a lot of Decker's early on. He was difficult to find ways to adjust because he was never consistent from day to day. One day he'd rise after eating. The next he'd drop. Some days he had large swings. Some days steady lines. There was no rhyme and reason and it drove me crazy because I didn't have enough to go on to figure out how to help him.

The levemir was a small miracle for him in that it provided him with a very steady curve pattern. One that we were able to use to work him backwards once he started his thyroid meds and adjust when he went on steroids, even when he was on every other day dosing of them. Having those patterns and trends was without question the key to us being able to keep him safe and in a good range during those times.

Having said that, just because it worked well for Decker, I can't say it will for Sissy. As you know, every dog is different. Any insulin that provided him with enough stability so we could track trends would have been something I thought was wonderful! Levemir just happened to work. Had he not been overdosed on NPH early on, that may have very well worked for him too.

As Jesse Girl mentioned, levemir is four times a potent as NPH. And with Sissy being a smaller dog it may become challenging to micro dose. Decker was very sensitive to increases with NPH but not so much with levemir. With him we got to the point we stopped thinking of it as being four times as potent and just focused on what his trends were and how it worked for him. We could shift 1u or even 1.5u (equiv. of 4u - 6u in NHP) and never had any worries once we'd done enough testing. When he was running more elevated than normal we could even give 1u additional insulin up to an hour post his normal dose time and it didn't interfere (for him) with his next 12 hour cycle. We never would have adjusted him by 4u-6u at a time on NPH nor would we have given him additional insulin.

It also seems that not many vets have a lot of experience with levemir so when they decide to switch dogs they take a cautious route and reduce the dose. Decker went from 37u of NPH to only 5u levemir (equiv. to 20u NPH).

I don't know much about vetsulin but wonder if that may be a better starting point? I know that does have less insulin per vial and does require a different needle. I'm sure others can give you info on costs and how long it lasts. I think you mentioned that you were not sure your vet / IMS had access to vetsulin but it might be worth going back to see if they can find access to it for Sissy.

Still pulling for the two of you!

Believe you are coming up on your one year celebration. Wishing you a happy early anniversary! You'e done a wonderful job and will get Sissy in a place you are both happy with - I have no doubt!

Just wanted to touch on your cost comment - if you were only using 2u of levemir, 4u total per day, a 1000u vial would last 250 days, provided you didn't notice any decrease or other problem in potency. So though the upfront cost is a lot more, the longer term cost may end up being similar to what you are paying for novolin.

stylynjm 07-19-2013 04:35 PM

Re: Sissy's Mom
Thank you so much for your info. Wow, 132.00 is lowest I can find. Not sure I can swing it money wise, just feeling helpless.

I wonder if a little more nph and maybe R or another food change might help.
Maybe adding chicken??? I don't know, really confused, but can't change anything yet, until I see where Sissy is going with this food change.
I guess I need to give it another week or two, but vet is not happy with still high bg's.??????????

Just really looking for something that can work for both Sissy and me!!!:eek:


jesse girl 07-19-2013 04:37 PM

Re: Sissy's Mom
i think hollie gives a great look how levemir works for dogs and many say they have the same response

r is a fast acting insulin mostly used if a dog gets a substantial rise after food where nph just cant keep up with . so if you have a pup that drops after food and shot its probably not appropriate we also use as a correction to higher numbers .

i think we talked about this before jesse reacts to insulin at different fasting levels the lower she is the harder she rises and the opposite happens when she is higher and drops so for jesse this gives her wobbly affect and there appears to be a rhyme and reason to it as her body seems to recognize her level of blood sugar and appears this is how her body reacts

so if jesse has constant fasting numbers she does very well but we have figured how to adjust to different levels when we see different fastings

i really donr think food is the culprit seeing very high numbers with insulin in the system just my thoughts

momofdecker 07-19-2013 05:10 PM

Re: Sissy's Mom

Originally Posted by stylynjm (Post 110635)
Thank you so much for your info. Wow, 132.00 is lowest I can find. Not sure I can swing it money wise, just feeling helpless.

Here is how I break down the cost:

Assume you give Sissy Novolin N for 30 days before it loses potency.

9 months worth of insulin at 25.00 per vial = approx. 225.00

If Sissy uses 4u total of levemir per day, a 1000u would last 250 days.

Divide 250 by seven days per week = approx. 35 weeks
Divide 35 weeks by four (to get approx. months) = 8.75 months

So Novolin cost for 9 months would be approx. 225.00
Levemir cost for approx. 9 months would be 132.00 - 175.00

The first vial was tough because we didn't have a lot of upfront money. After that we simply set aside the 25.00 we would have paid per month for the NPH and when we needed a new vial of levemir, five months down the road, we had most of the upfront cost.

A lot of folks don't realize that because of the potency of levemir you only use 1/4 as much insulin you use with NPH. So if Sissy were up to 8u NPH - 16 u per day, she may end up (depending on how she may respond) around 2u (4u per day) on levemir. And that upfront cost of 100+ dollars is a lot to digest when you are used to seeing 25.00 per month. But levemir is also a clear insulin and may very well last to the end of the vial (where NPH often loses potency around 30 days). So that 100+ dollar cost may potentially cover close to a nine month span for Sissy. So.... depending on how much insulin your dog uses, the cost can be quite close to novolin and often less expensive than humulin. Hope this makes sense. Just hate you to rule out levemir for costs alone.

stylynjm 07-19-2013 05:34 PM

Re: Sissy's Mom
So Holi,
Levemir would last 4-6 months. They said 42 days. I know that is just what the bottle says, but if it would last 4-6 months, yes, it would be worth it. where did you buy it, do you remember??
Thanks for making the picture clearer:D

Patty 07-19-2013 06:19 PM

Re: Sissy's Mom
My two cents worth ;)...you have 2 days worth of data on the food change. That's not much to go on in considering another food and/or insulin change. I really think you have a lot of room to tweak things.

If after tomorrow her trend is looking the same as the last 2 days and there are no rapid drops, I'd increase her insulin slightly to get her out of the 300-400s.

If you just aren't happy with the food aside from numbers, that's a different matter and I wouldn't mess around with making something work that you don't want to feed. But if it's the numbers that are worrying you, I don't think you have enough data to determine it won't work or can't be tweaked yet.


stylynjm 07-19-2013 06:49 PM

Re: Sissy's Mom
Patty, thank you. I agree. I think I need at least another week, with Sissy being so slow to change. I am happy with the food change as long as it is a step in the right direction.
I think I figured her food right, but here are the numbers. Check your calulations on it, maybe she is getting to many calories.
She was getting 1 1/4 cups a day at 311 calories a cup.
Now, she gets 1 cup at 488 calories a cup. Am I way over, I thought I was about 40 cals higher???See what you get!!;)
Tonight Sissy was 305, and I gave her 7 units. maybe that will drop her some??? she has been on 7 units, but above 350!!!so a tiny raise in insulin.

Thanks so much;)


momofdecker 07-19-2013 07:13 PM

Re: Sissy's Mom

Originally Posted by stylynjm (Post 110638)
So Holi,
Levemir would last 4-6 months. They said 42 days. I know that is just what the bottle says, but if it would last 4-6 months, yes, it would be worth it. where did you buy it, do you remember??
Thanks for making the picture clearer:D

Yes, for Decker the vial did last well beyond the 42 days. His last vial lasted around four months. The vial was near empty - we only left a couple of days worth of insulin in it for emergency back up purposes.

Dawn, Bogie's mom, is the only person off hand that I can think of that uses levemir at a dose close to what Decker was on. I'm not sure if she uses the vial or pens for Bogie though. She may be able to give you some additional feedback on how the potency holds up for Bogie.

We were fortunate and had one of the pens donated to us and it was shipped from out of state. We used it when Decker's last vial ran out. Never saw any potency issues with the pen either.

We'd called around when Decker was switched and our local Price Chopper grocery store had the lowest cost. I think it has since gone up and Wal-Mart may now have the cheapest cost near me.

stylynjm 07-19-2013 07:28 PM

Re: Sissy's Mom
oh Patty, sorry. The Wellness has 360 calories per cup!!!! So very close, within 20 cals??;)

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