+10 554 amps 507 +3 332 +10 302 pmps 321 .75u

will update #'s as they come in.
tom's feeling fabulous and is out chasing butterflies on this gorgouse 80 degree morning.
p's in place.
I am trying to start with a fresh softer kinder approach.

 

Re: +10 554 amps 507 1u

I don't normally post in LL, but if Lori is moving over here I want those making suggestions to think about this:

I have looked at Tom's SS several times and what I see is that Tom is bouncing on lev causing a low pmPS that she can't shoot the "full" dose on and then she is still trying to "shoot down" the higher amPS.

Yesterday he dropped at least 450 points! (600+ to 155) That alone, regardless of the nadir being mid 100s, will cause rebound.

As long as he continues to get 1u in the am, he will be too low in the pm for 1u. Lev needs consitencey and the way out of these bounces is to drop the dose.

Lori, I wish you had stuck with the .6u this am like you said you would last night (on Health). It will take several cycles, but he will even out. Now, with the 1u again (most likely 50% too much) he will drop 300 points or more AGAIN and keep the pendulum swinging.

 

Re: +10 554 amps 507 1u

507 amps is better than 600+! I hope Tom is on his way to evening out with this 1u dose!

 

Re: +10 554 amps 507 +3 332

has a dr. or vet ever said these words to you "a little knowledge can be dangerous"
sometimes it's true...sometimes it's just not true.
i don't know yet. so i'm stickin with my gut that this is not rebound and a case of too little insulin.
if i am wrong i have no problem saying in humble words, my mistake.

ya know...it's weird 4 years into the game and being treated as if you no nothing about your cat or about fd.
i am a newbie on this insulin granted...but give me a little room for err, knowing i do know my cat, i do know how to treat a hypo and am now keenly aware of how a hypo might sneak up on us. i will be vigilent. my gut says .25 was too little. .6 was too little. my gut says this is not rebound.
give me a little berth, please, i will take your words and my 'little bit of knowledge' and work with what i got.
k?

 

A note about consistency

Unfortunately, consistency doesn't mean a whole lot when the dose is too high to begin with.

More and more we are seeing cats coming from another insulin to Levemir who begin at too high of dose because it was based on their previous insulin's dose or because they read the Tilly protocol and see 1U or the weight recommendation. I spouted the begin-with-1U mantra for years myself.

It wasn't until Sheila came to the Lev ISG with Beau, that I learned that Levemir is the Gentle Giant. After 2 years on Vetsulin Beau was OTJ on Levemir within 3 months because Sheila identified he was rebounding on even .5U. Even such a tiny amount can wallop diabetes!

500s and 600s are not "normal" BGs for Levemir. Forget that "Levemir can't handle those numbers," we are seeing that with Tom it evidently can.

Think about that for a minute. 1U of an insulin notorious for not being able to handle extreme rebound numbers (500+ is almost always a rebound number) is dropping Tom by over 300 points. Why do you think that might be?

Because the 1U dose is too high.

Levemir likes consistency, yes, consistency in time, consistency in dose and consistency in blood glucose. You must allow Levemir to level out the blood glucose before you can begin to say you're close to an optimum dose. The way to do that is the start low and go slow approach. And the thinking needs to become very low dose, like .5U.

Yes, we bang that drum pretty loudly in Lev ISG. That's because it works. I don't mean to belittle any of the advice that's been given so far, but telling Lori to maintain a too high dose is going to continue to cause her upset and confusion because that's what doses that are too high do!! They create irrational patterns and the caregiver is left bewildered.

Lori, the .6U did not "work" because it needs time to work. You will rarely see a reliable trend with Levemir after 1 use of a particular dose. Please consider the possibility that Levemir will make you rethink everything you thought you knew about Tom's diabetes. You may have instinct about Tom, but not about Levemir. You cannot force it to work the way you think it should or will or the way PZI worked for Tom.

I know you are seeing 2 camps of approach right now - the 1U camp and the lesser dose camp. So ask yourself, is the 1U dose working? No, it does not seem to be. And very unlike PZI or Prozinc, you cannot throw more Levemir at higher BGs. That only compounds the problem of a dose which is already too high.

If you are ketone testing regularly (you are, right?), please consider going to .5U and maintaining as close to 12/12 schedule as you can (no more than 30 minutes either way if you can absolutely help it) through the weekend at the very least, then re-evaluate his progress on Monday. I am willing to bet you'll see a difference. That's what it's going to take to get these numbers to calm down. You have to work within the strength of Levemir, which is to maintain a steady level of blood glucose. Not the curves you see with faster acting insulins. Even a tiny dose is capable of that and when several of us very experienced Levemir users see 500s, the too high dose bell goes off.

BTW, Tom chasing butterflies reminds me of Gandalf after 2 weeks on Levemir outside catching a mouse! He had come off 2 1/2 years of swinging numbers on PZI and felt fabulous. So take heart and watch Tom playing - he doesn't know his momma is having trouble helping him. He knows he feels darn good and despite the difficulties, you have Levemir to thank for that, so I hope you'll keep an open mind and keep learning what others know about Levemir instead of trying to shout everyone down.

I am posting this also on Health.

 

Re: +10 554 amps 507 +3 332 +10 302

his +10 surprised me. he has been lower than this by far at +10.

 

Re: +10 554 amps 507 +3 332 +10 302

i wrote my words of appreciation on the concurrent thread going on here. i have accepted i know nothing and am willing to put myself in your hands.
based on this new +10 and looking at ss do you still want me to only shoot .75 tonight which is the new agreed upon dose for 3 whole days.
still?

 

Re: +10 554 amps 507 +3 332 +10 302

From the notes on your spreadsheet, it looks like you shot at +12 this morning instead of an hour early at +11 like you had been doing the past two days to get back on track. I am guessing that shooting an hour early the previous days gave you much lower numbers because you had more overlap than there should be. He could do something vastly different tomorrow as he settles in though. His body needs to get used to a normal pattern of insulin. I would recommend keeping with the 0.75u to see how he settles in. You don't yet have an idea of how he reacts to this dose without the alteration of shot times and/or dosing.

 

Re: +10 554 amps 507 +3 332 +10 302

after reading through all these posts here and on Health...
yes, i'd shoot 0.75u on as close to a 12/12 schedule as possible. shooting 1u has left you uncomfortable consistently shooting a full dose, so it just makes sense to reduce the dose to 0.75 unit. collect your data. we'll re-evaluate after at least 6 cycles (unless tom drops low enough for a reduction).

one thing to remember with the Ls...
a single dose can effect what you're seeing for up to the next 3 days. so don't expect miracles overnight, k?
we need to see what a consistent dose of 0.75u can do.

 

Re: +10 554 amps 507 +3 332 +10 302

Vicky --

No one in LL was insisting on Lori shooting 1.0u. Here's the recommendation from yesterday:

Just to also add, as you noted, the Tilly Protocol does provide a formula for initial dose based on a cat's ideal weight. It also stipulates that for a cat who is switching to Lantus or Lev, that the dose on the previous insulin be taken into consideration. I'm also sure you're aware that the Rand/Queensland protocol notes that the dose on Lev is approximately 30% that of Lantus. (I'm including this for newbies or others contemplating a switch to Lev.) So yes, Lev may indeed be a gentle giant!

 

ok shot pmps only 15 minutes late .75 into 321. a surfin 320's i might add.
i will do this for 6 cycles, 3 days.
please do not let his high's (400-600+) linger if that is where this dosecreas takes him. i will do it if you say it is right but i hope you won't say it is right.
tom is completely at your mercy as i am already not shooting my preferred dose.
i will do what your experience and wisdom says is right.
.75 12/12 give or take 15 minutes. which i can't promise will last all the time but i will certainly try
thank you for your patience and persistance.
it's been a long day but i am happy tonight and feel resolved.

 

sounds good.

lori, these are the guidelines we usually follow:

• Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).

• Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).

• Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...

• Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.

• After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.

• After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

http://felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

as you can see, it's all about nadirs. it'll be up to you to collect the necessary data needed to make dosing decisions.

glad you're feeling better. now don't forget that before bed spot check tonight! :lol:

 

I'm glad you're feeling happier tonight, Lori, and I'm glad you reduced. I hope you see better numbers soon. I know the switch is hard, but I think Lev might be a really good thing for Tom. Tinkles is a totally different cat on Lantus than he was on ProZinc, he feels so much better. I hope you get the same positive results! :smile: