? Keno 2/1 AMPS 347 - Should I switch from Lantus to Levemir?

[jacereske]

Previous condo

Keno has been fully transitioned to low carb food since 12/1/16. Her numbers are better but she is still not regulated and I see big highs and lows.

I am wondering if a switch to Levemir might even things out?

thanks,
Jeanette

 

[jacereske]

Bump

 

[Wendy&Neko]

Typically we suggest that people give Lantus about 6 months before considering whether to switch to another insulin. It has been that long now. I think what would be best for Keno is to stick to the SLGS guidelines for dosing, and see how it does first. Hold each dose a week, then do a curve and re-evaluate the dose. I see a lot of inconsistent dosing going on. Changes are to be made in 0.25 unit increments. Either for a decrease if she goes under 90 (like yesterday) or increase if nadirs aren't below 150. As a result of yesterday's 69, her new dose would be 3.75 units. I'd also like to see more curves in there to verify that +6 is indeed her nadir as that is when you are doing the mid cycle tests. Nadirs can and do change.

It's not uncommon for cats to bounce a lot. Heck, even my girl liked to bounce after 5 years on insulin. She still liked to bounce on Levemir, though maybe not as high as she did on Lantus. I liked Levemir better, but I have also seen some cats remain as bouncy on it. There is also the matter of the later nadir. Not all people can handle a later onset and nadir in their schedules. It worked for me, because 4 days out of 7 during the season, I was getting up at 4:30 for my exercise, and that was around Neko's nadir.

 

[Sienne and Gabby (GA)]

I agree with Wendy's observations. Holding the dose overly long can make it harder to see the kind of response you're looking for which is why you want to evaluate how effective the dose is after a week since you're following SLGS.

Also, I'd suggest not testing at the same time if that's possible. You want to get your pre-shot tests but if you can get some spot checks at times other than at AM+6 and PM +2, you may find that there are some lower numbers that you haven't been able to catch. Not all cats have their nadir at +6. (My cat's nadir was at around +3 -- except when it wasn't.)

 

[jacereske]

Typically we suggest that people give Lantus about 6 months before considering whether to switch to another insulin. It has been that long now. I think what would be best for Keno is to stick to the SLGS guidelines for dosing, and see how it does first. Hold each dose a week, then do a curve and re-evaluate the dose. I see a lot of inconsistent dosing going on. Changes are to be made in 0.25 unit increments. Either for a decrease if she goes under 90 (like yesterday) or increase if nadirs aren't below 150. As a result of yesterday's 69, her new dose would be 3.75 units. I'd also like to see more curves in there to verify that +6 is indeed her nadir as that is when you are doing the mid cycle tests. Nadirs can and do change.

It's not uncommon for cats to bounce a lot. Heck, even my girl liked to bounce after 5 years on insulin. She still liked to bounce on Levemir, though maybe not as high as she did on Lantus. I liked Levemir better, but I have also seen some cats remain as bouncy on it. There is also the matter of the later nadir. Not all people can handle a later onset and nadir in their schedules. It worked for me, because 4 days out of 7 during the season, I was getting up at 4:30 for my exercise, and that was around Neko's nadir.

Thanks Wendy.

The reason for the inconsistent doses is that I'm very hesitant to give 4 units when she is under 250 since I don't have any history of how low she will go. It seems like every time she is under 250 it is either at night or it's a day when I won't be there to keep an eye on her and do more testing. I have been cautiously increasing her under 250 dose by .25 and she now gets 3.25 when she is under 250. The next time I will be home to monitor and she is under 250 I am going to try 3.5

It concerns me that I am still seeng her AMPS and PMPS over 300. I know she drops after her shot but I would really like to get her under 300 at AMPS and PMPS.

I have been dancing around between 3.75 u and 4 u. Last time she was 66 at nadir I dropped to 3.75 but had to go back to 4 u as her BGs started to climb again.

I'm not able to do a curve once a week with my current schedule and my husband won't do one. The soonest I'll be able to do a curve is this Saturday. It is difficult since I work full time at an office. My husband will do the +6 test, but he is very uncomfortable doing more than that and he gets fussy when I change things up. Not helpful in this situation at all, but it's what I have to work with.

thanks,
Jeanette

 

[jacereske]

I agree with Wendy's observations. Holding the dose overly long can make it harder to see the kind of response you're looking for which is why you want to evaluate how effective the dose is after a week since you're following SLGS.

Also, I'd suggest not testing at the same time if that's possible. You want to get your pre-shot tests but if you can get some spot checks at times other than at AM+6 and PM +2, you may find that there are some lower numbers that you haven't been able to catch. Not all cats have their nadir at +6. (My cat's nadir was at around +3 -- except when it wasn't.)

Thank you.

 

[Wendy&Neko]

Even for new people, which you aren't, we suggest it's OK to shoot anything over 200. Lantus, and Levemir, are great at keeping numbers flat if you shoot lower. The more she's lower numbers and gets used to them, those preshots will come down.

 

[jacereske]

Even for new people, which you aren't, we suggest it's OK to shoot anything over 200. Lantus, and Levemir, are great at keeping numbers flat if you shoot lower. The more she's lower numbers and gets used to them, those preshots will come down.

Thanks Wendy. I don't know why I had 250 in my head.

I'm taking her .25 reduction tonight and will shoot that over 200 going forward.