Lev advice needed again.

day 2 on the lev. tom had sort of a flat day slowly heading down. question is he never made a curve and his pmps is the lowest part of todays cycle. only 80 points lower than amps but still, no curve, and at his lowest...could he still be heading down. and do i stick with his 1u dose.
my ss is updated.

 

thought i should mention it's already nearly 30 minutes past his shot time. i could wait and test again in 1/2 hour. if he's holding steady or lower...shoot 1u?

 

tom finally started his ascent upwards and i shot at +13.5.
am i to understand that it's ok to shoot if your +12 is the lowest number of your cycle and the curve upwards has not yet begun...before you even know if he's continuing down or going up?
still a little confused.
like going from a pc to a mac!

 

hi lor
that is where this data collecting comes in handy. If your cats nadir is at +12 and you have waited and tested and you know he goes up from there, then yes, you shoot normal dose. and this is shooting, sometimes, a low number. why? cause you know from the data collected that he is going to go up.
sometimes nadir can change. not right away, but seems after cat adjust to lev really well. data,data,data is the only way you know how your cat is going to respond. I have shot wheezer in the 30's and 40's (with normal dose)cause I know he is going to bounce and/or get a food spike.
hope this helps some
you have to totally erase PZI tactics from your head. lev/lantus is always adjusted according to nadir's, never the AMPS or PMPS and a nice steady dose. no dose hopping. cat must earn a reduction.
I do not give dosing advise.
put the handcuffs on and work with the lev, not against it. hang in there, you are doing well, it is hard to unlearn another insulin

 

Agree with dian.

 

Yep -- need to hold steady.

I highly recommend reading the sticky posts about "being Data Ready" to shoot low numbers.

Lev and Lantus give nice flat "curves" -- responses if you like that better. This means that eventually, you may be shooting the full dose when Tom is 80. This is based on EXPERIENCE -- collecting data on how Tom works this insulin.

Rusty (who is now living with Ella) usually has a preshot of 105 to 120, and goes down to 75-85, on a fat 0.25u BID. Tiggy has a bit more variation than that -- but the point is --- these insulins are completely different from PZI and Humulin N.

If we have a fur shot, Tiggy is up to 250-280, so he definitely still needs insulin -- but we don't often see a BG number much above normal range when his dosing and activities are consistent.

 

well amps this morning which is +11 today is 420 (boo) but since i wasn't sure last night if that +12 WAS nadir since all the testing that day was one lower than the next was i right to wait and test when he was going up? last night i can now say his nadir was likely +12 but before waiting and testing i was'nt sure.
today's high # could be anything from too low a number last night to too late a shot last night...right?
i'm willing to test as much as needed...i don't think i'll get tests for about 8-9 hours at night is all. is that critical?

 

Seriously? That is a huge indication that you need to SLOW down! Also, I think it also indicate he is getting too much insulin. Others may disagree with me on that, but since this is a +11 test (hope you didn't shoot on that) with no test before that AND we saw a HUGE response on the first shot (over 300 point drop) followed by a high, flat day, I really think you should drop to .5u with the next shot and start over.

Be sure to get spot checks often today. He may bounce high from that number*, but he could also drop more from it.

*42 is a safe number, but he is not used to it and it followed a steep drop, both of which can cause rebound bounces.

 

Please tell me you did not shoot at 42. You are not data ready to shoot into a near-hypo number. (I don't like anyone, no matter how data ready, shooting into a near-hypo number.)

That is fine. That is how you learn. And you may want to check that again before you carve into stone that Tom's nadir is at +12.

I'm not following that. Unless you made a typo on your PS #.

There is a reasonable limit to testing. But there may be times that some night testing would be nice.

 

You could have shot at +12 because he was in the upper 200s, but because you are new to the insulin and don't have data, waiting was ok. However, the clock starts over, so the next shot needs to me 12 hours later. You can move back in 15 mins increments per cycle to get him back on schedule.

Don't understand... can you rephrase that question?

Get your +8, +9 tests during the day as you can.

 

OMG i just corrected that!!!! before coffee! it was 420! i am soooo sorry folks.

 

+11 420

This is part of the learning process. I doubt it was too low a number during the evening cycle.

It may signal a need for more insulin, but Tom's body is still learning the Levemir. And he had a good drop the first day from over 600.

I would say shoot 1U at +11.5. Staying the course on the 1U, and slowly getting back to your desired shot time after the delay last night.

 

Whew!

Well, then, of course I would say stay with the 1u, gather data, and have another cup of coffee!

 

hi all, tom had a good day so far today...
amps 420
+2 340
+3 310
+7 190

soooo, if he lingers here at pmps, shoot 1u?
if he goes any lower at pmps shoot ??
if he goes up at all i know exactly what you want me to do HOLD THE DOSE!
anyone around at 9pm pacific?
remember last night his low of the day came at +12....
i'll test at +11 to give me plenty of time to ponder the dose question and hopefully get your words of wisdom
thank you,
lori and tomtom

 

yes

With a cat and guardian brand new to Lev, I usually recommend a shoot/no shoot line in the 130-140 range until you've done some data gathering. If under the shoot/no shoot line, I suggest testing every hour for 3 hours to see whether you reach the line and can shoot. If still haven't reached it at +15, I usually say just let the cat alone for the rest of the night and test again in the morning. It usually requires rebuilding reserves again, but that's my be-safe, conservative approach.

That's right.

I suspect you will be able to shoot at +12.

 

venita i get the no shoot #, i am familiar with that concept...but if he is above that line at a blue number you still want me to shoot 1u. same dose for 170 as for 600+. i know the ps is not the most important # but i would be willing to reduce dose in the mid blues unless there is advice to shoot the full u.
sorry, i feel like such a pain in the ---. i feel like i should be smarter about this. if it was a daytime shot i would not really worry as i can watch him and test as needed.

 

no shoot as opposed to micro dose? .5 or less?
if i get this info now i won't have to bug you all every day :lol:

 

This is where not really going by the preshot number comes into play. He didn't drop a whole lot yesterday, and the drop was considerably less today than the first day you shot too. The other option is to shoot a BCS (big chicken shot) and go with 0.5u, but know that he will probably be higher in the am, and you will need to take at least another 2 days to rebuild the shed properly and see what the dose will do. It all depends on what your gut is telling you to do.

 

I am at the same place Lori, Alley just tested at 127 PMPS and I did not shoot because he hit 59 during the day, cannot risk that happening at night, possibly even lower. I am not giving him his shot, at +1 he is 156, still too risky for me.
You are very new to Lev and probably don't have the data needed to decide.
Venita knows her stuff, that is for sure.
I am on mountain time, and will be here for quite a few hours for support, but I am not an expert on the shoot/no shoot rule. It's what you are comfortable with.

Pam

 

pam is'nt a micro dose better than no dose at all?

 

I would say yes, because Tom has not built his full shed yet. Alley is on 4 drops, a micro dose. Your Tom has had very high numbers and is getting great results on the Lev. Go with Venita's shoot/no shoot rule, I did, but again I have the month long data and I know my Alley will go low, maybe too low for the night.
Also, remember the 12/12 rule, you don't want to wait too long if you decide to shoot even a little dose. What time do you usually give him his shot?
P

 

WOW +11 136....... still goin down!

 

Wow, you are getting some serious hang time! I can understand your situation, you don't want him back in the reds if you don't shoot, but he still hasn't reach his +12 numbers.
Where is Sheila when we need her? She is so good at this stuff!

Pam

 

ya know pam, i am a hairstylist and i've had no apt's all week and tomorow i'm booked up.
i have to be conservative tonight...i want to shoot something but i want a very conservative impossible to hypo on amount of insulin in my boy. is that doable?
:lol: it looks like he read what venita wrote as a no shoot as he is smack dab in the middle of it!

 

Isn't that how it always is? Just when you think you can relax..Tom has other plans. As for a shot tonight, the way he is going, you won't see his nadir until morning anyway. So depending on his +12, and if you are comfortable shooting a lower dose, you will have to get more readings tonight to play safe. But if that boy goes lower on +12 etc, you may want to listen to Venita, since you cannot predict where he could go overnight. If you choose not to shoot tonight, get a good night's sleep and in the morning you should not have to worry about shooting too low AMPS when you will be at work all day. Just a thought.

Let me know his +12 ok?
Pam

 

yep i'll let you know. and if he get's lower forget about it altogether..and unless he goes up 20 or 30 points he's going dry tonight i guess.
how's your Alley?

 

Alley is great, unpredictable, but great, aren't they all?

He went from reds, to yellows and some blues and today he is in the greens again.
Don't know where I'm going with him yet. But he is settling nicely on the Lev, thank heavens.
And I was told I would get my kitten back (at 13 years old!), well he is running circles around my 10 year old civie, and jumping from couch to chair and back, just like he used to do 5 years ago. This stuff really works!

Keep me posted,
P

 

pam just checked out your ss. what a first day you had! :shock:
may i inquire as to what a drop is? i see you dose in drops

 

Lori, I'm around... do you have a +12 number yet?

I hate to see them go 24 hrs between shots if at all possible, but I agree with Venita on the comfort level thing and do not shot numbers for those new to Lev.

Depending on where he is a reduced dose might work.

 

yes sheila i'm about to test now. i also don't like to skip shot altogether. i saw pam shoots in what she calls drops which i'm assuming are lower than .25 and it was a dosecreas from that. wondering how one determines 'drops'
will post +12 now....141 so essentially no movement.
aiy yi yi, did you read where tomorow is my only full day at work.. i must be very alert becuase as you know when you cut and/or colour a womans hair it is as important as amputating an arm. :lol:

 

OK. So he is 141, seems to be nadiring at or near +12. ("nadiring" is not a word, according to my spell check!).

I think he will continue to rise from here. Will you be able to get a spot check in before bed? How about in the morning? What time would that be? I'm thinking either wait another 30 mins and retest, or shoot a skinny .5u now.

At least for the client!

 

I am not sure that the Pam's 4 drops is lower than .25u. There was some question about actual dose and I posted my "drop method" to her for getting micro doses and being consistent about it. So I am guessing that 4 drops is really .4u. But what really matters is that she and dh are consistent no matter they they call the dose.

Here are my microdose instructions:
The drop method I use is to practice with a used syringe and water or expired insulin and draw up 1u, then twist the barrel (clockwise if the needle is pointed away from you) slightly until a drop forms on the end of the needle. It will be about the size of the end of a straight pin. Flick it off and twist to form another one. Practice until you get 10 drops that size from one unit and 5 drops that size from a half unit. Those would be .1u drops, so you can dose fairly easily in any increment of .1u. If you want to perfect that, try for a drop HALF that size. Those would be .05u drops.

Lori, I think you will be going for micro doses soon enough and several of us on Lev have found that making dose changes in much smaller increments (usually in .1u increments, but sometimes in .05u increments) is very helpful for doses around 1u or less.

 

OMG :shock: seriously...i am to do that drop thing at 11 at night and first thing when i wake up in the morning...i can barely type out his numbers (as you saw)
i'll give you this..the lev results are fabulous...the work involved means you've EARNED every 'drop' you drop!

 

I'm here for a few minutes too -- have to work early tomorrow, so heading bedward soon.

If Tom is up from the 136, I would say shoot the full 1u

If Tom is still at 136 or down, I would say shoot a half dose rather than completely skip.

Just saw your post with 141. I would stick with 1u -- if you're worried, make it a skinny 1u

 

i'm sorry phoebe i've had many differing opinions tonight.. +13 149 shot .25
everything from skip shot to .25 to 1/2u.
it's only our 3rd day and with the limited but erratic data i have i just want to play it safe.
i really do appreciate your input and hope you'll continue to keep an eye on us.
just take a look at his ss.
2 300 point drops...i just can't afford to pump 1u tonight.
and if i'm wrong it will be good data right?

 

Lori, that was a good decision. I would have shot a half unit, but that's from my many months of lev experience, so .25u is good - and safe. Yes, you may loose a little momentum, but he is doing great and will be fine.

You will probably have to make the same decision again in the morning. I think its ok to slightly undershoot because you won't be home. Let today's numbers and doses be your guide. Maybe if he is under 150 shoot .25u and if he is from 150-250 shoot .5u. above 250, shoot 1u. I am not advocating a sliding scale, just recognizing that he will most likely need some insulin, you don't have much data on lev yet, and you won't be home all day. Better to err on the side of caution.

Looks like Tom loves the lev!

 

well sheila he is just full of surprises. +11 600+..should have shot that full u.
but i'll file this in my brain as data collection.
he is at this time a very late nadir-er :lol: and i guess i won't pay much attention to that.
please be aware that i have a sleep disorder that makes it near impossible for me to be fully conscious in the middle of the night. even if awakened i am at best 40% awake...sometimes it is referred to as sleep walking, sleep eatting, sleep sex even, sleep driving!, i would be doing sleep testing.
i have never been afraid of tom hypoing while on pzi so confident was i of how it worked him...now i am a nervous newbie since this lev works him in an unfamiliar and so far erratic way. check day 2 as opposed to day 1 and 3.
thanks for the support sheila,
lori

 

Lori, I think you did the right thing, it is all a learning experience.
Have a great day, hope you got some sleep last night.

Pam & Alley

 

Part of your late nadir thing in the past 2 days may be because you are shooting the am shot 1 hour early. That will effect the BG's considerably. When adjusting the shot times due to having to wait for a shot, try to do it in 15 min increments. Some kitties can do 30 min changes and not show number changes, but not all. I think just about every kitty out there will go a little lower than normal when shooting 1 hour early.

 

I agree with Kelly on shooting at +11. The rule of thumb is that shooting early = a dose increase and shooting late = a dose decrease. So, as you gather data, you will get more comfy shooting a lower PS - so, hopefully, won't be pushing it to a +13, but if that happens and you can't wait until 12 hrs later, you will need to shave a little off that +11 dose. Make sense? (It's a horrible run on sentence....)

Also, as you get closer to the proper dose, the swings will be less so you won't be seeing a 300+ point drop and worrying that he is dropping like that from a 200 or something when you are not home. I do think he may be getting a tad too much insulin on 1u - given these wild swings. The 1u is generating a consistent 300 point drop (except that second day) and that alone would cause the bounce to 600s. Trying .75u might even things out more.

Hope today goes well at work and you are not worrying about Tom.

 

Lori, I just read your lantus ISG thread. I wondered where you suddenly disappeared to.

Anyway, I did not understand that the +11 am shots were on purpose. That is not a good idea. Lev is so much a different insulin than PZI that you can't assuming he will react the same way on it in terms of PS differences. It really works best on a 12/12 schedule (or as close as you can). If you had to do an 11/13 for reasons of a work schedule there are ways to make that work better by doing things like split dosing - after you have data, etc. But at least start with 12/12 so you can see what he can really do on lev.

Also, I have been thinking about the 500s and 600s - those are not normal numbers for a cat on a low carb diet and on a proper dose of lev (or any insulin, in my experience) those are rebound numbers. He is dropping at least 300s points and soaring back up. That's rebound. Yes he hasn't hit a hypo number - that you have caught on a test - but he is swinging and bouncing all over. Lev doesn't cause that when it is dosed properly.

I saw in your LL post that you think Tom's pattern is to have numbers that drop "without any insulin" by as much as 300 pts after eating. I don't know. He has been bouncing a lot for a long time - I see it as the dose of PZI was raised. It looks to me like the increased dose caused the bouncing, not the other way around.

Honestly, I think that you need to start over and slow down. Start at .5u, give it time to settle (3-5 days), stay with 12/12, don't make dose changes on PS numbers*, and test as much as you can to find his nadir time and number. When you find the proper dose, or very close to it, the swings will stop and you won't have wildly varying PS numbers am to pm. So you won't have a suddenly low PS to deal with.

*but if you get a suddenly low PS, follow Venita's suggestions from last night. You can always retest in 30 mins, or slightly lower the dose if you are not comfortable shooting it and don't have the data that says it is OK.

 

I just want to reiterate for newbies that shooting a normal dose on numbers as low as 30s and 40s should never be attempted without a lot of experience and data. If Dian feels comfortable doing that, she has the experience to make that choice. I don't want anyone reading that and not understanding it is a very advanced technique and not right for many cats or caregivers. It is not anything I would ever do even with my experience and data.

 

thank you,
pmps +15 minutes 161 f.5 or let's just call it .6
i appreciate you looking at my ss. i agree my dosing may have been high causing rebound.
i just want to have a hand in, have a say in, what happens to tom.
i understand he at present has a +12 nadir.
the constant chant about shooting the nadir is tough when his nadir is not evident until 15 or 20 minutes past pmps. and now god forbid i shoot 15 minutes late.
perhaps i'm just not ready for this strict regimin. i really never wanted to do it this way. did'nt expect it to be 'the only option'
i will start shooting .6 at 9-9:15 am and pm.
hope this helps.

 

Lori, it's not that strict - at least that isn't how I operate with lev. I do my best to shoot 12/12, but my shot times vary by 15-20 mins and I think that is OK. I am careful if I shoot late to not move the next shot early by more than 15 mins (+11.75) or so. I am careful with the dose being accurate from one shot to the other.

It's not shooting the nadir, but using that number to guide the dosing decisions. Most cats nadir between +6 and +9 on lev (I think), but some are earlier and some are later and some are at +12 - or even later - although I suppose you could call a +13 nadir a +1 nadir, but in fact it would be from the shot 13 hours ago not the one 1 hour ago. So, for now, Tom's nadir and PS may seem to be one and the same, but with one PS being 600+ and the next 290 or something, those can't be true nadirs. That fluctuation should change as he stops bouncing around.

You DO have a say in this, of course you do. That's what it is all about. I just hate seeing the kitty swinging from 600+ to 100s and back and I think that doesn't have to happen. The best way to make that not happen, since you are just starting out on lev, is to go with what has worked for enough cats to be called a protocol. And starting low and going slow, and shooting 12/12 are the basics. That's all.

As far as his low point being 15 mins into the next cycle, you are starting to gather enough data to show that he climbs after that, but by lowering the dose you can more safely shoot even knowing he will drop a little bit more before climbing up.

I am not strict with the Tilly protocol with my cats, mainly because I found with both of them that the dose changes were too big. I make changes in very small increments of .1u or .05u, not .25u or .5u. And I think the starting dose should be .5u because I see too many cats on 1u that immediately start rebounding and that gets very confusing to deal with.

 

Lori, Sheila is right. At first it seems more than we can handle, like how can a low dose take my cat down enough? But it does. For 3-1/2 years Alley was on N, even up to 8 units one time. Not realizing there were low carb foods and home testing to find out his whole story.
After much anxiety and frustration, I somehow came across this board and my whole world changed. You can do this. You and Tom together will overcome this. Alley is on Lev, what 5 weeks now? NEVER thought after this short time (sometimes it felt like months!) I would be so much more calm and trusting, trusting...that is my word for Lev.
Take a deep breath, Lord knows you have had enough stress with the flooding and all, and now this, not many people could do what you are doing.
Alley is not yet where he should be, but I am taking baby steps. Once Tom is out of the high numbers, you will feel so much more confident. And it will happen, these great people here will see you through, we are all in this together.

So.. that is my pep talk for the day!

Have a great one,
Pam

 

tom's +10 this morning is 554. i want to say it's not that i don't understand what the folks here are telling me...i think they do not understand what i am telling them.
i just need to talk with someone on the phone who can understand what i am actually seeing and have them exlain to me why NOT to do what i believe is right.
that is the part i find soooo frustrating. tom is not getting too much insulin he is getting to little.
anyone with some lev exp. please pm me.
signed,
frustrated a

 

lori, i'll be blunt ok? you know me yes, i've been trying to at least do some reading here this week but haven't posted much simply because my life doesn't allow me much time for this stuff right now.

what you are saying you "believe is right" is actually wrong. that's what everyone is referring to when they say you have to forget the pzi way of things. you ARE looking at numbers like that 554 and wanting to shoot more insulin. that IS pzi thinking. and that is totally 1000% WRONG when using these insulins. you keep thinking that way, whether you realize you are doing it or not, and you WILL hurt tom. that probably stings a little i know and i apologize for that but i think as clear as possible works better for you yes? and i don't have a heck of a lot of time right now as my customers are going to start walking in here in just a few minutes.

you WILL NOT get numbers consistently in the 100's right now. you WILL get more high numbers than low and you WILL have oddities here and there. if i remember correctly it took Mousie somewhere between 2-4 weeks for her body to settle some when we switched to lantus and the 300's and 400's to be the oddity instead of the normal. believe me, after years of Mousie under 200, i was frustrated beyond belief too. but i listened to people and stepped back, breathed, and sat on my hands, as annoying as it was.

do NOT overthink this right now. I know you tend to freak out over high numbers but remember, high numbers aren't going to kill as fast as overloading the L shed and making tom have a prolonged hypo in low numbers because he got overdosed.

this isn't that hard, really. shoot twice a day, consistent dosing, as close to 12/12 as you can, and gather data as you can. you take ambien or something right? can you skip that occasionally and get a night test here or there? i'm not saying every night, but once in a while. then, in a couple weeks, it will hopefully be clear what changes need to be done.

and to be real blunt, if you don't think you can do that, i'd pull your pzi or prozinc back out and go back. the insulin you were using in my opinion was not the cause of tom's high numbers he started having. his underlying health issues were and now that he's had some antibiotics, for now that seems to be improving so perhaps you could go back.

if you decide to give lev a fair shot, maybe consider posting in the lev forum too? i know lantus is big and moves fast and everything and seemingly stricter than some people want at first so maybe for now, lev isg might be a bit more doable? i don't know, just some thoughts that are circling in my head trying to slow down, remembering to breathe, not panic-ing and minimizing chaos might help?

and last but not least, what i used to do when i poked, saw a number i didn't like and had the urge to cry.....sit down, breathe slowly, and just watch tom. remember to see him as a cat, not a 554. if he's eating, purring, playing and just being himself, the number is not number one. easier to say than do but we have to. or we'll go nuts. ((lori))

 

Hi Lori,

What we are trying to communicate is that Levimir and Lantus don't work with the kind of strategy you want to use.

The shed is a limiting factor, it simply is what it is. How it functions won't change.

STICKY: LANTUS & LEVEMIR - INSULIN DEPOT -AKA- STORAGE SHED

I want to direct you Atlas' spreadsheet. I am doing this with the caveat that how I am handling Atlas is based on a lot of collected data! I cannot tell you to do this with Tom, we don't have any data, but you might end up here.

Atlas bounced like crazy, would give me half-hour heart-pounding freefall hypo recoveries (these were not real nadirs), and everything I thought I knew about Smogyi effect, rebound, insulin OD....was wrong on Lantus. So we laid in the baseline data. How did he react at this dose, that dose, this feeding time, that feeding....look at my SS...it took a long time. Longer because I was being a bit stubborn, longer because I couldn't grasp some of what I was being told and how it fit into what I was seeing in his SS.

Look at the note in my comments section from 1/2/11...now that's frustration.

Pay attention to Attie's +9,10,11 readings. Often he gives me a DROP at those times. Nadir or false nadir depending on your POV. In stage 3 of the Roomp protocol it give you 3 options to deal with those kind of PS issues. We tried several for a while...which didn't work. I had to find my BOS and put them on...now that I had the data...

Recently I started following the last option in stage 3 ...feed and shoot as long as the number is above 50 and be available to monitor for signs of hypo. Lantus and Levimir are designed to be dosed in the over lap. This article explains what I mean.

Insulin Depot
http://petdiabetes.wikia.com/wiki/Insulin_depot

Edit to stress this point: In the perfect scenario, there are no high peaks.

The consistency of the dose is what makes that happen.

Now go looks at Attie's sheet again. This didn't happen in 1 day or 2 days or even 3 days...heck it takes 3 days to just fill the shed!


You haven't even made it through a few days! Don't give-up on a great support network just yet.

 

.

 

not in the mood to explain yet again what i'm doing with tom which is actually the 'right' thing to do. if you even want to see it look at the post marjorie and grace wrote on my lantus condo and see what actually taking the time to READ my ss, THINK about it and come to your own conclusions as to why i did NOT stick to one dose, and did NOT stay with 12/12.
this is so not enlightening or fun to be a part of anymore.
you cannot fly by and give the standard chant with everyone...

ETA i deleted the less than pleasant way of expressing my thoughts.

 

Lori, if you want advice, you need to calm down and listen / read it and have an open mind.

If you attack the people trying to help you, no one is going to continue to try and help you.

I know this is a frustrating time but -- need to take a deep breath and take it easy.

 

lori, you would not believe the amount of time and use of my brain that is going on here. it's not standard rant. i don't do the standard rant. anyone that's paid attention for the last 4+ years knows that. my replies are always to the individual i am talking to. i am known for personalization.

what you just said in that reply is downright rude and disrespectful to everyone that has posted to you this week. please don't do this, not right now when you need the help that is available.

i am speaking today because i have a bit of time to do so and i see that people are being alienated and i don't want you to not get any help in a few days when you need it because people are put off by the frustration, which comes across the net as attitude unfortunately. i know what your reaction is going to be to that and i'm sorry it's gonna go that way but it's necessary. i will respond to you because i don't want to see tom hurt, no matter how upset you get with me. to be completely honest i'd rather piss off a human than watch a cat get hurt.

 

Lori, honey, please don't pack up your toys and go home. I know you are frustrated because we are "talking" counter to what you think is supposed to be right for your baby. But several of us have a lot of experience with lev/lantus and whatever you are trying to do isn't working and, IMO, won't work. You can't customize how you use these insulins (any insulin) until you have the basics and the data in place.

I have looked at your SS several times and gone back over the past year when he was on PZI. I take all of it into consideration. My brain is VERY engaged. What I see is that Tom is bouncing on lev and you are still trying to "shoot down" the higher PS. All that does is make him low at the next PS, where you shoot less. Then he is higher again. Lev can't be used that way. I wish you had stuck with the .6u this am like you said you would last night. It will take several cycles, but he will even out. Now, with the 1u again that is most likely 50% too much, he will drop 300 points or more again and keep the pendulum swinging.

Yesterday he dropped at least 450 points! That alone, regardless of the nadir being mid 100s, will cause rebound.

We are trying to help. Frankly, insulting us out of frustration isn't going to help Tom. Right?

(I got your PM and I am thinking about it).

 

phoebe and sheila thank you...cindy you make it a standard practice to be blunt...this was my blunt.
now i'm going to go back and read slowly what was written.

 

no problem. blunt can be good :smile:

 

Ya know, I just reread this whole thread and I must say...THIS thread was ok. I apologize. I was going back and forth with this thread and a simultaneous thread I had going on in Lantus and THAT is where all this conflicting info was driving me nuts. I did'nt take into consideration that the stuff on that thread was not read by the folks here.
so a GREAT BIG APOLOGY TO YOU GUYS you all have been very helpful and tolerant and understanding basically the method to my maddness.
My fault was in posting in 2 rooms at the same time and getting incresasingly irritated by the 2 rooms not being in sync.
Please forgive me?
Lori
and tomtom too!
and I'm not kissing butt to keep you helping me...SWEAR!

 

A note on consistency (x-posted from Lantus ISG)

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'm not sure there was so much of a push for a specific dose as much as there was for a consistent dose. ?? would have to go back and re-read all the different threads over the week but that's what i'm remembering at the moment.

 

With Lantus and Levemir - the nadir can change some due to the dose.

If the dose is too much -- nadir will be later.

If the dose is smaller -- nadir will be earlier.

So it is entirely reasonable to change to 0.5u dose BID (same every 12 hours) and see if the nadir is earlier -- making it more comfortable to shoot at +12.

I have changed two cats to Levemir.

Tiggy was on 2.5u PZI BID. He is now getting 0.5u Levemir BID and sometimes a skinny dose.

Rusty was on 1.5u Lantus BID. He is now getting a fat 0.25u BID / skinny 0.5u (hard to measure in between).

So in both cases -- I found we needed LESS Levemir than the previous insulin, and achieved BETTER regulation.

Since 1u is giving a +12 nadir -- reduce to either 0.5u or 0.75u and keep that dose steady for 5 to 7 days.

 

What Phoebe is saying makes alot of sense to me.