? Need dosing advise after switch from Lantus to Levemir

For general info about Whisper, his story and our history, please see my post over in the Intro forum (http://www.felinediabetes.com/FDMB/threads/new-member-whisper-but-not-newly-diabetic.145785/). Whisper’s SS is up to date through AM Oct 11, but I haven’t had anyone else confirm that they can see it, so hopefully I have it shared correctly.

But here is a quick rundown. Whisper is currently eating purely FF Tender Beef Feast, ½ can four times a day (right after AM shot, AM+6, right after PM shot, and at bed), although he will scrounge more FF from the other cats bowls if he can muscle them out. He is 10 pounds, and is 10-14 years old. When he came to us in September he was on 2 units Lantus twice a day, not having been BG tested since June, and his health was generally poor. He might have been on 2 units twice a day for almost 3 years, we just don’t know. My vet had suggested that, after we were done with the Lantus vial (or whenever it lost potency or got contaminated, not necessarily used to the last drop), if were weren’t happy and well-regulated that we might want to consider a switch to Levemir. All of her feline clients are on Levemir, and I liked the idea of the smoother curves and later nadirs that I had read about, plus other successful transitions from Lantus to Levemir. Plus, it seemed valuable to me that it is where our vet has the most experience.

While I wasn’t testing as often as I should have on the Lantus, it seemed like it had an early-ish nadir for Whisper, and our curves seemed to get more jagged, with the one on 10/4/2015 bothering me, even though I was glad to see greens for the first time. Since the next couple of days were going to be wonky due to his dental procedure anyway, I decided to just go ahead and make the switch to Levemir since I really feel like we just needed to start from scratch with him. I probably didn’t give Lantus a good enough or long enough shot, but it seemed like this might be a good cutover point anyway.

On Lantus we had increased from 2 units when we got him, up to 3.5 (probably too fast, I shouldn’t have gone up a whole unit in the beginning like we used to for PZI), and I wasn’t testing him often enough, but for the 4 days right before surgery he was at 2 units of Lantus. So when we switched to the Levemir, our vet thought it safest to start down at just 1 unit rather than 70% of between 2 to 3.5 units.

I know that a lot of things are changing with Whisper, his diet, our dosages, his overall health, and I have read and re-read the SLGS protocol, and will continue to do so until it really sinks in, but look at our first day on Levemir, October 9th. Blues at AM+3 and AM+6. But then 530 at AMPS on October 10? Is this a bounce because his body was in the blues for a decent part of the day on Oct 9? Ugh I could shoot myself for not getting any tests after his night time shot on the 9th, but I am wondering if he got really low and the blacks resulted. I just hate to be sticking him all the time since he already runs when he sees me coming. I guarantee that he got NO dry food on Oct 9 or since. After he snarfed down his wet food at bedtime on Oct 9, he didn’t have any food before the AM BG test on the 10th.

I promised a specific question, and here it is. What thoughts do you all have on his 1 unit dosage of Levemir, even though I only have 2.5 days of data with it? Is it possible that we need to back DOWN to .75 or .50, if I understand this whole idea of bouncing, and that too much insulin and cause high numbers. I think that time will tell very soon, if a bounce really does last about 3 days, but want to get your opinions before maybe this time tomorrow when our 3 days are over and we are hopefully coming back down naturally. And what suggestions do you have for my test times? A full evening curve is difficult for me, and probably not entirely safe for me to do to Whisper, due to some medication that I take overnight for my own health conditions. But I am going to try to start getting bed time readings every day in addition to my AMPS and PMPS.

Other curiosities, of lower priority: In general how has our overall BGs increased after the first week or so (again, I KNOW that my lack of data makes any theorizations difficult), even though he went from Meow Mix 100% of the time to wet food 100% of the time, and in theory some of his medical issues should be getting better? Could it be just the stress of the move, his new housemates, and the exhaustive medications and testing?

Thanks in advance for any help that you can offer!

Sandi

 

Hi Sandi and Whisper and welcome to the FDMB!

When you switched from the Lantus to the Levemir, you probably dropped it back a little too much, but for now, I'd hold the 1U until his new depot has a chance to develop (about 5 days)

After that, you need to decide which protocol you're going to use with Whisper....Tight Regulation gives him the best chance at remission, but it's an aggressive protocol that's not for everybody and can require a bit more testing for safety. Dose adjustments can be made as often as every 3 days so you have the best chance to get the BG in control sooner

The other protocol is Start Low, Go Slow. Dose adjustments are only made once a week though and seeing high numbers for a whole week can really be hard on the caretaker...but it's also very safe

The reason we want those mid-cycle tests (as well as the pre-shot) is because dosing is based on how LOW it takes them....so we need to know that! We always want Pre-shot tests to make sure they're high enough to give insulin at all, but it's the other tests that tell us how well the current dose is doing. During the AM cycle, at least 1 test somewhere mid-cycle, and on the PM cycle, a "before bed" test will help us to see how Whisper is doing

There's no reason you can't come on over to the Lantus/Levemir forum, so here's an official invitation!! There's lots of experienced eyes that use Lantus/Levemir there to help you

 

Ok, didn't know that it would take a whole 5-ish days to fill up the depot...thought it would just contain decreasing percentages of Lantus, and increasing percentages of Levemir, until it was all Levemir. So that makes me feel better. Maybe that is all it is rather than starting too low (or too high), but we wanted to be safe since we weren't sure if our baseline Lantus dose was actually an overshoot of what it should be. I realize that will take us longer to get where we want to go, but hopefully in the interim we can get his teeth, skin, ears all healed up.

Yeah, shooting for the nadir instead of the pre-shot is definitely the hardest part about switching my mindset from PZI to Lantus/Lev. I will be doing SLGS for sure, curving every Sunday. Can't ever get a mid-cycle during the week, closest I can get is AMPS+9 (home from work).

Should this question be in L/L instead of here? I so, can I move it?

 

You can't "move" it, per se, but you can start posting over in L/L and put the link to this thread into that message

If you go look at some of the other posts over there, you'll see how we generally post