Need help transitioning from Prozinc to Levemir

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milosmommy

milosmommy

Member Since 2009
Our background is Milo was in remission for 5 years. In mid-December he was re-diagnosed and put on Vetsulin (that is all the vet had). I have a SS attached to my signature (acutally 2 of them). So the Vetsulin lasted 3 days and we went to Prozinc as previously we had been on PZI years ago. His numbers from the SS show he jumped all over. On Sunday the 11th I went to 3xs daily shots following guidance on Prozinc area. Still no solid changes. That SS is also in my signature. He eats the low carb FF cat food (WET).

I spoke to vet last night and this morning. Let me say I LOVE my vet! He is fantastic and willing to work with me. He prescribed Levemir today. I know most people do pens or order from Canada. I wanted to start ASAP and was able to get a vial for 186.xx or so at Walgreens (by paying $20 for a prescription card good for one year for Milo).

So now I am ready to start this new part of our journey and I don't know how to do it. I am going to make sure I know EXACTLY what I am doing prior to starting. I have read some of the information at the top of this group and plan on reading everything again.

What I need help with is transitioning. We are currently doing 3 injections at 730AM, 330PM and 1130PM. I know Levemir is every 12 hours. Would it be easier to transition on Prozinc back to every 12 hours and then go to Levemir. Ideally my times would be 630AM and 630PM. The doctor wants us to start with 1U. Is that the FDMB recommendation or should I start lower at .5U.

What is the best way to transition him. Any other thing I should know. I do need to change my U100 syringes to the ones with half unit markings. Most people get those at Walmart, correct? Is it the Relion brand? (I am pulling these things from the back of my mind). If I understand correctly you don't roll or shake the vial, and slowly fill syringe as you can't take out of syringe back into vial. Is it best kept on the shelf in refrig. I know I saw a video on people with paper towels around vial. Was that Levemir.

Any help and guidance is greatly appreciated. I just want easiest transition. So if it takes a few days that is fine. I want to do it when I will be able to be home the first couple days to see how he responds and most times I am able to do that. I don't want to give him a new insulin and leave him for an extended amount of time.

THANKS
Meredith and Milo
 
Hi Meredith, and welcome to you and Milo. Sorry you had to come back here after being OTJ.

A question first - how much does Milo weigh, and what is his ideal weight? If a kitty was brand new to Levemir we use a weight based formula, but for someone from another insulin, we also take into consideration the current insulin dose.

We do recommend monitoring closely the first few days on Levemir. What would be a good time frame when you can do that?

As for syringes, some people use Relions from Walmart. American Diabetes Wholesale is an online supplier that is popular, and if you go to their link from our shopping page, FDMB gets a percentage of the sales. I buy my strips there. Their Glucocard01 strips fit the Confirm and are cheaper.

Lantus and Levemir and handled the same - take a look at our sticky on Handling and Storage. There is a video there on how to withdraw insulin from a vial or pens. Pens are handy if you can get them next time.

Keep reading the stickies - I still reread some of them periodically, there's lots to learn. And keep asking questions, we love them here.
 
Hi Meredith!

Welcome to Lantus/Lev Land! I hope you'll like the Lev - we've seen some kitties do extremely well with it.

Looks like you've had Milo on about 3u per day total and that seems like it's getting him into some green and blue numbers on both insulins. Some of us are talking about what might be a good starting dose for him.

You've done an amazing job giving him 3 shots a day and all that testing. Hopefully he'll even out on the Lev and it won't be quite as much work. Good score on the vial!

When you transition from one to another, I think you would want 12 hrs in between the last Prozinc shot and the first Lev shot. You might want to start the Lev in the morning. The recommendation for Lantus and Lev is to check the cat's BGs about every 3 hrs when you're beginning - don't want any surprises!

From the Tight Regulation Protocol:
  • REQUISITES WHEN FOLLOWING A TIGHT REGULATION PROTOCOL WITH LANTUS OR LEVEMIR:
    • Kitty should be monitored closely the first three days when starting Lantus or Levemir.
      Blood glucose levels should at least be checked at pre-shot, +3, +6, and +9.
      More monitoring may be needed.
    • It will be necessary to test kitty's blood glucose levels multiple times per day.
    • Use U-100 3/10cc syringes with half units marked on the barrel for fine dosing.
    • Feed a high quality low carb canned or raw food diet.
    • Feed small meals throughout the day. Some kitties adapt well to free feeding.
    Many Lantus and Levemir users in this forum have been successful following a somewhat modified version of this Tight Regulation Protocol for the last few years. These "general" guidelines are based on anecdotal evidence and personal experiences of laypersons frequenting the forum.
    (Revised 10/28/2013)

    "General" Guidelines:
    • Hold the initial starting dose for 5 - 7 days (10 - 14 consecutive 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 consecutive cycles).
    • Each subsequent dose is held for a minimum of 3 days (6 consecutive 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.
 
Currently Milo is 12.4 pounds. The vet thinks 10 pounds is ideal, but I honestly don't agree. He is a big kitty. He has lost about a pound with us trying to get him down. I think about another pound is a good weight for him. Since DX he has lost about half a pound, once again with us trying. When he was OTJ he got used to eating every 3 hours or so. Not huge amounts but that is his 'normal schedule'. I did pick up from 'the list' the Natures Variety Instincts that are super low carb (duck and lamb). Expensive but he loved. That is one thing he will eat ANYTHING. I was aiming to try the TIKI CAT but living in a smaller town means not available. I am thinking of heading to Indy tomorrow and trying to get a few cans of that. Free feeding won't work for Milo...he'd eat everything at once. I do have 2 of the auto feeders so I can start for now putting food in there so he is more on schedule. He will sit and watch them until they open. Right now I have one set at 3AM...just so if he went low he had something. Still low carb and a small amount.

So I am able to start the transition anytime. I don't work full time, I sub so I can just not work for a few days. Right now getting Milo better is honestly more important than the little I earn.

If I want to start Friday, since I am thinking of going out of town tomorrow for a half day and want to test him should I do a 3U on the U100 in the AM of Prozinc at 730AM, skip the 330PM and then at 730PM give a normal full dose of prozinc. Then start Levemir on Friday morning at 730am. Ideally as I said 630 or even 7 every 12 hours is ideal. Could I get myself there tomorrow by doing 715AM and 7PM.

Is my thinking realistic or is there a better way. I am headed out to get the half unit marked syringes and my Levemir. They checked before I had filled and expiration is 12/16. I wanted to make sure farther out. I didn't fill in SS but 330PM shot was 324 preshot.

Thanks for info on ordering the confirm strips at that off site. I did buy there last week as my Walmart NEVER has the Confirm strips in anything but the 20. I am set with 250. He is great about letting me poke.

I appreciate the help. I plan on reading tonight and tomorrow. I am so glad I found this board years ago that helped Milo go OTJ and now that I can come back and get help.
 
I think your plan sounds pretty good. I'd guess (but let's get other opinions on it) that if you shot 7:30pm wiht prozinc on Thursday night you could start the Lev at 7am or probably even 6:30 if you want on Friday morning. ProZinc doesn't last as long as Lantus and Lev, so i kinda think starting the Lev at +11 of the Prozinc shot would be ok. But . . . let's see what others say.
 
If I understand, you're currently dosing a total of 3.0u per day. When transitioning to a twice a day dose, you divide the total daily amount of insulin in half. Alternatively, if you want to start over, you base the starting dose on a weight based formula.
initial dose = 0.25 x ideal weight in kilograms​

When switching between Lantus and Lev, we typically reduce the dose by 30% just in case there's a marked response. However, both Lantus and Lev are depot type of insulins whereas ProZinc is not. I think it's your call whether you want to drop the dose back by 30% or not.
 
The vet suggested starting at 1U BID of Levemir. Based on the math above if based on ideal weight it'd be about 1.3U. If I reduce by 30% it'd be .9U. Appears the 1U is a good starting point.

I got the half unit syringes at Walmart. I picked up my Levemir. Talked with the pharmacist about. She didn't know you checked glucose levels on diabetic cat. Was even more surprised it was ear or foot.

So does my Friday plan sound good. I liked Julie idea. Is that a good plan?

Thanks again
 
I think the plan for stopping Prozinc and starting Levemir sounds good. Levemir has a later onset, average around +4 but I've seen as early at +3 and my Neko is closer to +5.5. So if you start Lev at +11 of the previous Prozinc dose, that should be plenty of time for the Prozinc to be out of the system. After that you can move shot time by either 15 minutes a shot, or 30 minutes once a day.

We use the weight based formula as a starting point, but do take into consideration the dose of the previous insulin if there is one. Considering that 1/2 his daily dose is now 1.5U, you probably could go to 1.25U as a starting dose.
 
Wendy&Neko said:
I think the plan for stopping Prozinc and starting Levemir sounds good. Levemir has a later onset, average around +4 but I've seen as early at +3 and my Neko is closer to +5.5. So if you start Lev at +11 of the previous Prozinc dose, that should be plenty of time for the Prozinc to be out of the system. After that you can move shot time by either 15 minutes a shot, or 30 minutes once a day.

We use the weight based formula as a starting point, but do take into consideration the dose of the previous insulin if there is one. Considering that 1/2 his daily dose is now 1.5U, you probably could go to 1.25U as a starting dose.
Click to expand...
Thanks for the help. I plan on starting Friday. Tomorrow will be reading a third time all the stickies. I understand everything buy want to make sure I really do
 
That looks like a reasonable plan to me.
I might start with 1.5 units given the slow build up. With nadir testing, you'll spot if he's starting to trend low and back off before you have problems.
 
The 30% reduction doesn't apply after you do the weight based formula.

I think I'd go with 1.25u. It's slightly less than the total per day of the previous two insulins, but not so low that Milo will be in high numbers unnecessarily. It's up to you. Most people find it less nerve-wracking to go up in dose rather than have the dose be on the too-big side. I'd choose in the range between 1.0 and 1.5u.
 
I like Wendy's suggestion of starting with 1.25u. She's correct in that you use one approach or the other (adjust based on your current dose vs. the weight based formula). The 1.25u gives you a margin of safety should your kitty have a strong response to the Lev. Only some cats have a marked response to a change in insulin but there's no way to predict which cat will or won't.

BJ is correct in that it takes a while for Lev to build up and form an insulin depot. In addition, the approach to dosing is different that with ProZinc. You base your dose of Lev on the nadir, not on the pre-shot numbers and doses are held generally for 3 days.
 
I think we will start 1.5U and see how it goes. I started the transition this morning with low lower Prozinc. AMPS was lowest in days at 334.

Should I start a new SS or go back to my BID one. If I use previous one my colors aren't filling in. Is there a fix to that.

I know I keep saying thanks but I hope you all know how I appreciate all your gslo5.
 
You might start a new page. Right click on the standard page and duplicate. Label the page. Then go through and wipe out the existing numbers and you're ready to roll.
 
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