New member Zorro - Caninsulin to Levemir

Hi fellow cat parents

My tuxedo boy Zorro is a 12.5 year old neutered male. He currently weighs 5.2kg's and had been moderately overweight for a large part of his adult life. At the moment he does not appear overweight and I would estimate his ideal weight to be about 5.5kg's. He was diagnosed with diabetes around August 2017. At that time I knew nothing about FD and trusted our vet completely. Long story short, Zorro's doses were quickly increased from 2u Caninsulin twice a day after diagnosis to 9u Caninsulin twice a day (I know...) No glucose curves were done at the vet's practice, I was discouraged from home testing even though I enquired about it and so the doses were increased purely on the strength of urine strip test results and my telling the vet about Zorro's poor clinical signs - all of which I now know were the results of the most extreme, most severe rebound. My heart aches thinking back about it now. By some mercy I happened to be home from work one afternoon shortly after the 9u doses were started and I saw a hypoglycemic attack approaching. I rushed him to the vet where he had a seizure in the reception area. He received intravenous glucose and miraculously survived. Thereafter he seemed to do quite well on 2u Caninsulin twice a day for about a year. Early this year I saw signs that his dose may need adjusting (I still didn't know how to home test or even if it could be done - the vet was very vague whenever I enquired about it.) Anyway so we upped his dose again until we had reached 5u Caninsulin twice a day and Zorro's clinical signs were still poor. At that point I decided to educate myself about FD. I switched his Royal Canine Feline Diabetic dry food to lower carb canned food (Purina Fancy Feast) and I started to use a human glucometer to check his BG. I also first found another online forum that introduced me to Tight Regulation. All the people there were very helpful but I found it impossible to reconcile my work schedule (and my nerves) with Tight Regulation using Caninsulin. Caninsulin seems to be metabolized by Zorro very quickly so I was on a +6 dosing regime that had my nerves on edge day and night for nearly 2 months. Much, much sleep and working hours were missed so I had to give up that protocol. However I continued to keep track of Zorro's BG and have since acquired Levemir insulin and U100 syringes with half unit markings and I intend to change over to the Levemir tomorrow morning at 09h00 (South African time). Zorro experiences a lot of bouncing with the Caninsulin and if I had to dose him only every 12 hours then he would be in the HI's for hours before a next dose. I am hoping that the Levemir will give him and myself a break and will enable me to regulate him much better. (Oh, and I often check for ketones and Zorro does not seem to be prone to ketone formation, fortunately.)

When I came across this forum I felt relieved to see that there is a "Go Slow, Stay Low" protocol that can also be followed and I felt that it might be more "my speed". However, I noticed that the recommended starting dose for that protocol is very low whereas Zorro is currently often HI pre-shot so I think he'll need adjusted dosing.

At this stage I would therefore appreciate advice / suggestions regarding the following:

1. Do I need to give 12 hours since the last Caninsulin shot before I switch over to the Levemir or would 10 hours be okay? I would feel better about giving 12 hours between the 2 types of insulin but I know that then Zorro will be in the HI's for a few hours before I give the first Levemir shot. I currently dose his Caninsulin at approximately +8 because by that time it seems to have no more effect in his system. I gave his last Caninsulin shot at 20h45 this evening.

2. What starting dose would you suggest? I have found a few veterinary sites that suggest 0.5u per kg body weight if bg is over 20mmol/L and 0.25u per kg body weight if bg is under 20mmol/L. Our vet suggested the same but his "cut-off" bg was 36mmol/L.
Zorro is currently on an average dose of 3u when his bg is 28mmol/L and over - which is normally the case pre-shot. That kind of dose gives him a nadir of only 11.0 or 12.0mmol/L after +5.5 to +7.75 so his constant bouncing is not a case of having gone too low - it's probably just much lower than he had been used to for a long time. I have been avoiding the proper low numbers since I stopped Tight Regulation to see if that will flatten out his curves but so far it hasn't.

With it being Easter weekend it is the ideal time for me to make the change to Levemir insulin as I can watch him for 4 whole days. I'll really appreciate your suggestions.

I intend to start a spread sheet with Zorro's numbers over the weekend.

Thank you!

 

Hi Maritsa and Zorro and Welcome to FDMB.
What a time you have had with Zorro.....Yikes 9 units of caninsulin and the vet not testing. I am so glad it has all turned out OK. Do you still use that vet?
That's great you are testing the BSLs and are going to set up a spreadsheet. If you have any trouble setting it up, yell and we will help you. It's also great you are testing for ketones amd have swapped to low carb wet food. Do you know the carb %. We recommend 10% or less carbs.
With starting the Levemir insulin....which is a great insulin, I used that with Sheba. It has a later onset than caninsulin....around +3 or a bit later so you don't need to feed all the food before the dose of insulin but you do need to make sure Zorro will eat. We suggest feeding several smaller meals a day such as before shot, +3 and +5 both cycles. If you work you might like to get an automatic feeder. Levemir is a depot insulin and it takes up to 6 cycles for the depot to fill so don't expect to see instant results.
With the starting of the Levemir....... give the first dose of Levemir 12 hours after the last dose of caninsulin. Levemir is dosed every 12 hours.
With the actual dose....if you were a newbie we would suggest starting at one unit but since you are not a newbie we take the dose of the previous insulin into consideration. We also do not chop and change the dose as Levemir like to stick to the same dose unless Zorro drops too low in which case you would reduce the dose or if after a time you would increase the dose if the numbers were too high.
I would be inclined to start off with 2 units if his normal dose is 3 units as we don't know how he will react to the levemir. If you are going to follow the SLGS method you will need to stick to that dose for a week unless it is too much and he BSL drops low. We reduce the dose if it drops under 50 (2.8).
Always test before every dose of insulin and get a few midcycle tests if you can to see how low the dose takes him. We change the dose based on the nadir not the preshot.
As this is the welcome page, I will get you to start posting over on the main page where there are many more to help you and I will see you over there .here is the link
http://www.felinediabetes.com/FDMB/forums/feline-health-the-main-forum.28/
Ask as many questions as you like. We are a very supportive community who is very willing to help each other. You sound as if you have a great grip on this FD and I'm sure you will love the Levemir. It gives much flatter curves....but first you need to get the BSLs down a bit for that to happen.
If you can add the last few weeks of Zorro BSLs to the SS for comparison that would be really helpful. I hope I have answered all your questions. If not let me know.
Bron

 

Hi Bron,
Thank you for your reply to my post.
Yes, Zorro's little body has been through much abuse due to the uneducated misuse of insulin.
These days I fret over having dosed him 3u and test him way more than is necessary. I have no words to describe the feeling when I think back how I blindly and in good faith (knowing nothing much about how insulin works) dosed him 7, 8, 9u on the vet's advice and then went to work or to sleep... No words. Like I've said, I thank the universe every day that I was at home that afternoon when his liver had finally run out of glucose stores.
I won't blame you for judging me but yes, I still use that same vet - although these days I pretty much take care of Zorro's diabetes myself. We have 5 dogs and 3 other cats and that vet has been good with them in the past and he is one of the better vets in our town. I do intend to have a talk with him one of these days about how he treats diabetes, though. By some miracle Zorro survived what he was put through but I feel now that I know better I must warn the vet that something similar might happen to some of his other diabetic patients since he's not a proponent of home testing OR doing bg curves at his practice. (He believes in going by clinical signs mostly, together with occasional blood tests and urine strip tests for glucose. Anyway, enough about that.)

So, I started the Levemir this morning after just under 12 hours (11 hours 50 mins) since the last Caninsulin shot. So far so good. I ended up giving him 2.5u as a first dose as he was HI and I normally dosed him 3 - 3.5u Caninsulin on such a reading. I only saw your reply after I had dosed him so I was a little bit worried about my dose choice but all is going well so far. Right now at +9 he seems to have reached the "plateau" and over the past 3 hours has slowly continued to go down slightly from 17.3 (311) to currently 14.7 (265). I have not had time to set up my spread sheet yet and am not certain what I'll dose him in 2.5 hours' time if he is in the upper teens or lower 20's. I know that I need to be consistent with my dosing no matter which protocol I end up following but I feel that I should not give the same dose that I did on a HI. I know you are not able to give me official dosing advice yet but do you have any thoughts to share on that? I'm feeling that if he is not in the unknown HI's by the time I need to dose again, perhaps I should reduce to 2u and then stick to that dose for a few shots (presuming he is not HI again at pre-shot) and see how it goes. I used to follow a sliding scale with Caninsulin so please bear with me while I get my head around consistent dosing.
Regarding his food: I changed him (and our other cats) over to Purina Fancy Feast Chunky Chicken Feast. It was the lowest dry matter carb option (10%) I could find in South Africa because we don't import all of the Fancy Feast varieties. I am a bit concerned because I understand that very soon Purina won't be available in South Africa at all - at least for a while - so I'll have to find an alternative.

Okay I will post only on the main forum that you've shared the link to, from now on.
Thank you again

 

Hi Maritsa,
Now that you have started posting on the Lantus/levemir forum stay there. We usually get newbies to start off on the main forum while they learn but you are experienced with FD. If you can get your SS up and running that would help as we always look at that.
We don't judge anyone here on the forum so please don't apologise staying with your vet. We find a lot of vets are great but not so good with FD....many have not kept up with the latest treatments and methods of managing it. But they are good with everything else.

Now that you have started off with 2.5 units I think you could stay with that unless Zorro drops low. You are several hours behind us here in Australia so I think you have already given the PM dose. What did you decide to do? If you reduced it to 2 units just stay with that now and see how you go. We decide the dose on the nadir not the preshot number. Don't chop and change because of the preshot. Levemir likes consistency.

I think he has had a good response getting down to 14.7 from HI on the first dose of Levemir.
I don't know if you have seen these charts but have a look and see if you can see anything there that you might have in SA.
I feed my cats a raw diet.
http://www.felinediabetes.com/FDMB/threads/links-to-food-charts.174182/
I'll see you over on the Lantus/Levemir page
Bron

ETA. I see the SS is up and running. Well done!

 

Bron, could you please assist with the info link on how to get Zorro's SS onto my signature again?
I really need suggestions with his dosing, please.
You might recall, very shortly after having introduced myself and Zorro here I fell back on a different form of TR that was more familiar to me. However I now (again) realized that the only form of dosing that will work for our household long-term is 12/12 dosing. Currently his numbers are upsetting to me and I feel terrible for having wasted time by "jumping" between dosing methods. Help will be so appreciated. Thank you.

 

Hi, I'm just going to tag @Bron and Sheba for you to be sure she gets your message...She is in Australia I think so might not be on for a few hours sorry, I can't help with the link, not techie at all.
With love, nikki

 

Thank you so much, Nikki.

 

Hi Maritsa, As Nikki said, Bron may not be around for awhile so I will try to help you out.
Do you have the URL for the share version of your SS? If so, copy it. If not, you will have to get the share link URL again. If you need assistance getting the link, just holler.

To add your SS link back into your signature......

1. Hover your mouse cursor over your forum name up in the upper right of the screen.
2. Click on Signature in the left column of the menu that drops down. This opens the box where your current signature info is.
3. Type " Zorro's SS" or Zorro's Spreadsheet" at the end of your current signature.
4. Highlight the name you just typed for the spreadsheet.
5. Click on the on the toolbar at the top of the text box. That will open another box into which you can paste the URL for the SS.
6. Click on Insert. That box will close and take you back to your signature box.
7. Now scroll down and click on Save Changes.

 

Linda, thank you.

I've managed to link my SS again. If you're going to have a look at it, please note that only since 26/06/2019 ie. the last 7 lines of entries have I been trying to follow this board's method of TR, ie. a set dose every 12 hours.
My "starting" dose on 26/06/2019 was based on an average gauged from the doses over the previous 2.5 months and I lowered it by .25u after he went low that night already. Then I kept that dose for 3 days before increasing back with .25u for the past 3 days.
I am very tempted to increase tomorrow's AM shot with at least .25u again but I'll wait on some suggestions. It feels to me as if Zorro's numbers are getting worse and worse. I am wondering whether he is getting glucose toxicity and therefore some insulin resistance from being in the black and red numbers so much lately. I have been tempted to increase his doses more rapidly and to dose as soon as he hits +10 and is in red or black numbers by that time already, but I know I now seriously need to stick to a method.

Sorry about the SS that is probably surprising or even upsetting for people here to see, with shorter dosing periods and doses jumping quite a bit - everything I was told not to do on here. However I'm keeping the info there for data purposes in case it might help with assisting me. I have also not been maintaining the US version of the SS. If necessary I can update the US version as from 26/06/2019 and maintain it from now on.

 

Another thing: I am nearing the end of a Levemir cartridge and I could start dosing from a new one tomorrow morning.
I know it is recommended on here to never push air back into a cartridge but I have always been doing that when I get small air bubbles in the syringe. I just couldn't stand the thought of wasting at least a unit each time by shooting it into the air as recommended. Could that be affecting the potency of the insulin?

 

Sorry, I'm on a roll here... I also don't understand why Zorro's bg hasn't improved drastically since he's recently had his dental issues (which we never suspected) dealt with. He's also been on mostly all raw food for the past few weeks or so which was not the case before (he used to be on FF Classic Salmon Feast with about 10% dry matter carbs).
I have considered whether his current dose might be too high taking the above changes into account but because he doesn't stay very high and flat for every shot I am more inclined to think the dose is not too high. I might be wrong though.

 

Hi Maritsa
Do you think you could start a new thread in the Lantus/ levemir forum please? This is just the welcome page and we are not supposed to really give dosing advice here. You will get a lot more people on that forum who are experienced with levemir.
Here is the link
http://www.felinediabetes.com/FDMB/forums/lantus-basaglar-glargine-and-levemir-detemir.9/
See you over there!
Thanks @MrWorfMen's Mom for answering the SS question.
Link this page to your new thread for everyone to see all this information..
Don't push air back into the cartridge if you can help it. When you draw up the insulin, press the plunger in tight then put the needle intot the cartridge and draw up the insulin. That should help eliminate air. Any air left, just let it out into the sink.

 

Thank you Bron, will go to the Levemir forum now.