Raffy 3,75U Levemir Need dose advice

Hello; u can see the previous data at SS . But things are going bad.
I need immediate adviceses.

 

It's time to increase the dose to 4 u twice a day. You're able to test enough to follow the Lantus/Levemir TR dosing protocol. It would allow you to escalate the dose more quickly to get Raffy into better BG numbers sooner.

http://www.felinediabetes.com/FDMB/threads/lantus-levemir-tight-regulation-protocol-tr.1581/

 

.....or, maybe, you started with a too big dose. As far as I know bigger or smaller looks the same....like it's not working. With Lantus, for Rafy's weight (5,2 kg) a dose of 1.3u should be the start for the Tight Regulation ("the formula is 0.25 unit per kg of the cat's ideal weight"). For the Start Low, Go Slow even less.....05/1u for start. I don't know too much about Lavemir, though. Maybe you should chat about it with Rafy's vet.

 

What insulin and dose were you using before Levemir and what sort of readings were you getting??

 

Here is the link to your previous post, it will help others see what's been going on: http://www.felinediabetes.com/FDMB/threads/i-can-not-find-the-dose.181605/#post-2016501

 

thx Nat...

 

I think you can increase to 4.0 units. I strongly urge you to try to get both AMPS and PMPS tests each day.

I wonder if he's finding some dry food in the afternoon before PMPS.

 

Last night he couldn't go out AMPS was 423, we r back again with 400's but better

Deae Ovi, thx for reply.
We ve never tried a dose which is less than 2U.
We ve started to use Insulin with Humalin N, that was our old fashioned Vet's choice; and he took the BG levels to 70's with 4u Humalin twice a day, but you know Humalin N is lowering the level to fast and also it is going up so fast as well. AMPS was 430's +4 was 70-80 with 4u Humalin.
As a result of this we ve started with 3u lantus then levemir

 

This morning i ve cancelled everything
i ve reduced the dose 1.25U
AMPS was 423 , 1,25u, +3 it is 418
i ll check it again at +6....

 

Dear friend, please READ THE PROTOCOLS FIRST. With Lantus&Lavemir you have to keep the same dose for at least 72 hours before you have an idea if you need an increase or decrease of the dose. As well, these changes should not be more than 0.25/o.5u at once. Be patient - is the most important thing.
We tried to rush everything ourselves but we were going nowhere, getting crazy numbers - so we decided to wait 5-7 days before any change down (skipped or reduced dose under PMPS/AMPS under 180) - and at least 3 days before any change up (change up after 3 days only if BG was constant in red or black, otherwise wait for 5-7 days and see what happens). We'll run the 3-5(7) days cycles until nadir is under 150. That's the final target for now. When we'll be there we'll re-evaluate the situation and go further. Not sure yet if will work - these are the guidelines we decided to follow, we feel they are the best for Toronto. Use your sense, be patient...and yes, try to keep the kitty off dry food, is very important for the BG numbers. Good Luck !

 

Please make sure you checking for ketones regularly with such a reduced dose and high numbers.

I do not think you should have reduced the dose. If it took 4 units of Humulin to get him to normal numbers, then a lower dose of Levemir will not work. When we switch from one insulin to another, we do not go back to the beginning for dosing, I would increase back to 4.0 units and hold the dose at least six cycles, unless he goes below 90.

 

3 days passed with 1,25U. I could not make so many BG level tests beacuse of my duty times, but AMPS and PMPS values were around 430. And +6 values were 390.(i was able to do +6 just for twice)
Tomarrow morning i am planning to increase the dose 1.75u or 2u. I need your adviceses.

 

I don't see any PMPS data in your spreadsheet. I also don't think you should have reduced the dose. I would jump up to 4.0 units next, as long as you can monitor that cycle.

 

If you choose to start low and eliminate one level at a time.....because you can't check the BG all the time during day and night, I'd go safe with 0.25u at a time. Increase 0.25u every 3-5 days until you reach yellow for AMPS or PMPS or Nadir. After that, go for fine tuning (see the protocols for numbers). These are only guidelines, but I strongly suggest you don't go up too aggressive if you can't check the cat between AMPS and PMPS. As I lack experience and I'm good only at numbers, you may want to go with Wendy's advice, jump to her numbers and take it from there...she seems to have a lot of experience on diabetes....

 

You do enough testing for us to know that the lower dose is not enough. Neither was 3.75 units. Don't waste your time going backwards. The protocols allow for people being on a different insulin and switching to Levemir or Lantus. Neko started on Caninsulin and I made a huge mistake starting back at the beginning in dose instead of taking the dose of the previous insulin in mind. I wasted months getting to better numbers. In the 5 1/2 years I have been on the board, I have seen many a caregiver do a "recheck" by going backwards in dose. All it does is waste time getting to a good dose. In the worst case, I have seen a kitty develop ketones when the dose was lowered. Please make sure to test for ketones daily since you lowered Rafy's dose so much.

 

I made a dose reduction because we ve never used doses below 3u...
Right now i am sure i have to increase the dose. Yesterday evening , i gave 1,5u; and this morning we ve started with 2u. We were below 400 today.( you can check the datas on SS)
Do u think i should keep it at 2U minimum 6 cycles?

 

Make sure you're testing for ketones as often as possible. I would be testing for ketones once a day. I also agree with Wendy. I would not have dropped back down.

 

Hello Gurkan, since you switched from another insulin like Wendy said you should have been fine with the higher dosing. You test very well, and monitor Raffy well. You got a couple pinks that is good. If you are comfortable going back up to the high dose, then you can. It will take a few days for the depo to stabilise so just keep up with monitoring and testing. Sorry for the confusion, I think others didn't realise that Raffy was on another insulin prior to you switching to Lantus and creating a SS.

If you aren't sure or find you are getting different suggestions, feel free reach out to one of the members you feel comfortable with by adding there username to the post like this @Wendy&Neko . The will get back to you normally the next time they logon. I am still learning so I normally refer to more experienced folks.

Hope that Raffy is getting used to staying inside and not crying too much to go out.

 

How is Raffy doing? I see he is still high, you are catching up well, hope that you get some better BG soon.

 

I also agree with Wendy. Over the 7 years I've been on this Board, the only response I've seen to cutting a dose back the way you did was the kitty is in high numbers for even longer. With Lantus, you do not reduce the dose when you switch from a shorter acting insulin. You can switch insulin at the same dose. While a cat that isn't getting enough insulin can have BG numbers that look like a cat who's getting too much insulin, I don not think that is the case with Raffy. I believe what you're seeing is that you started Lantus at too low of a dose and your cat is now in high numbers. Reducing the dose again to 1.25u vs increasing to 4.0u is not going to improve your cat's number.

 

Raffy seems to be a tough kitty

 

I also have to jump on the same bandwagon as Sienne and Wendy.

What @Toronto & Ovi suggested is called a "rebound check". In my 7 years here, I've only seen that work twice and, in both cases, the vet started the doses at close to 10u. Doing rebound checks can end up causing glucose toxicity and often the dose then has to go back up higher than it originally would have in order to reach a good dose.

When you take the dose up slowly and systematically as you have done and in accordance with the TR protocol or SLGS and also test as you were testing prior to 8/12, you can't overdose the kitty.

 

Hello again; i was away from home 5 days. That's way i was not able to make so many checks etc.
Right now we are at 3.0u. I could not make the AMPS check, +4 was 449. The point that i can not understand is even with 1,25 or 2 units the BG levels were almost similar.
Is it a normal behaviour?

 

Yes it is normal, the depo needs to build and that can take up to 6cycles (3 days). Also, he may also just be a cat that needs more insulin than others. When you get closer to a good dose you will see more of a difference. The good thing is you didn't see and black numbers the last few days. You may want to go to 3.5 units tomorrow, if you do not see any lower than normal BG. Some cat are difficult to regulate, but you will get there

 

Dear Nat, with your kind support, i hope we will find the dose

 

Me too, Raffy is so adorable. I am going to talk with @Wendy&Neko as she is very experienced and see if Raffy would be a good candidate to fast track a little or not. What would help to decide is if you could try and get some BG test in the PM cycle. Example a +2 and and one when you go to bed. This will help just in case he has better numbers at night.

 

This evening i could not make a test before PM Shot He bite me....
I ll try to make it now. Right now it is +3, also i ll not able to make a test before AM Shot because i ll go to a flight 3 hours later

 

+3 / 463 ...

 

Going to 4.0 units S suggested before would not be fast tracking, but rather returning to a better dose. However, I would only jump back up in dose like that if it's a day you can monitor more closely.

Insulin is a hormone, not a drug. It's not like you add a bit more and their numbers get a bit better. Often you will see a cat stuck in higher numbers until they finally get to a dose that can move the numbers. You WILL find a dose that gets Raffy into better numbers. But you tried all the doses up to and including 3.75 units, and they were not the answer.

 

Mr Raffy doesn't like being tested
Agree with Wendy, if you can monitor all day tomorrow try 4.0u, If you can not monitor 3.5u may be better.
Good luck and let us know how Raffy is doing and feeling.

 

We are on 3,5 ... And PMPS was 378, i am do happy when i see numbers starting with 3 .
Hope to see numbers with 2 digits.

 

No dosing advice, just a bit of support for you, and to say I understand how happy you can feel to see numbers starting with 3 . Good luck, hope you find the right dose to get Raffy into a nice set of numbers really soon.

 

I am happy too. let's see how he does next few cycles. Of you can get a plus 2 and bed time test that would be good. If Raffy let you

 

I ve done +3 test, but not so good... Again 472.
Is it a reaction of a higher new dose?

 

Yes, that's possible. Keep the dose the same for the next few cycles.

 

Like Kris said it could be because of the new dose, it takes a few days sometime for their body to get used to a change in insulin. I could also be because of the lower number today. It's been a while since Raffy has a Pink number, so his body may have reacted by bouncing... which is going to a higher number because his body got scared of the lower than usual number. This is the fustrating part of regulating a cat, lots of ups and down, trying to figure out why. Once his body gets used to lower numbers bounces should be less, however some cats bounce all the time after a nice BG. You will get used to it.

 

Hi again, is your name Gurkan?

PS: Tomorrow if you can create a new post, that would be good as this one is getting a bit long and add the url from this post to the new post. Copy the address on your browser ... this one http://www.felinediabetes.com/FDMB/threads/raffy-3-75u-levemir-need-dose-advice.181943/#post-2024623 and paste it in the new post.

 

Yes, my name is Gurkan...
I ll do it tomarrow morning. Right now it is 00:52 Am , 7 hours left for the AM shot.
See you tomarrow with the new post.