? Switching from Lantus to Lev. Dose recomendations for an unregulated acrocat?

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Bronx's dad (GA)

Bronx's dad (GA)

Member Since 2016
Hi all. Just received Lev and would like to switch right away since I only have about a week's worth of Lantus and would like to save that just in case Bronx doesn't react well to Lev. I have read it should be 70% of Lantus (7.5u x .7 = 5.25u), but Bronx is not even close to yellow #s yet and finally seeing some pinks. I would hate to reverse this progress I'm finally seeing and the quicker I can get him out of danger zone the better. I have seen some do a 1-1 swap for acrocats and I think it is pretty safe to do so for Bronx as well since he is nowhere near hypo but I am hardly an expert. Maybe start at 7u? Thanks!
 
Paul, what is your ability to monitor after making the switch? Some cats show a marked reaction in the first or second cycle after changing insulins. Keep in mind the onset is more like +4-5 in some cats (though I've seen +3 on Lev) and the nadir may be anywhere from +8 to +12 (or later when on a better dose).
 
Wendy&Neko said:
Paul, what is your ability to monitor after making the switch? Some cats show a marked reaction in the first or second cycle after changing insulins. Keep in mind the onset is more like +4-5 in some cats (though I've seen +3 on Lev) and the nadir may be anywhere from +8 to +12 (or later when on a better dose).
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I could wait till tomorrow morn 8a to start Lev and will be home all day to monitor. Would make it easy: new year, new chart & new insulin! But would be hard to monitor all night if marked reaction is 2nd cycle, what is more important to closely monitor, 1st or 2nd cycle?
 
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There's no real way to know if Bronx will have a marked response and when it may occur. (Remember, we're talking about cats. They are predictably unpredictable.)

One thing to keep in mind is that the nadir with Lev, at least for most cats, is later than with Lantus.
 
Here is the link to your last post. http://www.felinediabetes.com/FDMB/threads/newest-member-to-the-acrocat-gang.170315/ We include those links to easily go back and see what happened previously.

As Sienne says, it's hard to predict a cat. Neko did nothing her first cycle and had a great second cycle of Lev. Jack (@saltycat ) had a strong reaction the first cycle. So I would be prepared to monitor both cycles. For Neko, I did a before bed test then set my alarm for +8 for a quick test at night. Once you figure out when the nadir generally is, it's easier to get up for a quick test. I learned what would likely happen overnight based on the preshots and before bed time test values. Keep in mind, many cats go lower at night. I would use that data to decide if I needs to set alarms for the wee hours.

I have discussed dosing with a few of the high dose caregivers, and we think 7 units will be OK to start. Depending on what you see, you may want to hold longer than 4 cycles for the first Lev dose.

Good luck!
 
Wendy&Neko said:
I have discussed dosing with a few of the high dose caregivers, and we think 7 units will be OK to start. Depending on what you see, you may want to hold longer than 4 cycles for the first Lev dose.

Good luck!
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Thanks Wendy! I will start at 7.0u tomorrow morn and make sure to closely monitor the first 2 cycles.
 
Jack tested positive for both Acro and IAA, he doesn't do anything half speed :rolleyes:. I think part of his initial reaction to the switch was the antibodies weren't prepared and it took them a few days to catch on. Since Bronx isn't IAA, hopefully he will have a little more controlled descent into better numbers. We also switched from Prozinc to Levemir FYI. He definitely had a strong reaction and I had a good bit of hand holding from the group here those first few days when he went from all pink and red, to greens and blues in a day. Good luck on the switch, hope Bronx reacts better to the Lev.
 
Hi Paul

I’m sorry for the diagnosis but we have some very experienced high dose moms here so you are in good hands!!

As Wendy stated, some cats will see a quick response to the switch from lantus to levemir and some, like my Gracie, will not.

I raised Gracie’s dose after 24 hours because she was high and flat and then I raised her again after four cycles. I’m not suggesting that you necessarily raise after two cycles (24 hours) but I definitely think that if he’s still high and flat after four cycles, I’d raise his dose to 7.5u.

I don’t usually copy and paste information but I think this information from Tilly’s webpage is important (the bold is mine).
Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours).
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As long as you are closely monitoring, if he has no response to the levemir after two cycles, you might want to ask for help but I definitely wouldn’t hold the 7u dose more than four cycles if he is high and flat.

Good luck with the switch.
 
Marje and Gracie said:
Hi Paul

I raised Gracie’s dose after 24 hours because she was high and flat and then I raised her again after four cycles. I’m not suggesting that you necessarily raise after two cycles (24 hours) but I definitely think that if he’s still high and flat after four cycles, I’d raise his dose to 7.5u.
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Thanks Marje. I do think I will go right back to 7.5u if Bronx is still high and flat after 2-4 cycles. I am finally seeing some pink #s and don't want to lose the progress we made.
 
I assume you'll be posting when you make the switch. I agreed with Wendy about starting at 7u, and then let's just see what Bronx does and go from there.

See you tomorrow!
 
julie & punkin (ga) said:
I assume you'll be posting when you make the switch. I agreed with Wendy about starting at 7u, and then let's just see what Bronx does and go from there.

See you tomorrow!
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Yes Julie, started at 8a EST with 7.0u of Lev. He was 361 AMPS which is a good number for him. Seems the dosage increases of Lantus (0.5u every 4 cycles) were finally trending him lower. It will be interesting to see how he reacts to the Lev.
 
Good luck with the switch! Doodles (IAA only) had a very marked response to the change. He was on 12u of Lantus, along with R multiple times a day. We started with 10u of Levemir on April 17, 2016. Doodles typically nadirs at preshot and sometimes as late as +15. I recommend you test every 3 hours for the first few cycles.
 
Doodles & Karen said:
Good luck with the switch! Doodles (IAA only) had a very marked response to the change. He was on 12u of Lantus, along with R multiple times a day. We started with 10u of Levemir on April 17, 2016. Doodles typically nadirs at preshot and sometimes as late as +15. I recommend you test every 3 hours for the first few cycles.
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Thanks Karen. Do you still have to use R with the Lev? I think that will be my next option if Bronx still stays high and flat. Is Lev like Lantus in that it likes a lower number, which R will do, to grab onto?
 
Bronx's dad said:
Do you still have to use R with the Lev
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Very rarely anymore but yes, R can be used the same way with Lantus to help bring the numbers down. You'll have to get close guidance from the group here if/when you first start using it. It's a good tool but if not used correctly/safely it can do more harm than good.
 
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Bronx's dad said:
Do you still have to use R with the Lev
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It has been a good tool for me to have in the toolbox. I still use some R with Jack. He is on a big Lev dose so we sparingly use R to try to bring the numbers into a better range. Lev is good at holding numbers down, the R is good at getting numbers down a bit. It is potent stuff and takes some time to carefully work on finding the right dose. I had a lot of help when first using it.
 
Once we see how he is going to do, we can teach you to use R if need be. It works really well especially with levemir.
 
Marje and Gracie said:
Once we see how he is going to do, we can teach you to use R if need be. It works really well especially with levemir.
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I will increase .5 starting tomorrow morn to be equal to the last Lantus dose level if I don't see any crazy drop these 24hrs and then increase .5 every 4 cycles as I had been doing with Lantus. At what point should I consider using R? I really don't like that he has been at such a high BG level for so long and have no problem being aggressive at this point as long as I am home to closely monitor.
 
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Bronx's dad said:
I will increase .5 starting tomorrow morn to be equal to the last Lantus dose level if I don't see any crazy drop these 24hrs and then increase .5 every 4 cycles as I had been doing with Lantus. At what point should I consider using R? I really don't like that he has been at such a high BG level for so long and have no problem being aggressive at this point as long as I am home to closely monitor.
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Let's not get too far ahead on plans yet insofar as dose. It's ok to raise the dose tomorrow but let's see what he does in four cycles before you decide to increase every four cycles. I think you should play that by ear.

We also need to give the lev a bit of time to see how he does before we toss R into the mix. I'd say at least a couple of weeks but let me talk to Wendy and Julie as well.
 
Marje and Gracie said:
It's ok to raise the dose tomorrow but let's see what he does in four cycles before you decide to increase every four cycles. I think you should play that by ear.
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I based the .5 increase every 4 cycles only if he stays in the reds and pinks. Would definitely slow down if I see even one yellow.
 
By the way Paul, I will be around next weekend and would be happy to teach you how to use R if you would like and if you will be around then. It's a good tool to have in your toolbox. um, you're in New Jersey? What time do you shoot? I'm in western Oregon.
 
julie & punkin (ga) said:
By the way Paul, I will be around next weekend and would be happy to teach you how to use R if you would like and if you will be around then. It's a good tool to have in your toolbox. um, you're in New Jersey? What time do you shoot? I'm in western Oregon.
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Thanks Julie! Around 730-8. I can get R OTC?
 
ok, let me see if any east coast folks that are experienced R users might be available that early - that's 4:30am for me. I'm not going to be up then! We can do a different point in the cycle too, although with most cats we start at preshot. I actually like doing later in the cycle. We could also do the pm shot if that's not too late for you.

The goal of using R insulin is to only lower the blood sugar by 100 or less points. Depot insulins do great at holding blood sugar flat but less well at pulling high blood sugar down. By using R to lower the blood sugar a little bit the Lev will be able to do its job a little better. We don't want to drop his blood sugar too much or too fast, so initially we'll start with a tiny dose. After you give it, you'll test hourly for the following 4 hours so we can see what effect it has. It's not uncommon for the first trial not to do too much. We're starting with a tiny dose because some cats do react. Even when Punkin was getting more than 10u per shot, I usually didn't use more than 0.5u with the R.

Yes, you can get R over the counter - look for Humulin R or Novolin R. Prices can vary quite a bit, so you might want to call around to different pharmacies. We'll use the same syringes that you use for the Lev.

Also you probably already have high carb supplies, but just to make sure, I'd always want several cans of gravy cat food plus a bottle of syrup (honey, maple syrup, karo/corn syrup) available, plus I kept an unopened bottle of 50 strips just in case.
 
By the way, would you start a new thread with your reply? We'll find you there - it's the custom of this group to open one new thread for each cat every day so the threads stay manageable and don't get too long.
 
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