? Switching to Levemir from Lantus, have questions for the switch.

Prior condo

We are looking at switching Zeke to Levemir on probably Tuesday. I have been told that to start with a dose about 25% of his current Lantus dose, is this correct? From there, how would we increase his dosing, or would we just follow the normal TR protocol at that point? Wanted to find out if there is anything extra need to be doing for dosing once we start. We are going to be testing every 3 hours till we find out when his nadir is for Lev and then look at adjusting shot times to better fit our scheduling so it will be much easier to be watching him at the times he would most likely be dropping low. Right now we are sleeping during the later part of the PM cycle, which is when he could possibly be hitting his nadir with Lev.

 

I believe you start with 75% of the current Lantus dose. When I switched, I increased following the normal TR protocol, but I don't know if that is what you are "supposed" to do.

I think the best thing is to monitor during the switch. Osha didn't do anything crazy, but others say that some cats can have a dramatic response to the switch.

Osha's typical nadir is now around +9 to +12. It takes a little getting used to, but for us it was worth the learning curve.

Good luck! Levemir was a life changer for me and Osha. Waaaay flatter and more predictable numbers.

 

Thanks for the response. I am glad I am asking since you started with 75% of the dose and I have been told 25% of the dose, so would hate to start with the wrong amount. Zeke loves giving the crazy numbers. We finally got to shoot his current dose 3 cycles in a row, because he kept going way low and would be having dropping numbers come shot time so wasn't going to shoot. So ready for some flatter numbers. It is mainly me and my daughter testing, but we can easily test around the clock since she is home schooled. Planning on every 3 hours (unless he tells us more is needed) till we have a better idea of how he is going to do etc.

 

You start at 70% of the Lantus dose, somthat would be about 2.5 units for Zeke. The reason for the lower dose is that some cats have a strong reaction to the switch, so I would do the switch when you can monitor closely for the first couple of cycles. As far as the protocol, you just follow it as normal for dosing. However, if the new dose is clearly too low, you can fast track up. Post here for advice if you think that is happening. Remember that for the first few cycles of Lev, you will also have the Lantus depot in play.

By the way, you will really have to learn to shoot lower with Lev, especially if PS is near Zeke's nadirs. You did have some shootable numbers that you skipped. If he's at or near nadir at PS time, low but above 50, giving him his meal with his shot will bring him up. It is easier shooting low with Lev, because the onset is later so you have several hours to bring him up with food.

 

He was still dropping and didn't want to shoot a dropping number.

Ok, thanks.

 

Could that cause him to go lower? Say, like it would if we increased his dose?

 

You will have to get used to shooting dropping numbers with Lev. I did it all the time. I would occasionally see a nadir of +13 to +15. Even on Lantus it's fine to shoot a dropping number, as long as he's above 50. Getting periodic +1 tests will tell you how much of a food bump he normally gets. Remember, you are shooting the number at onset, so there is still time to raise the numbers with food.

The Lantus depot in play just means that it'll be harder to see the Lev patterns, and you may see some Lantus action. The Lev depot won't be built up yet either. We suggest a reduced dose because some cats show a marked response to the switch. ECID.

 

I was always seeing to never shoot a dropping number, so that is why I didn't.

So basically, we are looking at at least 4 good cycles to really starting seeing the Lev in action? And to know it is the Lev and not residual Lantus?

 

Not shooting a dropping number is a myth. Check out this post: http://www.felinediabetes.com/FDMB/...ging-protocols-good-idea.111088/#post-1173098

 

Thanks, I book marked that to help me remember on it. So basically, even though he will appear as dropping, as long as he is above 50, still shoot correct? Just monitor closely in case he needs steering for the first couple hours to make sure he starts his rise?

 

Yes, of course it depends on your ability to monitor. Not shooting a dropping number may be something for newbies, but once you know how to manage his numbers with food, you can get good flat cycles with shooting green.

 

We have recently switched to Lev if you wanted to look at the transition on the SS. @Phoebes also recently switched as well.

 

I am commenting to follow... I am seriously considering trying Lev too.

Good luck!!! Ill be on the lookout for your condos =)

 

@Wendy&Neko Zeke must have heard us talking. I know the number is 48, but it is pretty much 50 with the way things go, so safe to shoot? Of course we are going to be able to monitor all night, my daughter is just waking up lol.

 

Thanks for letting me know, I will be watching yours to see how things go. We are looking at starting Tuesday morning.

 

I would stall 15 minutes and retest. Shooting below 50 is not recommended.

Crazy cat!

 

IKR!

I have already fed though because fatboy has already been driving us crazy for the last hour straight! I am about to order some feliway diffusers and spray so I am hoping that calms his big butt down. He is extra stressed because he isn't liking the puppies, they are too much energy for him lol. I will still test and make sure he is rising and that it is enough of a rise then post.

 

@Wendy&Neko well, he dropped more to 38 so gave some HC and will skip this shot. When he nose dives, he tends to go whole hog into it. We will test again at +13 and see what he is at.

 

Are you kidding me?!? He must be reading his condo! This was my laugh of the day.

 

I think us switching was the best thing yet. I only wish I'd switched sooner.

 

IKR! We were just talking about shooting/not shooting dropping numbers and here he goes doing the exact thing lol. Well, he insisted on no shot, so no shot for him tonight. We made it 3 straight cycles without craziness lol.

 

Yalls nadir didn't really move a whole lot, and yall are getting a lot of nice flat cycles. Would love to see some of those. Zeke can't seem to make up his mind what he wants to do right now though, so hopefully the switch to Lev will help him figure that out.

 

@Wendy&Neko Is it possible this dose is too much for him still? Seem every time his depot starts getting full since we hit 3.5u, he drops below 50 or pretty dang close. But at 3.25 he wasn't getting the low numbers like he needed. I know I am about to switch, but very curious on this since this is the type of happenings that makes me start second guessing things. Asking also, because if the starting starting dose of Lev is going to go by the Lantus dosing and this dosing is too high, would that cause any issues right off the bat?

 

How do you like having such a late nadir? Doesn’t worry you if you’re out at work and can’t leave food out? Silver is on Lantus but also nadirs around +10.

 

I work from home and we free feed our 3, so no issues here. Once we learn when he will nadir, then we will see about adjusting the dosing schedule if needed. I am also not the only one testing him which is why once we do the switch, he will be getting tested every 3 hours like clockwork til we learn how he will do with it.

 

+13 71, will test again at +13.5 and +14 to make sure he isn't going to head back down. Little turd.

 

I would definitely reduce with that 38. With your recent dosing all over the place, hard to say what you should reduce to. Maybe 3.0 units.

One thought, you might want to start getting some +9.5 or 10's when you see him sliding down during a cycle. That way you could see if he's in danger of going low at PS, and intervene with a little food do he's safe tonshoot a couple hours later.

 

OK. And we shot 3u this morning. His ps was 171, so he never really went up much even though he didn't get a shot last night. So at 3u, starting dose will be about 2.25u of Levemir?