Switching to Levemir from PZ - Acro kitty needs your advice :)

Hello! This is our first post on the L/L forum, and we need some help. Rocket has been on ProZinc since Feb of this year, is still highly unregulated, and has ranged from 111-694 (AlphaTrak) just this week with no apparent pattern. He was diagnosed last week with Acromegaly, which I know makes it much harder to regulate. But, we've been increasing his dose (perhaps too slowly), and it seems the higher the dose, the higher his numbers go (with exception to the weird occasional bounce, if that's what they are).

We've ordered Levemir in hopes of getting flatter and more consistent numbers. It should be here tomorrow or Tuesday. I'm still digesting all the info in the stickies, so bear with me. Here are my questions:

1) Looking at his spreadsheet, what would you all recommend as his starting Levemir dose? He's currently on 5 - 5.5U of ProZinc using U-40 needles. His vet, who I don't think has ever prescribed Levemir before us, recommended starting with 4-5 units (using U-100 needles of course). Wouldn't that in effect be doubling Rocket's current dose (based on units per ml)?

2) We're currently testing with an AlphaTrak, but I'm going to pick up a human meter tomorrow. I've heard that the difference in human meters vs. pet meters is more pronounced in the high numbers. Given that Rocket is peaking in the 600s, is this a concern? Or do I really just need to focus on the blues and greens no matter which protocol we choose? So far he tests negative for ketones during these high peaks.

3) Any idea whether SLGS or TR is better for Acro kitties? Or will it be difficult either way?

4) He occasionally has very late PM nadirs - since Lev has a later nadir too, could this be a problem?

5) Unfortunately I'm having surgery on the 26th (a week from Friday) and will be in the hospital one or two nights. I've read about "building the shed." Is this a terrible time to switch? My husband knows how to give shots, but has never tested BG and is very reluctant to. I'm not sure our current bottle of PZ will last 'til the end of the month.

I hope I'm not asking too many questions. I feel lost most of the time, not knowing how to dose my poor kitty with his roller coaster spreadsheet. All advice is hugely appreciated, and please let me know if there is anyone in particular I should tag about this. Hugs to you all.

 

1) we would suggest a dose around his current Prozinc dose, so perhaps 5 units. Some cats have strong reactions to the change in insulin, especially if IAA was also in the picture. The two insulins are different concentrations, 5 of Prozinc in u-40 is the same as 5 of Lev in u-100. Make sure you switch on a day and night you can monitor regularly.

2) spreadsheets look nicer with human meters. High is just high when over 300. It can make a difference depending on which dosing method you choose. With TR, you can increase by larger amounts and sooner if the nadirs are all over 300. 300 on at AT might be 200’s on a human meter.

3] If you can manage it and are on he is on a low carb wet or raw diet, I strongly encourage following TR with acros, so you can stay on top of changing insulin resistance.

4] Neko also nadired late, not uncommon with acros. On Lev she often nadired at preshot time. I was always home and able to monitor then, You do have to get used to shooting low. Neko’s onset was also later, so I had plenty of time to get food in her and get the numbers to rise before onset.

5) We call it the depot now. Shed was a term just used here and caused vets to look at you funny. If you can test enough to figure out how low the dose is taking Rocket, we can help you find a safe “petsitter dose” for DH to give while you are away. I would switch when you have at least a week to build the depot before you go. It took my DH a while to step up to testing too. So glad when he “manned” up, not so much when he started commenting on my technique,

 

Thank you. This helps a TON. I really appreciate it. Hopefully I can start the Lev on Tuesday at the latest, and go from there. I don't have much planned between now and my surgery so I should be around to test quite a bit. Did I already say thank you?

 

TR is indeed better. But I will be open and state that it was challenging for Leo and his fluctuating acromegaly (pituitary tumor). He bounced all over.

Leo's 2016 pre-SRT insulin demand was on a steep growing curve.
2016 - went from 4.0 units to 18.0 units/dose in 6 months - I couldn't keep up with this, and also keep my job
2017 Aug and Sept - bouncing all over
etc

So, yeah, I varied the dose within a range. Levemir isn't perfect for that. But I tried to get Leo decent nadirs as much as possible.

Starting spring 2017, he was also on a 6am daily prednisolone pill. That did a daily increase in his A.M. values. So I also compensated for that.

 

Mkay. I'll aim to really get into TR when I'm back from the hospital and on my feet, so I can do it the right way. Until then I like Wendy's idea of finding a safe "petsitter dose" that my husband can work with. Man I can't wait to get this hospital stay over with! It'll only be a couple days but that's enough to make me worried. It'll be over soon. (Breathe!!!)

I hear you about how much work this really is. You were such a good friend to your Leo.

 

Good luck with the switch. I hope Lev will be a good choice for you.
And best of luck to you with your surgery and hospitalization.

 

Thank you.

 

Welcome Kes! I'm so glad you and Rocket have found your way here. I'm also happy you're switching to Levemir. I'm probably biased (we've tried Vetsulin, Basaglar, and now Levemir), but I absolutely LOVE Levemir! Lou's finally regulated on it, and it was a bit harder since Lou's an IAA-only kitty (another high-dose condition). I am wishing you both lots of luck with Levemir and good luck and healing vines for your upcoming surgery!

 

@Wendy&Neko
@JeffJ
And anyone else who would like to help

It's me again. So its PM+9 right now and we just got our first green ever - 90 on AlphaTrak. PM+6 was 179. He had an all black day yesterday as far when I was able to get tests. While I'm happy to see the green, the little guy is so unpredictable. Our Levemir package should be arriving today. Do you still think we should we still start him on 5U of Levemir? I know, Acro, but I'm still wondering what is triggering these large bounces lately, if our dosing is off, etc. And of course I'll test again in a bit to see if he's still going down. Posting on the Acro forum just in case too.

 

Guess who likes being an unpredictable cat.

90 is still a safe number, but if you want to go cautiously on starting dose, especially since you won’t be around in a week, you can try 4.5 units. Just make sure you keep testing for ketones.

BTW, we do have a couple other acro kitties on here on Levemir. You can check out the posts for Amethyst and Olive and see what their spreadsheets look like. Biscuits is an acro still on Lantus.

 

Thank you again. It'll be an interesting day. I'll check out the other acro/Lev kitties.

 

Aaaannd an hour later we’re at 175. Still was nice to see the green, if only for a moment.

 

Wow, that is a bouncy shot to the moon. Rocket needs to cool those jets and stay on earth.

Leo was bouncy a lot - the active pituitary tumor can pulse, leading to the bounces.

 

Ha! I know Panic's mom was saying that our cats seem to be following their names... Panic is all over the place, and Rocket likes to shoot up sky high.

Yeah, I noticed that he was bouncy too. I'll take a better look at his SS when I get back in a couple hours, but did you do much dosage adjustment based on his numbers? Seems really hard to do when our acro kitties bounce so much.

 

Let's get Rocket on a stable dose of Levemir before doing any variations.

Yes I adjusted dosage based on preshot. The adjustment was within a range. Not covered by the protocol. My goal was blue numbers daily, after the SRT. I was not a great reference case for sucessful regulation - there were periods where I was working 50+ hours. My goal was to keep Leo alive. An example is Jan 2017. Dose was 8.0, and I varied him from 6 units to 9 units.

I was going to reference you to Sara's chart for Pig - handle name LuvinThisPig. She finally regulated him pre-SRT at 59 units/dose. Before that he was too hard to control. After SRT, Pig was moderately stable at 16 units/dose.
https://docs.google.com/spreadsheet...FyvQoWqyMa_uaWaZsEAzXuWuXxyq0WVjB9RG/pubhtml#

A current Acro, but no SRT or cabergoline patient is C.C. whose marvelous bean is JanetNJ. While C.C. is on Prozinc, you can see some dose adjustments. And C.C. likes all the rainbow colors like Leo did. To me, Janet taking care of C.C. and her son's eyesight - she is the Mother of the Year.
https://docs.google.com/spreadsheet...prrwY_fPHbcFk0KNVUltdBxnk/edit#gid=1815515737

 

Here we don’t dose the L insulins based on preshot, unlike what you have been doing with Prozinc. Rather we look at the nadirs or how low the dose is taking the cat. It is one of the mind switches you will have to do when you switch, We find that steady dosing stabilizes the depot and gives less wonky numbers. What may look like bouncing could just be wonkiness from the depot being unstable.

Neko was also on Levemir and relatively well regulated after her first year. If you are interested in reading spreadsheets of acro Lev kitties, I can find more for you. Let me know.

 

Let's get your kitteh on a stable dose.

Wendy is correct. Depot insulins (levemir, lantus) evaluate nadir values to determine dosages.

With real bouncy cats it is just a challenge. I did use preshot to judge the dose in concert with nadir values. Sara tried to regulate Pig using the standard protocol as well, but Pig was as bouncy as Leo. If a cat doesn't have a good nadir, or bounces all over, it is very challenging.

I will be very open about Leo's dosing - I did not follow the protocol strictly. He was too bouncy. And we all know he didn't die from diabetes.

 

Thank you both. Rocket is going to be a challenge for sure, but I think I’m up for it. Lots to learn. I just hope everything is ok until after my surgery. And sure, I’d love to see some more spreadsheets. Something to look at during recovery time.

 

Welcome Karen & Rocket!

Bronx is another acro kitty on Levemir. As you can see on his spreadsheet, it was a hard time getting him regulated, even after he had SRT back in May of 2017. You are not alone here, many acro moms & dads only a click away

 

Welcome! Great group of supportive people here - and the kittiehs too We're not ACRO but we just switched to Lev - hoping for regulation at the least - that other 'R' most likely will allude us - but that's acceptable. Luci is a championship high diver and loves her drama - she seems to be less dramatic on Lev - but we're still new at the Lev game.

Best wishes on your upcoming hospital stay!

 

Thank you so much! Sorry I missed your post yesterday. Rocket has had his first Lev dose this morning so *fingers crossed*!!!

 

Hello Bronx's dad! Nice to meet you. Thank you so much. We're looking into two different places for possible SRT as we speak. Lots to think about.

 

Thank you!!! Best of luck with your switch to Lev too. Glad to know our dramatic kitty is in good company.