We changed over to Levermir from PZI

My name is Peg my cats name is Toby. He was diagnosed a year ago with Inflammatory Pancreatitis and is on 2.5 mgs of
Prednisolone 2X a day. We have tried to take him off this but he gets really sick. Even just a little reduction starts him vomiting and runs a fever. Then we have to syringe feed him . He was diagnosed with diabetes about a month after the pancreatitis .
He was put on BCP PZI insulin. Started out at two units ended at 4.5 to 5 units and never got regulation. A month ago he had a cbc and chemistry panel done all was normal. Decided to change him over to Levermir to see if I could get better numbers. This is the Fourth day on it we started at .5 units the first night . Then it was suggested to give one unit because he was on
4.5 PZI and his numbers were high. The second day numbers still high and tested small ketones in urine. was suggested I give unflavored Pedialyte and put extra water in food which I did. Increased insulin to 1.5 units numbers started going down. That was day two. Day three numbers are getting better but end up at 450 pms. Day four which is today got ketone test and was neg.
tested 1.30 am bg is 322 cat not acting like his self. He ate but,had to try three different flavors of cat food . He on ff classics.
usually not a picky eater. He 9 yrs.old. weights 13 lbs. down from 18 when first diagnosed. My vet. has never used Levermir . I
don't know what to do. Have gotten some help on relaxed Lantus but posted here to see if anyone had any suggestions on dosing . Sorry to have written a book but, don't know what else to do at wits end. Thank - you Peg and Toby

 

Hello Peg, and welcome to you and sweet Toby to the TR forum. We have both Lantus and Levemir users here using the Tight Regulation Protocol. There are a couple of kitties here who are also on prednilisone, Melissa/Tarragon who posted on one of your Health posts and Anne/Liz/Zener. There is lots of information in the starred Sticky Notes above. What is Toby ideal weight? We usually pick a starting dose based on kitty's ideal weight but also consider kitties dose on any previous insulins.

Levemir (and Lantus) are both depot insulins. They are dosed based on the nadir (low point) and take several cycles to build up the depot to see what the dose can do. You'll hear a lot of talk of "patience pants" here. :lol: From the Protocol Sticky:

For now, I'd stick to 1.5 units for 4 more cycles. Levemir likes consistency in dosing, so stick to the same dose, regardless of the preshot value. The spreadsheet shows that Toby got 1.25U yesterday morning, then you did 1.5U last night, so that restarts the cycle count. Since Toby is prone to ketones, we'll fast track after he's been at this dose for 6 consecutive cycles.

Keep testing daily for ketones. It helps us if you mark in Toby's spreadsheet Remarks column the ketone test results.

 

Toby Ideal weight is 14lbs. he is Tall but not big boned. When he was 18lbs he was over weight for him. He's a black and white
dsh. He is also tailless. He takes miralax for constipation 1/8 teaspoon 2x a day. I upped the dose because of the ketones.
When he was on the PZI he had high numbers but never ketones . They happened when I started out on a .5 dose. Increased to 1unit . Still had ketones didn't know what to do Saw the weight scale and increased to 1.5 Units. Hope I didn't mess him all up.
He hasn't been very perky since we started this insulin. Was hoping we would have a miracle. Saw in the think tank how cats a couple of days felt so much better on Levermir and got better control. Talked my vet. into letting me try it . He seemed to feel good on the PZI but such high numbers. Here I go writing a book again. Thanks for your reply, Peg and Toby

 

Hi there and Welcome

I think you and Toby will be very happy with a long acting insulin. Your biggest challenge will be forgetting what you learned about using PZI ;-)

I want to encourage you to test frequently (at least 2x per day) for ketones. The period of transition from PZI to Levimir is a vulnerable time for kitties that are ketone prone. Any ketone test result greater than 'trace' warrants a call to your vet.

 

Just tested Toby for ketones he now tested moderate. Put a call into the vet. waiting for return call. He is still eating and drinking. and syringe fed him more water. Does this mean the dose isn't high enough or if it hasn't built up in his system enough. This is the fourth day on it but changed his dose so they said it's like starting over again. Hope this changes around soon. Peg and Toby

 

The Vet. called and said as long as Toby was eating and drinking on his owe that he would be alright . Told her I was syringing
extra water into him. She said to keep watch and if anything changed to give her a call. Sure hope the insulin builds ups soon.
Hope we can make it that long before he gets sick. Peg and Toby

 

are you using a human glucometer or an Alpha Trak, peg?

Welcome to LL! Let's see what we can do to help you help him.

by the way, it's helpful when you write a book. you never know what little tidbit helps us figure out what's going on. more details are helpful.

 

Have you seen this post on Pancreatitis?

There is a "recipe" for ketones - it is not enough insulin + not enough food + infection or inflammation = ketones. You want to interrupt this equation to get him out of danger. It sounds like you're giving him lots of water, give him lots of food too. Is there any possibility he has some kind of infection or inflammation other than the pancreatitis? Bladder infections and dental infections are fairly common in diabetic cats.

 

I use a human meter relion prime. I am glad I joined so many people trying to help. It's good to have some one to talk to the
stress is something else with this illness. Peg and Toby

 

Peg

Do you have any bags of subcutaneous fluids there? You can get more fluid in him by giving him subqs as opposed to just adding water to his food (which is a good start and smart thing to do). A few of us are discussing dose and will get back to you shortly.

 

Peg, Toby was really started too low on the Levemir. I saw your vet suggested that dose. Typically, the previous dose is taken into consideration, and Toby was only getting in to the 200's on 4.5u PZI.

What's your availability on testing and monitoring him? Usually when ketones are more than a trace, we suggest people take their cat to the vet. It can be risky and difficult to deal with moderate ketones at home. You would need to test a lot, keep him eating, probabaly give him the sub-q fluids and possibly use a second insulin, "R", which is fast acting and brings numbers down fairly quickly, but doesn't last long like the Levemir does.

edited to add: are you up for all of that? and available?

 

He had a cbc and chemistry panel about two weeks ago because he's been on the prednisilone for a year now. His teeth are real good. The Vet.said everything is normal. I just started changing over to levermir he didn't have ketones all the time he was on PZI insulin but his numbers were high. He acted like he felt good. I think because we aren't on the right dose or the insulin hasn't built up enough is why we got the ketones. He was on 4-1/2 units PZI and now on 1-1/2 units of Levemir. This morning
he showed neg. ketones. later in the afternoon he had moderate ketones. Tomorrow will be 5 days on Levermir but, changed the dose and I guess I have to hold that 3 days anyway. Peg and Toby

 

no, the development of moderate ketones changes the picture. we'll likely suggest you increase the dose sooner.

did you read my post above? are you up for some intensive monitoring, because if not, the vet is going to be the best choice. it might be the best choice anyway.

we're still talking - keep checking back often.

 

No I don't have any subQ Fluids here and have never given them before but,would learn if I could get them. I am in maine and it's 9.30 the vets is closed for the night. Will give water and food tonight and see if I can get some in the morning. I am scared half to death now . Just worried about losing him. Wish I would have left him on other insulin. Numbers were high but, he felt
good. Peg and Toby

 

I gave him some unflavored pedialyte yesterday the vet thinks that might of put his bg up because it had dextrose in it thinks that might of kicked the ketones up higher. What do you think? Peg and Toby

 

if it has dextrose in it, then it's possible it's increasing his blood sugar.

I didn't mean to scare you, but it is serious. There is another new kitty on here, Charlie/EllieKozak, who has just gotten through ketones. Has he already had his Lev shot tonight? I don't see it listed on the spreadsheet. If not, how long til it's due?

 

Yes he's had his shot at 6.00 Pm bg 397 just took it bg 319 at +4 should see in the 200's soon. Peg and Toby

 

Just posted latest numbers they have gone down some from yesterday. Peg

 

ok - marje is going to post a little bit to you in a while about the difference between PZI and Levemir. You're going to have to learn a new pattern of cycles with the Lev. It was a very smart choice to switch him though - cats do really well on Lev. PZI is a good insulin too, but Lev seems to have a longer duration and ability to hold a cat's BGs down. Holding a cat's blood sugar flat and in normal numbers is the best thing for the cat.

Definitely check here for dose suggestions before you shoot in the morning.

eta - As you get test results it helps us if you put them in the ss as soon as possible.

 

Just got another ketone sample and it has gone to small ketones. Did the test twice to make sure. Just syringed a bunch of water and he ate again. He doesn't eat a lot at a time buy,he eats often. Peg

 

that's great news. those ketone strips can be tricky. you have to time it exactly and have good light to be able to read them.

keep testing him for ketones 2x per day for now.

are you available tomorrow to monitor him? say every couple of hours but more if necessary?

 

yes,can be home to test. Will make sure he's alright. If not off to the vets. he'll go to get fluids. Been syringing water every few hrs. Been giving ff classics pates. Got about five cans open so he will try each one. Probably getting pretty full now. So are we going up on his dose tomorrow? Peg

 

we're talking about increasing to 4.0units. He was on 4.5 and 5.0u with the PZI and the 5.0u finally got him into the 90's.

What do you think about that?

 

Don't know too much about this just read that it was for hard to regulate cats. You don't think this is too much of an increase?
Do know his legs seemed weaker after we started this insulin at such a small dose. Probably would have been better but, we reduced his PZI to 2.5 to see if he was on to high of a dose . Then we played around with it some more . then I changed to this insulin might of been to much for him. Do you think he will be alright till morning now that his ketones went down. Will still feed and give water tonight. will take another bg sample at +6. Peg

 

if you had started here on the TR forum, we'd have suggested you start with the Levemir around the 4.0units. It is a big increase compared to his current dose, but he probably should've started higher on Lev and it's less than he was on with the PZI.

If you're not comfortable with it, you could go a little lower and "fast-track" him by increasing every 4 cycles until we're seeing better numbers. The situation with the ketones makes it more important to get him to a good insulin dose as quickly as possible. Some cats are prone to ketones, and we don't want them to return. As you saw today, ketones can develop very quickly.

 

Skipped over to RL and read the post from marj. I will go with what you guys suggest you've been at it a lot longer than I . I know he's acting now like before he was on insulin. Legs weaker kind of moping around. Want to get him back to health as soon as possible. Just took bg again still at 319 same as it was at +4. now it's plus 6. Just gave more water when I pinch between
his shoulders in goes right back in place. So hopefully not dehyrated. Will warm him up some food and go lay down for awhile.
Want to Thank everyone for all your help would have gone crazy by now from worrying what to do next. So tomorrow the plan is 4 units right? Then monitor throughout the day. Hope to get a ketone test in the morning but, you know how that goes. ha ha. :lol: Goodnight to all, Peg

 

Peg

Sorry I missed you but will post this and hope you see it tomorrow.

If he's weak in the back legs, he might be getting diabetic neuropathy. I would get some zobaline and get it started. When they have ketones, in addition to the extra fluid, they also need more calories. I would be sure he is getting about 1-1/2 to 2 times more calories than you normally give him.

So far, I'm not seeing a real lev pattern on his SS but that's not unusual considering the little bit of data. Typically, lev onsets around +4 and the nadir comes anywhere from +8 to +12. Lev, like Lantus, can take a second dip which means the kitty will nadir and then the numbers will come up a bit, and then come back down but not as low as the nadir. Lev is known for its nice, long duration. As you increase the dose, we should see a pattern develop.

One of the greatest things about lev is it allows us to consistently shoot green numbers because the next shot won't onset for a few hours. We will help you learn to gradually shoot lower numbers (we don't shoot below 50).

 

One way to get a ketone test is to make up a spare box. I put a shallow box lid from a case of copier paper into a largee garbage bag, then put in some dry lentils. You can use aquarium gravel, dry beans or gravel...anything non-absorbent. Then shut him in a room to eat and hopefully pee. Tip the box and you can test his urine.

 

Tested Toby's bg and it was 368 at +8. Gave more food and water he's doing about the same . Hope to have more information soon. Peg and Toby

 

Gave Toby 4 units this morning bg was 428. Will this increase help him today? Or does it take a few days? Going to call Vet. this morning he is starting to get weaker. Still eating but, have to bring it to him . Been syringing water . Hope he doesn't have to stay at the vets. because it stresses him out to much. How long should it be before we see results with this insulin?
All stressed out with this making me wish never switched. Wish I got more information before the switch . The dose would
have been pretty much working by now and might of saved us a vet. visit. Will they have to give him a fast acting insulin to bring his bg down? I know they will give subQ fluids. Thanks to all that stayed up last night to give me advise. Hope toby is feeling better soon. It is almost 7.00AM Vet. Opens at 8.00 AM Will try to get him right in. Peg and Toby

 

Got ketone test on Toby 6.30 am showed trace ketones tested twice to make sure. He ate good breakfast plus fed every 2 hrs.
through the night. also syringed water. The skin Between shoulder blades doesn't stay pinched up but, hind legs are weaker. He alert and interested in things. I have vitamin b12 shots that I got at the vets. I give these once a week. Should I give him one
now? Does he still need to go to the vets with trace ketones or monitor through the day and see how it goes. Peg and Toby

 

Just tested Toby's bg at +3 and it was 312 down from 428 with 4 units . He seems better after he rested ate again gave water.
He even jumped up in the chair beside the door he wanted to go out in his pen. Going to wait a couple hrs. to see how he does
before i call vet. Peg and Toby

 

i think you're probably ok to continue with the routine you're doing. sounds like you're doing a fantastic job of getting food and water into him. great job!

if he's moved into trace ketones, with the increase in insulin and eating well, i don't think you need the vet. His leg weakness will improve with more insulin bringing down his numbers. yes, it's ok & good to give him another B12 shot. It is water-soluble so if it's more than he needs, he will pee out the excess. Vit B12 can really work wonders in a cat.

I'd test his blood sugar every 3 hours today, and switch to more frequent if he's approaching 100. We're essentially re-starting him on the Lev at this higher dose.

from the Tight Regulation Protocol yellow starred sticky:

And the info Wendy gave you yesterday still applies:

The goal of Tight Regulation is to get a cat into normal, non-diabetic numbers (50-120) so that the pancreas can heal, if at all possible. Newly diagnosed cats have a significant advantage in this - in the first year is considered newly diagnosed. Sooner has a bigger advantage than later. None of us can say which cats will go off of insulin and become diet-controlled, but it is so much better for the cat's body in every way to have normal blood sugar numbers.

Don't regret switching to Lev - really. Once you're past this hump, i suspect you'll be very pleased with it.

 

Morning Peg

You're doing a great job of taking care of Toby. You are on the right path.....keep pushing the fluid and food. Did you have a chance to read back through the posts because Julie and I both left you info after you went to bed last night.

Julie is correct that the B12 shot won't hurt him but it won't do anything for his neuropathy. He needs the zobaline that I linked last night. It is made specifically for diabetic cats for neuropathy. I would google it and find the cheapest price and get it ordered as soon as possible. The dosing instructions ae on the bottle.

I don't think you will see numbers come down significantly from the 4u dose yet. That is going to take a few cycles. But let's give him at least four cycles and then see where he is. I'm a levemir user and I love it.....I switched from Lantus and saw a big difference but it takes time. The depot insulins, Lantus and levemir, see great for nice long curves where the insulin doesn't go in and out like the shorter acting insulins but the down side is they cannot yank down high numbers like the short acting insulins.

I'd suggest you start a new thread today so we can track him like we do the others. What you want to do is click on "new topic" and in the subject line, put "9/9 Toby AMPS 438 +3 312". As you get additional tests, then add them to the subject line. To do this, you always have to go back to the very first post of the day in that thread (we call it a condo), click "edit" and then update the subject line and click submit.

Thanks Peg. I'm so glad he's feeling better.