Starting Levemir- no tilly protocol

Hi everyone! After using prozinc since september 2010 we are switching to Levemir. Mostly for the cost issue. We are up to 7u bid and rising, so a switch to levemir will be more cost effective. However due to the constraints of our lives we're not going to be doing the tilly protocol. We can't run curves that frequently, and I need to sleep at night--I'm a pregnant mother of a toddler. DH would sleep through a hurricane. So, I'm looking for other Levemir users who are more flexible with their use of it. We're working on a toe infection right now, so the insulin switch won't happen until after that gets cleared up. Also there are occasions when life gets in the way and we can't always shoot 12/12. Is there anyone who found that it has some flexibility with regards to its timing?

Thanks lots!
Claudia & Charlie

Hi Claudia,

Welcome to Lantus Land and Levimir!

There is a description of the basic protocol in the sticky at the top and general monitoring suggestions. Both Lantus and Lev. benefit from as close as possible to a 12/12 dosing schedule and consistent amounts. The sliding scale of PZI doesn't work with the L's. The problem of not dosing 12/12 is it affects the "shed," which actually then affects the overall dose Charlie will utilize. Just try and stick as close as possible as you can.

The suggested monitoring schedule during regulation is every 3 hours or so.

AMPS
+3
+6
+9
PMPS
nightly spotcheck, generally before bed.

Did you get the test for IAA and Acro done yet?

I think long-term for you and Charlie it will make your life a bit easier. The first few weeks will be a bit rough around the edges.

Trust the good advice givers here, especially since Charlie may be a high dose kitty.

:YMHUG: Welcome and I hope we can get Charlie on the road to a healthy recovery!

Claudia,

Have you posted on the Levemir forum? It is not as busy as the Lantus one, but everyone there uses Levemir. They are very good about catching up with people in the morning and the evening, if they are not there in the daytime. viewforum.php?f=10 I don't know if everyone uses the tilly protocol, but you can sure ask!

Hi Claudia, I'd check in w/ Lori and Tom. They just made the same switch and can give you a better idea of how to handle things. Lori is still working on the rough around the edges stuff.

Hi Claudia,

My Ennis has been on Levemir for 4 .5 years, and we don't use the Tilly protocol because Ennis is very well regulated and only gets a shot every 24 to 36 hours.

When we started using Levemir in 2006, there was no protocol. That was back when it wasn't even available in the US and we got it mail order from Canada. No script needed. No rules except the basics we had learned from previous years of treatment with a PZI. Like the lawless old West.

There was a small bunch of beans watching with envy as Steve "experimented" with Jock in Sweden. That was back when there weren't ISGs, so postings were on the health board. Some of the early users I recall were Julie and Smokey (she's not around here much), Cindy and Tritone, Cheri and Patriot (she pops in when called through PM), and Vicky and Gandalf (still here and active). (Sorry if I have forgotten someone. That was a rough stretch for me and I wasn't around much.) Then, of course, there is Steve and Jock, who isn't around much but can be called through PM.

I understand your limitations. That shouldn't keep you from effectively treating Charlie with Levemir. You may not achieve remission, or you may. I would be glad to follow you and Charlie and offer advice when I can. Please let me know what Board you will be posting on, Lantus or Levemir. I see you do have a SS. Good. Maybe you can start a separate Levemir page when you make the change.

One thing you will need to consider is your starting dose. The Levemir protocol suggests .5U. You may feel that is a problem given your current, much-higher dose, so that would be a good topic for discussion. Also, it looks like you are using U40 syringes.

You will need to buy U100, .3cc, 30 or 31 gauge, short needle syringes with 1/2 unit markings. They are available in the Relion brand at Walmart and on Hocks.com (I use the GNP brand). The U100, .3cc, and 1/2 unit marking are the MOST IMPORTANT.

So, let me know if you want me to round up some of the really old timers to follow you at the beginning, and I will see what I can do.

I wish you the best.

To answer your question about timing. You have a life. You do what you need to do. Hopefully you will try to get to 12/12, but if you can't, you can't and that's OK. You are already doing so much more than most people with diabetic cats do (the ones that don't show up here).

Edited to add: Good thing crossposting on Health. I wouldn't have seen you otherwise.

Laurie/Mr. Tingles are experienced PZI users who made the switch to Lantus. We treat Lantus and Levemir the same since the protocol is the same for both types of insulin.

Venita is correct in that starting dose is lower than where you are currently dosing when the weight-based formula in Tilly is used. However, the protocol specifies that if you are switching from another insulin, that dose needs to be taken into consideration.

You may want to monitor both this forum and the Lev forum and decide where you feel most comfortable. We tend to be pretty protocol, numbers, and test driven here. I'm not that familiar with the Levemir forum to be able to outline any differences between the two ISGs.

Please let us know how we can help.

Hi Claudia,

We don't follow Tilly to the letter. My hubby does 95% of the kitty care since he lost his job over 2 years ago.

He doesn't post, and it is like pulling teeth for me to get info from him. (I'm "criticizing" him... :roll: )

We will shoot sometimes at +10.5 if we have schedule problems and Tiggy's BG is ok to shoot. And we return to normal schedule the next shot -- again, assuming Tiggy's BG is ok to shoot at that time.

We have been caring for Tiggy for almost 2 years, and most of that time has been using Levemir. Tiggy is well regulated, so our do not shoot number is pretty low (based on data). If he is below 100, he gets a half dose.

Tiggy has been diabetic for about 7 years, so the likelihood of him going OTJ is extremely low.

Since Charliemeow is up to 7u BID, I would recommend that you have the IGF-1 and IAA tests done.

My first diabetic cat, Norton, had Acromegaly which caused him to need a higher amount of insulin than "usual". We discovered it after coming here to FDMB and having the IGF-1 test done at the recommendation of members here.

Levemir is an excellent insulin for Acrocats. Lantus stings at bigger doses because the liquid is acidic.

Hi Claudia & Charlie, welcome to LL!

I agree with those who have suggested getting the IAA and acro testing done, sooner rather than later. That info will help you make decisions about the path you want to take as far as how tightly you want to regulate Charlie. I see he hit a green number and if he is acro, you will want to avoid those green numbers. If he were my cat, I would pursue that testing ASAP. I wanted to say that first, because I would consider that my top priority at this point if I were you.

I'm a little bit confused....you say you aren't going to follow the tilly protocol, because you can't do curves that frequently and you need to sleep at night. Where did you get the idea that you need to run frequent curves and you can't sleep at night? You are doing a good amount of testing during the day, and we ask that you get a before bed test...not test all night. Naturally, if you get a low number before bed, you will need to stay up and deal with it, but that would be the case with any insulin you use. Please don't judge by the amount of testing I do, I have always been a testaholic, even when we were using ProZinc! ;-)

I would suggest that you look at the stickies at the top of the forum, most particularly the tight regulation protocol sticky. For the first 3 days, we suggest testing at PS, +3, +6 and +9....this is for safety reasons, some kitties get a big response initially when they start Lantus/Levemir. It also says that you will need to test multiple times per day...which you do already. If you get low numbers, you will want to test more....that makes sense, right? As far as dose, I would not suggest dropping down to 0.5u to start Lev, we suggest taking into consideration the dose Charlie is on with his current insulin. When you are ready to make the switch, you could post here and ask for guidance on a starting dose...we take several factors into consideration.

While it is best to stick with a 12/12 schedule, everyone has times that it isn't possible for various reasons. However, it's best to start out shooting as close to the 12/12 schedule as possible, because that is the best way to gather data on how the insulin works for your cat. When you shoot on an inconsistent schedule, it affects the shed and you get wonky numbers. That will slow you down while you are trying to get to an effective dose. If you mean that you regularly need to shoot early/late due to a scheduling conflict, there are ways to minimize the effect, by gradually changing your shot time. For other situations, you can post and get suggestions of how to deal with a particular situation, people do that all the time. I doubt if there is anyone here who has not gotten off schedule from time to time. Life happens!

Hi, Claudia. I am just posting to give you an idea of how the Lev ISG operates. We are very flexible on how you choose to post. Many of us either adapt the protocol to our cat's needs, or don't really use it. But it is a good place to start to get the basics down. And when things are just not making sense, it is a fall back. But you don't have to post all your numbers every day or anything like that. Maybe you could read a few posts over there to get a feel for how things work.

It's great that you have a SS and I think your amount of testing is fine. You will have to do a few curves, but not every day. Once you have an idea of how Charlie handles lev, getting PS tests and a few spot checks is good - as you seem to have been doing already.

Vicky, who posts on Lev, has to change her shot schedule twice every week for her work schedule, so there are ways to do that.

Thank you everyone for your tips and advice. I feel pretty intimidated by this switch mostly because of the ss's I've looked at of lantus users. It truly looks like a majority of them run almost daily curves. I'm confident that I can do well by Charlie with the number of tests I am able to get. My current goal is simply regulation. Yes, remission would be awesome, but for now regulation would be a dream come true.

I am aware that acro and iaa are both distinct possibilities, but the tests are on the back burner for now for financial reasons. I have discussed the testing with my new vet and he was very agreeable to it, but the blood work doesn't cone cheap. Sooo...it waits. From what I've heard from another acromom, charlie's ss looks more like that of an insulin resistant cat than an acrocat, but only the tests will tell for sure.

Thanks again!!