Starting Levemir tomorrow - LOTS of questions

Hey, Y'all!

Hershey has been on ProZinc since 1/13/12. To celebrate his 5-month anniversary we are switching to Levemir :smile: . We are HOPING this change will help his reach regulation and not have the major swings we've seen. THANK YOU to everyone who responded to my recent thread in PZI as we've been deciding what to do. Doug and I have done a lot of reading and wanted to make sure we had a pretty firm grasp before starting tomorrow. Here's what (we think) we've learned and some questions:

- Back to BID
- Don’t roll pen – Don’t keep in fridge door
- Pen can possibly be used to the end if refrigerated/handled correctly
- Going with 8/8 – Test/Feed/Shoot – Start with .5u? Or how decide where to start?
- Wait 3 days, no matter what the numbers?
- At the end of 6 cycles, evaluate up or down dosage?
- We’re shoot regarding nadir, not PS number.
- Do not shoot line in the sand nadir 50?
- When his nadir has not been consistent to date, how do we know when to test and if we’ve ‘hit it’ so we know what to shoot off of?
- Is there a best location to shoot? We’ve been shooting kind of between his shoulder blades.
- So, we shoot the first time – it goes to the shed? How will that look in his numbers? Will his numbers increase until the shed is filled?

PLEASE correct anything we've misinterpreted. Thank you for your time and assistance!

Libby (and Hershey, too!)

 

Welcome Doug, Libby, n Hershey!

Correct! And instead of possibly it is usually. All of us are pretty careful about the insulin anyways so it isn't like it's going to get damaged by what we do. You can leave it out for a few hours without any bad effects (unless your kitchen gets into the 90's and then I don't know)

Starting dose is usually 50-75% of your previous dose. With you shooting such low doses... You might want to follow someone else's advice as I haven't been there yet.

Unless Hershey has a hypo on his first cycles, I do believe that is usually the way to go. I haven't had constant nadirs in good numbers so others will have to prevail on this one.

I shoot R/L flank, down by tummy. She's got give there. I used to do shoulder blades but always found hard nodes that I found out were undelivered insulin. So tummy sides she goes. And Sneakers was getting insulin those first few days, maybe about half, while her 'shed' filled. And she didn't have too high numbers either. I was pleasantly surprised and happy about it.

 

Hi Libby and Doug and Hershey!

Yep!

Right. No need to roll. Fridge door probably wouldn't hurt it much, but might as well not take the chance.

Yep. Keep an eye out for floaties, etc., but otherwise you should be good for a while.

0.5u BID looks like a good starting point to me. You might find that it is not enough, since she was getting more Prozinc than that in a day and Lev is *generally* considered to be less potent. You can always adjust the dose quickly if necessary.

Usually we suggest 5 days on the starting dose. BUT - you're switching from another insulin, and you know how to test if you need to. There is no reason to sit on a dose that is clearly not working, so I would say that after a few cycles, if you can tell that 0.5u BID is not enough (high flat numbers), then go ahead and adjust. You can study Jill/Alex's 2009 spreadsheetfor a good example of how to adjust a starting dose. Jill purposely tested more than required so she could use this spreadsheet as a teaching tool. Jill adjusted the dose fairly aggressively in order to get Alex into good numbers as quickly as possible, knowing that she would test/feed as much as she needed to keep Alex safe. You can be more or less aggressive depending on your needs.

see my note above.

right, but don't completely ignore the PS, of course. Especially at first. You'll probably want to ease into shooting lower numbers.

kind of, but as I said, easing into shooting low is a good idea just to be sure you have enough good data. See Lantus & Levemir - Shooting and Handling Low Numbers for an explanation of how we handle low preshots in Lantus ISG.

Don't worry, you probably won't see a clear nadir at first. Most of the time it is hard to spot a Lantus/Levemir nadir until the cat gets to a good dose (and sometimes even then, because the action is so flat). Nadirs also move. Basically you're looking for numbers to hit green at some point during the cycle. If they don't, then adjust according to protocol. The response we usually see is a whole lot of nothing, dose increase after dose increase, the numbers look the same, until one day all of a sudden there is a breakthrough. It is very different than PZI or Prozinc in that way.

That should be fine. Some people notice different results with different shot locations. For me, the scruff was the only place I could shoot without being scratched to death, so I went with the scruff. :lol:

Most cats don't see much action with their first shot of Lantus or Levemir because the first few doses do go largely to the depot. However, we do sometimes see a very marked response in the first shot or two. We don't know exactly why, but it has happened often enough for us to take notice. For that reason, I suggest starting Levemir in a cycle in which you can monitor.

Good luck with Levemir! I think you'll be happy with your choice.

 

Welcome Doug, Libby and Hersey!

(Ok, just deleted everything because you already got most of the answers)

However, I am almost thinking you want to start at .25u because your total daily amount right now is as low as 1.3u (if I am reading the SS correctly). And it looks like you were getting very low (30s) nadirs when he was on 1u bid. That's about where Beau was and I started him at .5u which ended up being too much.

Also, I want to say this again - do not hold the dose if you get a nadir below 50. As for when nadir might be, you are right - hard to say - but test (spot check) between +5 and +8.

A nadir of 50 is not a "do not shoot" number, but a dose reduction number. It's what I go by at any rate. There are some that won't reduce until below 40. A true do not shoot PS number is one that you arrive at with lots of data. Generally, with lev you can shoot much lower PS numbers than you have been used to with ProZinc, but you want to work up to that by shooting lower and lower when you are there to monitor and test to see what happens. Beau would drop into the 30s if I shot even the tiniest amount below about 150-160. Others shoot PS's down to the 60s. Not me though.

Ah, the "shed". Well, I would not even think about this as it will probably just confuse you. I happen to believe there is no shed. There is a whole thread here about the "depot" where I go into detail if you are interested. Think of this insulin more in terms of very long duration where there is still insulin circulating at +12, but the dose is fading. You can not count on starting at "zero" every 12 hours. One dose is waning while the other is waxing, so to speak. You are dealing with balancing the timing of the dose onset, duration and overlap with the next dose. As you increase the dose, duration increases and, therefore, overlap. Just start low and slowly increase.

Which brings me to this: You will want to be making dose changes of .1u, not .25u or .5u - based on where Hersey is now. This is something you will need to practice. The Lev 101 Sticky had links to the "drop method" photos and instructions, Here is a link to Lev 101: http://www.felinediabetes.com/FDMB/viewtopic.php?f=10&t=682 Look for the links below the first chart.

 

Hi Libby!!
Welcome to LEv!
I really am hoping that Levemir will work for Hershey!
I think all your questions have been answered, so I will stay on the sideline,
cheering for you guys!
Good luck and I am sure this will help!

 

Good luck Libby! We are probably right behind you in an insulin change. My vet is asking we go to Lantus but a big change nonetheless!
Hoping the change goes smoothly for you and for the best possible outcome for Hershey!

 

hi libby and doug! sorry to see you found it necessary to switch insulins, but hopefully levemir will allow you to get the results you're looking for.
just a few comments to add to libby's remarks...

i agree with libby. 0.5u looks like a good starting dose to me, too. you're not new to feline diabetes nor testing so let's see how things go. the dose can always be adjusted if necessary.

again, i agree with libby.

i'm glad libby linked alex's 2009 spreadsheet. like she said, i tested waaaaaaaaaaaaay more than necessary for the sole purpose of creating a spreadsheet that could be used as a teaching tool for levemir users. i also wanted to illustrate what happens when shooting low preshot numbers in order to reach that long flat curve both lantus and levemir are known for. my goal was to bring down alex's numbers as quickly as safely possible. please don't get scared off by the amount of testing. today i generally test only four times a day... unless alex is experiencing health related problems. she has CRF, kidney issues, liver problems, and allergies. :cry:

yep, ease yourself down into shooting low preshot numbers. it's the easiest way to become comfortable shooting low preshot numbers. after awhile, you'll have collected enough data to feel comfortable shooting preshot numbers over 50... as do most lantus and levemir users in the lantus TR forum.

so glad libby linked that document! lots of good info there. take some time to read it thoroughly and ask questions you may have.

i've tried shooting alex in several different locations. no go. i value my fingers too much to continue trying. i rotate the injection site at every shot, but generally speaking i shoot the area between the shoulder blades as well as the scruff.

here's a diagram and notes about other injection site locations you *could* try if you want... although not really necessary:

i'd like to take libby's comment one step further...
while *most* cats do not see much of a response to the first few doses, some do... which is why we always encourage new levemir users to test at preshots, +3, +6, and +9 for the first few cycles. if hershey happens to be one of these kitties, you could see a marked response *usually* within the first three cycles. as long as you're testing, it's not a problem. we can help you steer the numbers. the dose may or may not need adjusting. oftentimes, we respond to the initial response with a reduction and we're fooled.


there's a certain amount of adjustment when starting a new insulin, but we'll help you along the way...
good luck!

 

Hi Doug, Libby & Hershey!

(Love the name and love the Avatar! I've got a big black panther looking dude myself by name of Harley.)

You've already gotten some great advice so I won't repeat any of it, but I just wanted to welcome you to Lev!

Oh and tell Hershey we're stealing his car keys - no more IHOP runs...
:smile:

 

welcome Libby, Doug and Hershey too !!


I think you will really like levemir and Hershey will to cat_pet_icon fingers and paws crossed ;-)

 

If the "generally" accepted formula is to start at 70% of reg dose when switching insulins, that would put the starting dose at .42u. (daily total on current insulin has been as low as 1.2u. 70% of the if .84u and half of that is .42u).

I think .5u is too much. I don't know where the idea comes from that lev is less potent than other insulins. I have not found that to be the case. Many cats end up at lower doses of lev than on lantus after the switch. Even an experienced caregiver needs to be cautious on the first few shots.

 

Tilly's Diabetes Homepage Protocol: Tight Regulation with Lantus® or Levemir® for Diabetic Cats

Phase 1: Starting dose

In many cases, the starting dose of Lantus or Levemir has been 0.25 IU per kg of the cat's ideal weight and is always dosed BID (two times a day, 12 hours apart). If the cat received another kind of insulin previously, the starting dose should be raised or lowered by taking this information into account. When selecting a starting dose, it is important to know that while Lantus and Levemir have a longer duration than other insulins, they also have a lower potency in most cats.

The cat should be monitored closely on the first 3 days on Lantus/Levemir: do curves between the AM and PM-doses, e.g. AM pre-shot, +3 hours, +6 hours, +9 hours, PM pre-shot. Generally the starting dose is kept for 3 days. Test for ketones daily. 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). It is extremely rare that a cat will need to have its dose reduced in the first 3 days, but if the cat falls below 50 mg/dl, reduce the dose.

Measuring curves regularly is important, as well as measuring all pre-shots and taking random spot checks. It is important to know that most cats do not have reproducibly-timed nadirs. It also is not uncommon for a nadir to occur at +12 hours after a shot. If you are fortunate to have a cat with a very reproducible response, you can test less often than with a cat that has a varied response.

 

Can someone please explain what "lower potency" even means? When we have a cat like Thumper drop from over 400 to below 100 on their first dose of Levemir, a conservative 1U after 1.5U of Lantus previously, I cannot agree about "lower potency." Sure that may simply mean the depot needs time to build up steam, but Levemir is a Gentle Giant. It can bring BGs down rapidly once it gets the ball rolling. We used to consider it had trouble with high BGs, it does not when used correctly. Too many times those high BGs were caused by bounces which in turn were caused by too much Levemir.

Sorry to hijack your introductory post, Doug, Libby and sweet Hershey. Welcome!! One of your questions was about Test/Feed/Shoot. You do not have to wait till after feeding to give Levemir. Levemir's slower onset means there may be a food spike for some cats over the first couple of hours after the shot. If Hershey is a good eater, he should be fine if you Test/Shoot/Feed, if that works for your schedule better. I always tested, gave shot and then put the food down for Gandalf. He was always a good eater.

Levemir works best when using a step up approach. Starting with too high of dose means you have to back down the scale, which may not be as easy as waiting for that below 50 nadir two times in a row. If the dose is too high you're going to get rebound, resulting in BGs which look almost convincingly like not enough insulin. If you start at only .25u, you do not have to remain at such a low dose for very long if the BGs don't seem to move. But switching at too high of dose is counter-productive and can allow the cat to remain in BGs higher than necessary for too long.

One of the problems with Prozinc/PZI is the lack of duration for some cats. So the swinging on Prozinc is actually caused by the its inability to hold BGs to a stable pattern over 12 hours. Levemir is able to hold BGs steadier over a 12 hour period, but we have to get him to a good dose to achieve that.

You also asked about shot location. My personal preference for shot location is what's identified in the photo as "side of chest." Basically it's just behind the front shoulder. The skin is thinner there and it's easy to pull a little bit of skin up, instead of a huge tent, and get the insulin just under the skin when injecting almost parallel to the body. Depending on the cat's weight, some cats have too much fat between the shoulder blades to tent easily.

Good luck!! Please ask any other questions or clarifications you need.

 

Thanks for the warm welcome!! Y'all sure make me more at ease about tomorrow!

Vicky - Don't worry about hijacking the thread; I learn a lot from the discussions. :smile:

WHEN TO SHOOT - You brought up something I meant to ask. I find it easiest to shoot while Hershey is eating. If I do it right, he never even checks up. If I wait until he's finished, he's too interested in what's in my hand and what I'm doing. Is it okay to keep shooting while he's eating? And, YES - Hershey is a GOOD eater! I didn't think we'd ever fill him up - increased his food to 9-oz daily and he said, "Too much." So, backed him down to 8-oz and he lost weight. Yesterday, increased him to 8.5-oz and he's eating it. I thought his ideal weight would be 12-lb, but can't force him to eat those extra ounces, so maybe he's saying somewhere between 10 - 11-oz is his idea of ideal weight.

SHOOTING SITE - According to the picture - I guess I've been shooting more side of chest. We tried a couple of other places and thought rotating through might be the answer, but he had such differing BG's! He had hip surgery several years ago and we thought that surgical hip might absorb differently, too. But, looking back at his SS, those wonky numbers could've just been him. I've gotten in the habit of fur shots lately. SO frustrating that I'm doing it the same way I have for months...well, obviously, I'm doing SOMETHING different since the fur shots are new...trying to make sure to take my time and really pay attention to what I'm doing so, hopefully, if I give another fur shot I will notice something I'm doing differently.

PROZINC - You mentioned the lack of duration. We found it petered out for Hershey by +10 (almost always); we moved to TID, but still doesn't last the whole 8 hours.

paha - Sheila - I've gotten pretty good at eyeballin' but I don't think .42u is happening! ;-)

Thanks, Marty. Still nervous, but ready to get started! I wish we could start tomorrow morning, but when the prescription wasn't called in until time for the pharmacy to close, it just wasn't possible. So, we'll start at 8pm.

CHANGING SHOT TIMES - I heard it was harder to change the shot times with Levemir. That's why we went with 8/8, so it would right for Sundays.

Thanks, Laura. We had a hard time finding a name for Hershey. The kids kept picking names and calling him, but he wouldn't look at them (obviously, meaning he didn't like the name). We came home one night to find him asleep in Doug's lap next to Doug's candy wrappers (apparently, they had a party in our absence!). We called him Hershey and he looked up. There ya' go! Yeah, I've always said he was actually a panther. He's a pretty big kitty (Lu measured him at 35.5" to the tip of his tail.) and he's like people. He sits very tall and regal. Something about us and black cats. We had Smokey, then Hershey and now have Oreo, too. :smile:

Good idea about taking the keys; it's a LONG walk from our house to IHOP!! :lol: :lol:

Thanks, Jill - It sounds like y'all are thinking somewhere between .25 and .5 is the best place to start. So, what if we start at .4u and SCREAM for help? :smile: The information said +3 +6 +9 between AM and PM doses. So, not between PM and AM? I was planning to do both for the first couple of days (unless I sleep through the alarm, which I have been known to do since starting this dance).

Thanks to you (and Alex, too!) for all of the effort on the SS. I've been studying it. As my daughter would say, it looks FAANCY. (AAA sound very stressed by my southern daughter! My son used to tell her she needed to teach her (then) boyfriend how to talk country ;-) )

Hershey doesn't have any other problems right now (that we know of). I used to go to church with a vet, ran into her in Costco, talked about FD and she said to send her the SS and she'd give me her thoughts. She asked what kind of tests had been run to rule out underlying infections, urinalysis, etc. I hadn't even thought about all of that, only bloodwork was done as far as I know. Going to ask about that when they go back on 7/13.

With TID, we've been testing 6 - 9 times a day, so we're kind of used to lots of testing. Said I should buy stock in diabetic supplies!!

Donna - I was thinking you were going to mention changing insulins soon. Maybe you could come on over to Lev, too? Thanks for the well wishes. Let me know where you go so I can check up on you!

Hey, Denise - Thanks for cheering us on!

Sheila - If I get a reading of (50) are you saying to automatically reduce the dose or wait for it to happen, again - that 'repeatability' thing and all that? I'm so afraid that we've missed his window of opportunity because I backed off too quickly in the beginning. But, then again, I didn't have enough data and wanted to keep him safe. I keep telling myself I'm doing the best I can each time there is a decision to be made. Sometimes I listen ;-)

Thanks for the link. I'll wait until tomorrow and read it with fresh eyes.

Hey, Libby - Thanks for the links, wish I had it in me to stay up tonight and read them. I've always been a night owl, but now it's harder to get up in the morning. I would blame it on 'maturity' but I'd rather blame it on FD!

Thanks, Heather - for talking me through this. I've never heard anyone mention nodes of undelivered insulin...I had no idea...

THANKS to EVERYONE for taking the time to help educate us. I've read your responses a couple of times (and plan to read them at least a couple more times!) and look forward to reading the links y'all provided. Guess I need to note where y'all are so I can figure out who's up when I am...Sorry I got so long-winded that's not like me at all :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol: :lol:

 

Yes, shooting during eating is fine if that works for both of you.

Are you using 1/2" needles? U100 syringes can be purchased with "short" needles, 8mm or 5/16th." Do you need resources for that?

Perfect example.

I would LOVE to know where you heard that or who told you that. Reason being that I developed methods of moving Levemir shot times around which work better than skipping shots or changing multiple times over a period of days. It's simply taking advantage of and understanding Levemir's extended duration by splitting doses and reducing doses if the shot time needs to be earlier. Peggy, who just lost Mickey, used it successfully for him, but he unfortunately had other health problems and had intermittent periods of regulation. Levemir is very flexible and safe in this regard and I dislike someone giving you or anyone else the impression it is not. Yes, staying with a 12/12 shot schedule is best, but life intervenes and we have to make exceptions. I can help you do that if needed.

You can do that, stay at the dose and see if the <50 repeats itself. Other factors beside too much insulin can cause a low, not eating as much for example. It is also worth looking at the whole cycle, because if that 50 is off a preshot of 80, then that's not a dangerous 50, that's probably just Levemir working its magic. But a <50 off a 300 preshot probably means the dose is too high.

You're welcome.

 

Welcome to Lev, Doug N Libby and Hershey too!

This is a great thread, please continue to ask questions. I hope Hershey settles in nicely.

 

it looks to me like thumper was about to clear a bounce when the first dose of levemir was administered. with that momentum in place, it's not surprising thumper dropped as much as she did on the very first dose of levemir. she probably would have done something similar had she been given lantus.

however, as libby mentioned in her post and i reiterated in mine... every once in awhile we see a kitty have a marked response within the first three cycles when switching to levemir from another insulin. we don't know why. it doesn't happen with every kitty new to levemir, but it's happened often enough for us to have taken notice. this is why we suggest shooting only 70% of the last "good dose" when starting levemir. the TR protocol suggests testing at preshots, +3, +6, and +9 for the first three days. we've found if this unexplainable phenomenon happens... it usually happens sometime in the first three cycles. personally, i don't think this applies to thumper, but the phenomenon is worth mentioning again.

just my thoughts...

 

sure, try a starting dose of 0.4 unit if you like. heck, start lower if you want to. as sheila pointed out, 70% of 1.3u comes out to 0.42 unit. however, even at 1.3u (prozinc), it appears hershey remained under dose, but you hold the syringe. start wherever you feel most comfortable.

initially, you want to test at preshots (i should have been more specific in my post above by noting amps and pmps), +3, +6, and +9 for at least the first three cycles. unless of course, the numbers tell you more testing is necessary. the TR protocol suggests testing at these times for the first three days. see how things go. we've found that *usually* it's not necessary to keep up that kind of testing schedule for a full three days.

i'm glad alex's ss is helpful. i'll let her know all the pokes are helping another kitty! :mrgreen:

 

Are we talking total daily dose or each shot? 70% of 1.3U is .91u.

If you're talking total daily dose, then half of the .91 is .45u so that would be each dose. Sheila, did you start that because the BID doses were different and totalled 1.3U? That's fine, but it's too confusing to keep mentioning .42u as 70% of 1.3U, because mathematically that's incorrect.

I would like an explanation of "Lower potency" though. Thumper's first dose aside, Levemir has proven itself to me to be plenty potent if managed properly. I am just afraid that the "lower potency" statement may give some the idea that you need a larger dose for it to be effective. In fact, smaller doses can work exceptionally well, compared to other insulins.

I had a curious thought this AM. Just how many cats involved in the Tilly protocol development were using Levemir? Do we know? 2005 is the first recorded use of Levemir for cats, Steve's Jock while he was in Germany I believe. 2005 is the first copyright date on the document. Was Steve involved in the German board? He still has the most complete information in the Pet Diabetes on real world use of Levemir in a cat. More cats have used Levemir in the intervening years, and probably there are quite a few now on the German Diabetes-Katzen board, but I'm just curious as to why Tilly includes Levemir if very few cats were using Levemir at the time the basic protocol was written. Forgive me since I don't know anything about the German board.

 

oops! my bad. i'm sorry. i sure didn't do a very good job phrasing that comment.
i was referring to sheila's statements:

and

your best bet is to contact kirsten at tillydiabetes and dr. jacqui rand at the university of queensland with your concerns and for answers to your questions.

 

Welcome over here Libby!!! Hopefully Hershey will adapt well to Lev - it's already seeming to do better for Grayson, although it's still really early in the dance - he's still getting used to the new music!

I don't know this for a fact, but since I was shooting 6u ProZinc TID (started TID about the same time as you), then 6u BID for the week I was away, then started at 3.0u Lev, the numbers weren't that drastically different to start out with. So the potency question - I don't know that I would say it's not as potent. But clearly I still need to increase...

Do you think we should warn the Lev regulars that they're on the verge of an invasion of the PZI folks? :lol:

 

Sorry, but I think the invasion has already started (from a former PZI user). Just a trickle down the dam, only a trickle. Don't mind the crack going up it as nothing... will... happen...

Oh well, they must be thinking "Where's Tom Thumb when you need him?"

:lol:

 

Vicky, the numbers that are stuck in my head from reading someplace are 55 Lantus kitties and 18 Lev kitties. I know I've read that multiple times someplace on the stickies or on a link off of the stickies.
I saw someone post the other day that the remission numbers were 84% for the Lantus and 82% for Lev, but I'd never seen that breakdown before.

Carl

 

Vicky - We're using
"short needle insulin syringes
3/10cc for 30 units or less
5/16" length slimline needle
31 gauge needle
half unit markings"

I need to read up on your information about changing shot times. With Doug's rotating schedule, the kids' schedules (and our first grandbaby on the way!) we have things come up from time to time.

Now I'm confused. Guess that means more reading ;-) ; I'm one of those learn by doing kind of people, but don't want to endanger Hershey while I'm doing it...

Hey, Marcy - Thanks for the well wishes. I hope he settles in nicely, too! We've talked about it, but I'm afraid I get a lot of

Jill - I agree that Hershey seemed under-dosed on ProZinc. I kept trying to raise the dose, but then he's skyrocket on me; that's been the biggest frustration. Hoping it's just he needed a different insulin. All day I've been talking to myself about the initial dose (.4u vs .5u). As I've said, I don't want to be timid and not do the best for Hershey. With less than 4 hours until shot time, I guess it's about time to make a solid decision...

Hey, Lu - Thanks for the official welcome. Glad Grayson is showing signs of improvement on Lev. I need to go check the posts for an update on his testing... And, no, you never warn people about a trickle ;-)

 

carl, i think that's a question for kirsten of tillydiabetes. the numbers you're quoting are from the only researched and published TR Protocol document with lantus or levemir available today. numbers involved in this latest study and the number of cats which have played a role in the development of a certain protocol over the years may not be one and the same. kwim?

i'm not sure how many of you have been around long enough to realize the TR protocol with lantus or levemir... as we know it today... has been updated a few times. what was known as the "tilly" protocol on the fdmb has had some changes over the years. what was known as the "rand" protocol has been changed twice since i first read it. today, the two are combined into a single TR Protocol after a joint collaboration between the german-katzen forum/kirsten and dr. rand/U of Queensland. they combined their resources to come up with today's protocol. in other words, as time goes on and we glean more information... protocols change... just like in human medicine. ten years from now we may see a more advanced approach. who knows?



edited to add:
carl, you can find those 82% and 84% figures you mentioned in Abstracts from ACVIM Forums (presented by kirsten roomp & jacquie rand).

 

whatever you decide will be fine. if you're in a quandry... go with the lower dose. doses can be increased if necessary.
as i've said to others many times, "there's more insulin where that came from." :mrgreen:

 

You are correct Carl, as that is the info I was given by Kirsten from the German Katzen board today after I emailed her. Seems like a pretty small group. It was a study using the German board members conducted by D. Rand from the Univ. of Queensland.

 

We have already noted it. :smile:

 

Good Luck Libby! Wishing you and Hershey ALL the best with Lev!

 

Thanks, Kim. Sitting here reading and reading and...well, reading...periodically taking a break to breathe ;-)

Thanks, again, for all of your help with ProZinc and TID!!! Stop in and see us and we'll be back to check on things in PZI-Land, too. :smile:

 

How could you not :lol:

I was here in Lev such a short time that I won't even pretend to know anything.

But knowing Hershey's dance as well as I do I will say that I agree with Sheila and would start at .25u. His P still kicks in every once in a while and you can always raise quickly if it proves that it isn't enough. But dancing backwards from starting too high is so much harder.

 

:17 ago we shot .5u (so :07 before you posted) nailbite_smile

 

I was strongly leading toward .4u, but Doug didn't think the .1u would make that big of a difference on the first shot...Had planned to test at +3, now wondering if we should test earlier...feeling wayyyy out of my comfort zone...

 

Try not to worry too much!
You will be fine and you have so many eyes on you now!
we are all here for you! and praying that Hershey does well

I hear ya about the invasion of the PZI er's!
Looks like we are all a comin over!
look out,, it is about to get real busy!

 

Good luck with the Lev! No worries about the dose, it is a conservative one and even if the numbers do drop, that is a GOOD thing, right?

Vicky, thanks for contacting Kirsten. Did you happen to ask about the potency question too? I'm curious what input she might have about that.

 

Sounds like a party!

Thanks for the encouragement and the prayers!

 

I did and am waiting on a reply. It's middle of the night there now

 

Hershey will be fine. If he gets a drop and bounces, then you'll know to drop back to .25u. I got a response the first day, but if I remember right, the second day was more informative. The first day I tested every hour I was so nervous. I think waiting to test at +3 is fine.

I see +2 was not much movement. That's expected.

 

i'm curious, too. evidently carl emailed her, too. he also sent her the link to this thread so maybe she'll post.