? 3 days on Lev, can I increase?

Discussion in 'Lantus / Basaglar (glargine) and Levemir (detemir)' started by Kate & Toby, Oct 28, 2019.

  1. Kate & Toby

    Kate & Toby Member

    Joined:
    Aug 23, 2019
    Hi all,

    Toby switched from prozinc to Levemir on 25/10, he has already had some ketones so I dont want to hang about at these high numbers, is it too early to increase? Need to shoot in 20 mins, can test overnight but not much in the day.

    Thank you all in advance!
     
  2. Kate & Toby

    Kate & Toby Member

    Joined:
    Aug 23, 2019
  3. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    I think you can. Typically, when you switch insulin, you can make a unit-to-unit switch. In other words, it looks like Toby was on 1.75u of Prozinc and you started Lev at 1.0u. I'm inclined to suggest that you increase to 1.5u given how high the numbers are however, will you be home to monitor? The dilemma is that it takes 5 - 7 days for the insulin depot to form. Generally, you hold the initial dose for about a week in order for the depot to stabilize. This is my concern -- the depot will get it's act together and numbers may drop. On the other hand, Toby was in pretty high numbers on Prozinc.
     
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  4. Sienne and Gabby (GA)

    Sienne and Gabby (GA) Senior Member Moderator

    Joined:
    Dec 28, 2009
    Kate -- just an FYI, I'm not reliably on the Board during the day. I work full time. I try to sneak a look but some days it's not possible. There are other experienced members who may be around. Let me know if you need some suggestions about who to tag.
     
  5. Kate & Toby

    Kate & Toby Member

    Joined:
    Aug 23, 2019
    @Sienne and Gabby (GA) thank you! Both for your input and for suggestions of people, yes please. I went with 1.25iu in the end. I will try and hold now.
    It's such a fine balance as he is so prone to getting ketones. Thanks again x
     
    Sue and Luci likes this.
  6. Sue and Luci

    Sue and Luci Well-Known Member

    Joined:
    Nov 3, 2017
    I'm glad to see you increased. With those high numbers it looks like Toby can use it.

    One quick question for you - have you read the protocols (in the stickies at the top)...are you following TR or SLGS?

    Have you posted in the forums previously? If so, could you please copy/paste the url from that post into your condo for today? It will help us to have the background on you and your kitty...

    Welcome to the LB&L forum :) Toby is adorable!!
     
    Kate & Toby likes this.
  7. Wendy&Neko

    Wendy&Neko Senior Member Moderator

    Joined:
    Feb 28, 2012
    Hello and welcome to Levemir. A favour to ask of you, could you put a blank line in the spreadsheet between the last day of Prozinc and the first day of Lev. That just makes it easier to spot the change.

    I agree with Sienne that you could profit from an increase to 1.5 units at least, if not 1.75 units. I switched from an in and out insulin to Lantus (first) and regretted going back so far in dose. I hope you will like Levemir as much as I did.
     
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  8. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I’m also sorry we didn’t get to you earlier. In looking at his SS, he really didn’t do too much on 1.75u on PZ. I am with Wendy that I would urge you to go ahead and increase his Levemir dose to 1.75u in the morning if you can monitor. I used Lantus first and then switched to levemir and wished I started with it. It’s a great insulin.


    Just a quick note about this just for a learning experience. When we have a cat that has recently had DKA and is at high numbers, we don’t worry too much about which method is being followed (note that SLGS is not a protocol but just a dosing “method”). Cats that have had one bout of DKA are more easily susceptible to a subsequent one; that doesn’t mean every cat that has had DKA will have it again but the potential for it is greater than in a cat that has not had DKA.

    Even if Kate was doing SLGS on PZ and then switched to Lev, we are more concerned that we get to a good dose fast than the particular method. Once we have Toby at a better dose which would, hopefully, decrease his chance of another DKA bout, then Kate can decide if SLGS or TR is better for him. There is no rush for any member to select SLGS or TR; they need to get their feet on the ground first. But, definitely, in a situation as this, we need to get to a good dose as soon as we safely can.

    Thanks, Sue :):):)
     
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  9. Kate & Toby

    Kate & Toby Member

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    Aug 23, 2019
    Thank you for your replies, Toby has had 3 full blown episodes of DKA and twice I have had ketones present at home (once as recently as yesterday) and have pulled him back with pushing fluids and food. I am very nervous at these high numbers and that's why I switched to Lev as it stood us a better chance of getting him lower, I agree I need to get to a better dose quicker, I'm just really concerned as I cant test loads in the day time, but very happy to test throughout the night, I'm also really struggling to get my head around the depot and how this effects dosing.
    Thanks again for all your input, my boy wouldn't be with me without the help of this board and for that I am forever grateful to you all. X
     
  10. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I understand; however, neither Lev or Lantus can pull down these high numbers quickly. It takes time; a few of us have worked with CGs who are dealing with DKA to use R insulin as a bolus to bring the numbers down quickly. What it does, when given at the correct times with the Levemir, is give the Lev a lower starting place. Over several cycles, the BG improves and the Lev dose can be taken up, as needed, without fast tracking it.

    I understand that using R is not likely to be an option for you because you do have to be able to be there to test for, at least, four hours. It’s something to keep in mind for evenings, if you like; however, we strongly urge that you work with a member who has experience using R to teach you the ropes. There are alot of caveats and cautions but it can be safely used.

    On another subject, for some reason, your World SS is not converting some of the values to the US SS. If you’d like me to fix this for you, please send me a PM and I will get editing rights and check the formatting for you so it works a little better.
     
  11. Kate & Toby

    Kate & Toby Member

    Joined:
    Aug 23, 2019
    Thank you, i have read a bit about the use of R, whilst i would love to be able to get these numbers down and trust you guys completely, I feel out of my depth with this concept to be honest, and I work all day Monday to Friday, I test mostly at weekends and overnight.
    I'll pm you now as dont know what is up with my spreadsheet! You are an angel x
     
  12. Bron and Sheba (GA)

    Bron and Sheba (GA) Well-Known Member

    Joined:
    Feb 21, 2015
  13. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    How are things today, Kate? Any Ketones?
     
  14. Kate & Toby

    Kate & Toby Member

    Joined:
    Aug 23, 2019
    Negative ketones again this morning and this afternoon and I just did a BG reading at +8 and he was 18.6 mmol which is the lowest he has been in days!! Hurrah!

    He is eating well and a happy boy. I will tray and get some extra tests in tonight as it seems the insulin might be starting to work.

    Thank you for checking in on us :)
     
  15. Kate & Toby

    Kate & Toby Member

    Joined:
    Aug 23, 2019
    He knows that I keep some treats in my bedside table!
     

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  16. Red & Rover (GA)

    Red & Rover (GA) Well-Known Member

    Joined:
    May 18, 2016
    Smart kitty. Glad he's feeling better enough to signal that he wants a treat.

    I keep emergency chocolate stashed in my bedside table.
     
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  17. Marje and Gracie

    Marje and Gracie Senior Member Moderator

    Joined:
    May 30, 2010
    I’m glad he’s got negative ketones today. It’s also good to hear his BG is coming down. We can offer you some more advice when you have a chance to update his SS.

    In this forum, we do one condo per cat per day with all of your questions (no matter if it’s about syringes, dose, food, etc) in that condo. Could you please start a new condo for today with the title which would look like below:

    10/29 Toby AMPS XXX +2 XXX +6 XXX +8 XXX

    That’s just an example; you might have different tests. Please put the US numbers in the title and not the World numbers; sometimes things move fast here and we don’t have time to convert especially if we are helping multiple members at a time. When PMPS rolls around, you can delete all the AM numbers and start over again in the same thread with PM. You’d just edit the thread title, delete the AMPS cycle BGs and start with PMPS cycle BGs.

    Thank you Kate!!
     
  18. Kate & Toby

    Kate & Toby Member

    Joined:
    Aug 23, 2019
    Thank you! All done! And spreadsheet updated
     
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