? 8/25 KARAMELLE AMPS 299 +2 281 +4 170 +7 207 PMPS 317 +2 344

[JoM]

8/24 KARAMELLE AMPS 161 +2 179 +4 281 +7 335 PMPS 342 +2 316 | Feline Diabetes Message Board - FDMB
I posted on the Facebook page yesterday but wanted some input here too. I was at the vet yesterday (with another cat) and we got to talking about Karamelle. I mentioned that I cant really seem to get her regulated and that her numbers just go up and down along with the dose. He mentioned we could try a different insulin and actually told me to ask you guys what you think. A few people on Facebook mentioned Levemir but that we cant get it in the US anymore. When I looked at Marks in Canada, where they said you have to get it from, it seems quite pricey and Im not sure how much it is to ship.
I guess Im just wondering if someone can look at the spreadsheet and see if this is something I should consider or if I should just wait a little longer. She seems fine although now that she has Pancreatitis, I have to keep her on meds to eat. But otherwise she seems ok. She acts a bit sluggish when in the 300's and more fiesty when shes low. She doesnt drink or pee a lot and shes gained all the weight back and more that she lost initially. Id really never know she had diabetes and that her numbers were so wonky if I wasnt testing every day.
Id love some feedback. Thanks.

 

[Wendy&Neko]

We usually tell people to give a particular insulin a chance for six months before considering changing. You have done that. There aren't a lot of options for insulin for cats that are better than Lantus. I really liked the switch to Levemir for Neko, but now there is the supply issue in the US. And Lantus costs have gone down quite a bit in comparison. Prozinc is an option, but most people get a better response from Lantus. ECID of course, the insulin that works best for you cat is the one you should use. You just have to figure out what that one is.

Things to consider with Levemir is that typical onset is +4, typical nadir is +8 and how that fits with your schedule. That's a deal breaker for some people but I liked the later nadirs. Neko onset closer to +5 (though +3 seen more), and nadired even later, often at preshot time. You get used to shooting lower.

However, I do have some comments about dosing. First, I'm not sure the fat and skinny dosing is doing much for Karamelle. I'd go back to 0.25 unit changes. Plus, if a dose isn't giving you anything below 150, I'd increase after 6-8 cycles. I tended to hold low blues for 10 cycles, medium blues for 8, high blues for 6.

 

[JoM]

We usually tell people to give a particular insulin a chance for six months before considering changing. You have done that. There aren't a lot of options for insulin for cats that are better than Lantus. I really liked the switch to Levemir for Neko, but now there is the supply issue in the US. And Lantus costs have gone down quite a bit in comparison. Prozinc is an option, but most people get a better response from Lantus. ECID of course, the insulin that works best for you cat is the one you should use. You just have to figure out what that one is.

Things to consider with Levemir is that typical onset is +4, typical nadir is +8 and how that fits with your schedule. That's a deal breaker for some people but I liked the later nadirs. Neko onset closer to +5 (though +3 seen more), and nadired even later, often at preshot time. You get used to shooting lower.

However, I do have some comments about dosing. First, I'm not sure the fat and skinny dosing is doing much for Karamelle. I'd go back to 0.25 unit changes. Plus, if a dose isn't giving you anything below 150, I'd increase after 6-8 cycles. I tended to hold low blues for 10 cycles, medium blues for 8, high blues for 6.

MY whole reasoning behind doing the 1.5f (and I only do it on that dose) is that every time I increase to 1.75, I get limes. Not right away, but always eventually. So then we are back to 1.5 which usually yields pinks and yellows, maybe some blues and occasional greens, but nothing really consistent and more higher than lower numbers. So I thought something in between might work better.
Just curious when you made the switch from Lantus to Levemir, what dose did you start with? I might try the Levemir even tho its so much more expensive. $23.94 Lantus (thats what Ive been paying for one pen) vs $169.99 (plus whatever shipping costs are) for Levemir. I will probably wait till Im close to being out of this Lantus pen tho. I just opened it. I mean if I was getting all pinks or even higher, I would be much more motivated to switch right away. Plus its still hot in a lot of places. Id rather order it when its cooler so I dont have to pay for all the extras to keep it cold.
What is the onset? I know the nadir is the lowest number. She typically doesnt have a specific time when her number is lowest but I did just recently write down what time of the day the lowest number (nadir) was (at least what I knew about of course) from Aug 1 thru Aug 24 so far. These are all nadirs even tho I say highest. It just the highest nadir at that time.
AMPS - 8 times - lowest 60, highest 273
+2 - 1 time - 56
+3 - 1 time - 171
+4 - 4 times - lowest 74, highest 335
+5 - 5 times - lowest 58, highest 279
+7 -1 time - 210
PMPS 1 time - 259
+2 pm - 2 times - lowest 228, highest 264
+11.5 -1 time - 38

So it looks like AMPS wins, followed by +5. So what does that tell me??? Not sure.

 

[JoM]

However, I do have some comments about dosing. First, I'm not sure the fat and skinny dosing is doing much for Karamelle. I'd go back to 0.25 unit changes. Plus, if a dose isn't giving you anything below 150, I'd increase after 6-8 cycles. I tended to hold low blues for 10 cycles, medium blues for 8, high blues for 6.

I will raise the dose to 1.75 on Wednesday. I know I could raise it now but I have a medical procedure coming up on Tuesday and I dont want to mess with her dose before that.

 

[Wendy&Neko]

From the New to the Group Sticky Note:

• Onset - the length of time before insulin reaches the bloodstream & begins lowering blood glucose
• Peak/Nadir - the lowest point in the cycle
• Duration - the length of time insulin continues to lower blood glucose

For Karamelle on Lantus, onset seems to be about +2 or a bit earlier - not much +1 or +1.5 data to figure that out. But in a cycle she's going down, her numbers are down from preshot at +2. Some people use the onset and compare it to preshot to determine whether they are going to see an active cycle. This might mean going to bed later for you or moving shot time up. I didn't go to bed much later when Neko switched to Lev, but I did look at patterns between the AM+9, PMPS, and PM+3 or +4 (when I did go to bed) and see if I could figure out when she might be going lower than night and if I had to get up in the wee hours. Thankfully her nadir on Lev was between +9 and +12, and I am often up at +9 for my workout.

Nadirs can and do move around. Neko's nadir on Lantus varied from +3.5 to +13, though most often in the +7 to +9 range. Bounce breaking cycles give you later nadirs, cycles where they might be going low often nadir early, but ECID on that.

Just curious when you made the switch from Lantus to Levemir, what dose did you start with?

We switch at 70% of the Lantus dose. Some cats have a strong reaction to the switch, so that reduction is a safety factor. Often the Lev dose ends up somewhere near the Lantus dose.

 

[JoM]

For Karamelle on Lantus, onset seems to be about +2 or a bit earlier - not much +1 or +1.5 data to figure that out. But in a cycle she's going down, her numbers are down from preshot at +2. Some people use the onset and compare it to preshot to determine whether they are going to see an active cycle. This might mean going to bed later for you or moving shot time up.

So you basically figure out the onset when the numbers are going down, not up. Down is an active cycle and up is bouncing??

 

[Wendy&Neko]

Onset is usually the same for each cat.

Up at +2 is typically bouncing, down depends on how much. A "normal" Lantus cycle will have some downward movement. A bigger drop at +2 means a more active cycle needing more monitoring and/or higher carbs.

 

[JoM]

Onset is usually the same for each cat.

Up at +2 is typically bouncing, down depends on how much. A "normal" Lantus cycle will have some downward movement. A bigger drop at +2 means a more active cycle needing more monitoring and/or higher carbs.

In your opinion is Karamelles SS normal? Or does it look like somethings off. I think she goes over 300 too much, but if I raise the dose she drops into lime. Should I just be ignorning the drops. I know I did that last time for one or two of them but then had to end up lowering the dose again. I guess Im just not sure how serious dropping down into hypo for one reading or two, with no apparent symptoms, is. I can keep on the way weve been going, but I hate seeing her bounce so much and go up into the 300's which does clearly make her feel lousy.

 

[Heather & Shooter]

Things to consider with Levemir is that typical onset is +4, typical nadir is +8 and how that fits with your schedule.

This is almost always the case for Shooter.

and nadired even later, often at preshot time.

This seems to happen more lately. It was scary at first but now it's not so bad.

Plus, if a dose isn't giving you anything below 150, I'd increase after 6-8 cycles. I tended to hold low blues for 10 cycles, medium blues for 8, high blues for 6.

Great info! I'm going to try to remember this.

I might try the Levemir even tho its so much more expensive. $23.94 Lantus (thats what Ive been paying for one pen) vs $169.99 (plus whatever shipping costs are) for Levemir.

Holy smokes! I used to pay $169.99 for a BOX of pens (many years ago). I just got online to the canadian pharmacy I used to use and apparently they aren't even selling insulin anymore. For the last few years I've been getting my Levemir from a friend at the gym who uses Levemir himself. He's on medicare or something and gets a ton of it for cheap. I don't even want to tell you how much I pay him for a vial. It's nothing. Good luck with whatever you decide Jo.

 

[JoM]

Holy smokes! I used to pay $169.99 for a BOX of pens (many years ago). I just got online to the canadian pharmacy I used to use and apparently they aren't even selling insulin anymore. For the last few years I've been getting my Levemir from a friend at the gym who uses Levemir himself. He's on medicare or something and gets a ton of it for cheap. I don't even want to tell you how much I pay him for a vial. It's nothing. Good luck with whatever you decide Jo.

Wow, you are lucky to have such a generous friend.