Dosing Advice for Switching to Levemir

Hey,
I posted in the Levemir section, but I thought I'd ask here, too.

I'm switching Chester from Lantus (he's at 15 units, no change AT ALL in his BG levels - steady 490-570 all day, every day). The vet wants to start Levemir at 2 units - I'm a little worried about his BG getting even higher. What has been the experience of switching a cat to the new insulin from Lantus? How much lower have you started with Levemir?

Probably will be starting tomorrow, since I'm nearly out of Lantus at this point.

Thanks!

 

Quick answer is you may want to go with 70% lev.

Chester's getting 15u BID of Lantus? You've already tested for acro and IAA, yes? Was the test for IAA also done at the same time?

I found your old post about Chester testing at "250 or something in November2009" and I found that you had started a ss in August, so I wondered if you could attach your current ss to your signature as it would be helpful to others with acros to offer suggestions.

 

As for the spreadsheet - I haven't updated it in a while. I should probably start doing that again.

Chester has been tested twice now for Acromegaly, he's come back positive both times. IAA - what is this? If it's insulin resistance, then he tests negative for that, but I'm not sure it was done at the same time.

I'm working on figuring out the signature thing, but I am not sure how to insert the links properly. confused_cat

 

That's great if you can post the ss.

Do you recall what the number was in the acro test? The normal range for negative is 12-92.
The other test for IAA would not have been part of the other test .... 2 separate tests.
IAA Test
IGF-1 (Acro) Test


You say he was tested twice? When were the tests done and what were the two results?
Just curious, but how come he was tested twice?

 

Hi there!
When crossing from Lantus to Levemir, you should start at 2/3 the dose you are on and work back up. Like you say, you don't need to lose momentum at this point. I think your Chester is going to LOVE levemir! (((hugs))) and nice to meet you!
..Carolyn

 

He was tested twice - once in November 2009, once in November 2010. The vet did not believe he had acromegaly because he went into remission for seven or eight months.

Since Chester tested borderline for hyperthyroidism, the vet assumed that was the main issue, and it was not treated last year. So, the vet put Chester on methimazole to regulate the thyroid. Nothing changed in the BG levels. We kept raising the insulin amounts, nothing is happening. He's still a high flat curve. After four months on Lantus insulin.

He was above 200 both times on the IGF-1. The IAA test was definitely done in fall 2009, and he tested negative.

The vet is extremely concerned about starting high on Levemir. He was thinking 4 or 5 u BID, even though we were at 15 u BID Lantus. So.... I gave him 4 this morning, but perhaps I should've gone with something a little higher. 10u would be 2/3 of my Lantus dose. The vet was trying to get me to leave him for a few days at the emergency clinic. Like I can afford that - especially if it's unnecessary!

Thank you all so much!!

 

Ask the vet if you leave him there for a few days, would it be free? Before he replies, tell him that his answer will also be your answer. Of course, it's unnecessary for you to leave Chester at some emergency clinic for the switch of insulin.

No, the 4u will be quite low, but you will see that from your testing. If you were at 15u on Lantus, you could easily have done 10u with Lev.

I had been told recently that on the switch, the sheds are separate, so as your Lantus shed is lowering, your Lev shed is filling. I thought it was an interesting piece of info that I wanted to pass along.

It may be a good idea to do a fair amount of testing during the transition so that you can see how the change is affecting Chester. I switched both of my acros from Lantus to Lev, and while Oliver did not show much change, Shadoe was much better on Lev.

If you can get copies with the numbers from the acro and IAA tests, there is an acrotracker sheet where we have all entered our numbers, and you can enter yours as well.

 

Ah, ok, that's good to know about the Lantus lowering and Lev increasing - I suppose it will make for some odd numbers for at least a little while.

So far today, I've checked at +3 (480) and +6 (470). He seems to be exhibiting similar behavior as usual - lethargy, drinking a lot. Keeping an eye on him, and will probably increase his dose fairly quickly at least to 10 u. But, we'll see what happens.

I have hope!

 

I am glad you have hope; I am sure you will be pleased with the Lev once you get up to the correct dose.

Be sure to add your numbers to your ss and add the link to your signature so that we can help you out with suggestions and dosing. From the 2 numbers you mentioned, it seems like you will be able to increase that dose. As well, be sure you are watching for ketones due to such high BG numbers right now.

 

Those are low numbers for Chester, actually.

Question, though - how do I test for ketones when I have multiple cats? I do have test strips, but I'm not sure how to use them properly.

 

The best advice is to post on health and make your subject something like "Need ways to check for Ketones in multi cat house" and I bet you will get several suggestions.
What works for one person may not be good or convenient for another.

 

I feel obliged to confess that in over 4 years of feline diabetes treatment among 3 diabetic cats ---- I have NEVER tested for ketones. (in a multi-cat home)

One characteristic of ketones -- the breath will smell sweet or like finger nail polish remover (both humans or cats with ketones) so -- if your kitty looks sick and his breath smells unusual / sweet chemically smell -- time for the vet or isolate with a litterbox to get a sample.

 

Ok, good to know.

In the past, I've smelled his breath - of course, his breath is always rather icky. I think he's needed dental cleaning for a while.

 

just saw this how is chester doing today?

 

If Chester is anything like my Silverado, when he pees it creates a huge puddle that the litter can't absorb right away. Just wait till you know he's doing his duty and as soon as he is finished, dip your ketone test strip into the puddle before he has a chance to bury it. I hope this helps.