Please share experience on Levemir use_Very concerned w/NPH

Hello everyone,
We are new to this forum and writing to get some help and advice.

Our 13 years old female cat was recently diagnosed with FD. Here how it is all developed:

Initially, high BG (300) was detected on 01/21/13 when we noticed a loss in weight (from 13 to 11 lbs) and increased urine in the litter box. Vet suggested monitoring BG and make adjustment in her diet. We changed her diet from dry\wet food (mostly gravy based) combination to low carb wet food diet only and BG dropped to 118-150 level. We were home testing using ReliOn "Confirm" type glucometer (bought at Wallmart). Her new diet was as follows: she gets wet food twice a day (6-30 am/6pm). We use Fancy Feast Classic canned food (Code,Sole,Shrimp Feast/Chicken Feast/Salmon Feast, Ocean Whitefish), EVO's 95% Chicken & Turkey, BFF's Tuna&Chicken in gravy. She also gets once or twice a day 10 pellets of dry food as a treat (EVO's Cat&Kitten or Nature's Variety's Raw Instinct or Purina DM). She also begs for milk and sometimes gets a 30 ml portion (no more than once per day).
She was acting normally with changed diet. We stopped taking BG measurements.

All was appearing normal till last week when she suddenly became sleepy and could barely move, lost appetite completely. Her weight dropped to 8.8 lbs. We took her to the vet again on 05/16/13 and BG was around 350 plus ketones in urine (40-80 mg//dl). Her mouth appeared to be dry. Vet gave her IV (50 ml) and a series of shots: Cerenia and Famotidine as well as buprenorphine 0.6 mg . On Friday , 05/17/13, her condition did not improve. We syringe fed her in the morning and end up taking her back to the vet the same day. Suggestion was given to leave kitty at the doctor’s office to do IV and insulin intro. Our vet works with NPH insulin primarily. She has less experience with other insulin. On Saturday, May 18 our vet started NPH (we bought it at Wallmart) insulin injection. Cat weights 8.8 lbs. Starting dose was 1 unit. She still refuses to eat on her own and is being a syringe fed. On morning, 05/18/13, BG was at 222 and doctor increased a dose to 2 units. The same situation with eating. No appetite. Vet started to give her Cyproheptadine to boost appetite.

Prior to hospitalization our cat was not receiving any other medication. We're not sure about any other health condition that cat might have that could impact FD. Liver and kidney (per vet) seems to be functioning fine based on the blood work taken on 05/16/13. We have a copy of results but not sure how can it can be posted.

We picked up JJ today from the hospital with instructions to give her 2 units / 1 unit spread over 12 hrs. We think it is important to have injection of the most effective insulin from the start. We've read all general guideline information on various forums and understand how treatment protocol works. Still, we are very concerned with the use of NPH, especially reading some additional information available on the internet. Seems like majority of owners/practitioners domestically are given the preference to PZI while overseas owners/vets are using levemir or Lantus. We really want to help our kitty to get healthier and get her off the juice ASAP but in this case the right and timely selection of proper treatment is important.

Should we ask our vet to switch to Levemir or PZI before long? We are leaning toward levemir.
PLEASE advise and provide any information or links to veterinary articles addressing efficiency of long lasting insulin, specifically, levemir.

Many thanks
V&N

 

Re: Please share experience on Levemir use_Very concerned w/

Where are you located? We have members all over the world, so "overseas" could mean anything, as can "6:30am". If you are asking for time related info like "should I raise her dose at 7 pm?" we don't know when that is. Better to ask, "Her shot is in 2 hrs, should I raise the dose?" All posts are time stamped with the READERS local time.

NPH is not the best insulin for a cat because of the fast onset and fairly short duration. Cats have much faster metabolisms than humans. Levemir and Lantus have the longest duration, followed by Pro Zinc.

ALL insulins need to be given every 12 hours (bid). I am not sure what the vet means by 2u "over 12 hours" (maybe you meant to type EVERY 12 hours?). Starting dose should be .5u bid or 1u bid - dosing is not based on weight in cats. Dose increases need to take more than just one number into consideration. You have to look at preshot tests and mid cycle tests to see how the cat is responding to the dose and how low the BG drops. And increases should be smaller than 1u because it is too easy to miss the best dose, which might be .75u or 1.25, and so on.

What is most concerning for JJ is her not eating. And it sounds like she is dehydrated. Has the vet suggested giving sub-cutaneous fluids to her at home? They are pretty easy to do - and she will probably need more than 50ml - more like 100ml daily for a while. I have two cats on SQ fluids right now. One gets 100 ml every day and the other gets 125 every other day. Dehydration can really ruin their appetite. SQ fluids will also help to flush ketones from her system.

Food should be low carb. That gravy food probably has higher carbs. I feed pate-type food and mix some water into it. I use Wellness grain free and PetSmart Great Choice mixed together. I understand about the kibbles as treats, but you might want to try boiled chicken instead for now. My cats love boiled chicken. Just cut up and boil in plain water, freeze in small portions along with the broth and give after testing or whenever.

Did you vet check for hyperthyroid? That can cause increased thirst and urination, as well as dehydration, which can cause a UTI, which can raise BGs and the combo of infection, decreased appetite and increased BG is a recipe for ketones - which are very dangerous. I think dehydration also plays a role in that equation.

Here is a link to a great website with all kinds of info on diabetes in cats (and dogs, I think):

http://petdiabetes.wikia.com/wiki/Main_Page

Down at the bottom of the pages are links to articles (footnotes). You might find something in there that you can share with your vet to convince him/her to let you switch to levemir.

Do you test at random times throughout the day? Can you post her numbers for a few days or a week? You can do it like this:

amPS - 250, shot 1u (morning PreShot)
+4 - 175 (four hours after the shot)
+7 - 145 (seven hrs after the shot)
pmPS - 285, shot 1u (evening PreShot)

That will help us to help you.

 

Re: Please share experience on Levemir use_Very concerned w/

I am not a fan of the NPH insulins in cats. They drop the blood glucose (BG) numbers very fast and the duration is usually only about 5-6 hours. Some cats do get a longer duration. You don't know unless you are doing frequent testing to find that nadir and to find the duration of the insulin.

When you are using the NPH insulins, it is very important to feed your cat first before the shot, 30-45 minutes is recommended. That is because of the very fast onset of NPH insulins like Humulin N and Novolin N. You also need to remove all food in the later part of the cycle. Once the insulin is gone, if your cat continues to eat, the BG numbers will simply go up that much faster.

Lantus and Levimir are both good insulins to use with a cat as are PZI and Prozinc.

 

Re: Please share experience on Levemir use_Very concerned w/

Hi Sheila,
Thank you for the wealth of information provided along with the links.
We’re located in OH, USA. By reading information available on the internet, we’ve gotten concerned with initial insulin selected by our vet. If you have any more articles or links to the websites where DVM share their opinion no the advantages of long lasting insulin, please share it with us? We wanted to take this info to our vet and hopefully influence her initial opinion on the insulin used.
Based on the instruction given to us when JJ was released, we have to administer two insulin injections every 12 hours: 2 units in the morning and 1unit in the evening. We injected 1 unit this evening after a small meal that JJ had (1/2 of 3.3 oz can of Fancy Feast) . She’s still shocked after 3 days in the hospital and rather slow and sore at this point.
We were not given instruction to do SQ fluids. JJ was not checked for hyperthyroid.
All food that we have in the house is low carb food.
Even so we were told not to do random checks unless we see JJ is not tolerating insulin well (not sure how this can be determined yet), I’ll try to take some measurement with a RelyOn glucometer we have.
We also were instructed to bring JJ back for checkup in 2 to 3 weeks for fructosamine test.
We’re too novice at all this and advice will certainly clarify a lots of unknowns.

Deb, thank you for your comments on insulin types and feeding advise for NPH use.
Please share your experience on what syringes and needle gauge is best for insulin injection.
Vitali

 

Re: Please share experience on Levemir use_Very concerned w/

You definitely want to have the 3/10cc insulin syringes, with 1/2 unit markings if possible for when the dose may be in 1/2 unit increments.

Needle length is personal preference. Some people really like the short 5/16 needles, others hate them and only like to use the 1/2" needle length.

Gauge on your syringes can range from 28 to 31 although the 31 gauge are so fine that they may bend too easily. I think it was Kpassa who said she actually broke off a 31 gauge needle in her kitten Michaelangelo one time.

I used the Walmart Relion 3/10cc, 30 gauge, 5/16" needle length, with 1/2 unit markings. For me, the shorter needles gave me more control. I was shooting insulin into a long haired cat and had no problem with the short needle length. Just had to find that bare spot in the fur, pull up the skin a little bit and shoot into the 'door' of the tent. Worked great for me.

What else can we help you with?

 

Re: Please share experience on Levemir use_Very concerned w/

You want some research on the better insulins? Be careful what you ask for, I have a ton of links. ;-)

How about starting with the Merck Veterinary Manual which your vet should have access to. Recommendation for cats is Lantus (aka glargine). http://www.merckmanuals.com/vet/endocrine_system/the_pancreas/diabetes_mellitus.html#v3271697

Next, how about a slide show presentation by the University of Queensland Centre for Companion Animal Studies? Talks about the different insulins and benefits of each one. You can see that NPH types are way down the list. http://www.uq.edu.au/vetschool/content/clinic-stlucia/feline-dm.pdf

Third, how about a good article from U of Queensland again talking about diabetes mellitus. http://www.uq.edu.au/ccah/index.html?page=43391&pid=0

Fourth, ask your vet if they have access to the vet journal Veterinary Clinics of North America, Small Animal Practice, Feline Diabetes which was just published in March 2013 and has some of the most current research on feline diabetes.

And last but not least, the AAHA Diabetes Management Guidelines for Dogs and Cats was published in June 2010. This is another vet journal. https://www.aahanet.org/Library/DiabetesMgmt.aspx

Happy reading and let me know if you need or want more research articles. :shock: :shock:

 

Re: Please share experience on Levemir use_Very concerned w/

Deb,
thank you for all the links. It will keep my night light burning
which insulin did you use?
Vitali

 

Re: Please share experience on Levemir use_Very concerned w/

Well, here's the thing: How are you going to know if she is or isn't "tolerating" the insulin if you don't test her BG? And what does the vet mean by "tolerating"? If they mean, is the dose working for her or is it too much, too little? Again, without testing - without the data - how will you know?

I can guarantee you that your vet's answer is "The frutosimine test!" OK, here's the thing about that. Imagine that you had a huge pot with money in it and someone stole all of it the first day, but replaced it 2-3 weeks later just before you returned and counted it. You might think that you had the full amount of money in there, when, in fact, it was empty for every day in between. Now imagine that the money was in the bank and you get daily interest. The bank doesn't count it going in and then only once more at the end to determine what interest to give you on a daily basis, right? They count it every single day. Which is more accurate?

You can have a cat at 250 in the morning, you shoot 1u and at night they are 275 and you shoot 1u. But at 5 hours after the shot their BG was 39, but you didn't test. The next morning they are at 350 and you shoot 1u. That night they are at 400 and you shoot 1u thinking the dose needs to be raised. But, at 5 hrs after the shot the cat was at 35. If all you have are those test at shot time it looks like the dose needs to be raised, so the vet raises the dose to 2u., 'cause, damn, 400 is really high. The next day the evening number is 500. Whoa! WTF is happening? Well, at 4 hrs after the shot, the cat's BG was at 27. Rebound is causing the BG to climb. But the average BG has been something like 300 (I didn't do the math) and that is what the fructosamine test is going to show you. It will NOT show the chonic overdosing, dives and rebound to higher numbers.

In humans, what would you think if your pediatrician told you to go ahead and shoot insulin into your toddler without testing? In humans the protocol is to test before every shot and every meal, at least.

Fructosamine is old school and, IMO, only useful to determine a diagnoses of diabetes because a single test from blood obtained at the vet will show an elevation. Two weeks ago I had to take Beau to the vet. He is diet controlled. I tested him before I got the carrier out. He was 100. At the vet he was 215.

Diabetes is home managed - that means testing before shots and at spot checks in between. The vet won't come to you home and yell at you if you test more often. It won't stress the cat out. You do have to reward them with treats, but they come around and learn that testing is tolerable, if not an enjoyable bonding experience.

And, speaking of tolerating, I have treated three diabetic cats. I have caught them in really low numbers and really high numbers with tests. Well, Cami has not had a really low number yet, but she has had some near 400s lately. She is the only one where I have seen what I think is a detectable behavioral change based on her BG. Neither of my boys did even when they dropped into the 30s. The only way to know what is going on is to spot test. That is the reality of living and treating a diabetic cat 24/7.

Vets don't expect owners to do all that for their cats, so they downplay the need for it, or simply don't know about it, or some may hate giving over control to the owners. But this is YOUR cat, not the vets and the vet works for you, not the other way around.

OK - lecture over. :roll:

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
Very clear lecture. Thank you. Could you please share what type of insulin you use and what is the best spot for taking BG sample (ears or paw)
Vitali

 

Re: Please share experience on Levemir use_Very concerned w/

Vitali, I am using levemir. Cami is my third cat on it. Beau, my first diabetic, was started on vetsulin - another rapid onset, short duration insulin. He was on it for 2-1/2 years before I decided to switch him to levemir. He was on levemir for 3 months before going OTJ (off the juice). He has been OTJ for 3-2/3 years.

I have always tested on the edge of the ear in that thin strip between the vein and the edge. I have also found that only ONE brand of lancet works well, BD Ultra Fine II. I have tried a half dozen other brands in the same gauge and none work as well and some seem to hurt the cat. I hold the lancet in my fingers for better control, make two quick pokes just next to each other, wait a second and then pulse my fingers on the ear below where I poked if a drop doesn't form right away. After the drop is in the strip and the meter is counting down I wrap a small piece of facial tissue over the edge of the ear and apply pressure for a few seconds to stop bleeding and prevent bruises.

I have never tried to test a paw pad, but I know there are others who do for various reasons. The ear seems easier to me, but I think they both work.

 

Re: Please share experience on Levemir use_Very concerned w/

You are welcome on all those links. For my foster cat Wink I used Lantus insulin. It's another of the good, long duration insulins recommended for cats.

If you look at the end of my post, you will see some information below the solid line. This is part of my signature. You can put some information in your user control panel, profile tab, edit signature in the free form text box that pops up and then submit to save. we usually put information like our name, cats name age and sex, diagnosis date, insulin used, meter used for home testing, any complicating medical conditions your cat has like hyperthyroidism or CKD. Yes, a lot of this information is scattered in your posts but not so easy to find as it would be in your signature.

Would you also go into the user control panel, profile tab, edit profile and add OH, USA to the location field and submit to save. Don't worry about any of those other fields. Most of us do not use them.

This information helps us to help you better by having a quick snapshot of info in each post.

Thank you for considering doing this.

 

Re: Please share experience on Levemir use_Very concerned w/

Deb,
I'll fix signature page tonight.
I bought yesterday ReliOn 3/10ml 31G 8mm needle syringes. The dials sare so small that it is hard to see where 1 or 1.5 units really are.
I've read somewhere that BD syringes are easier to read. What is your experience on that?
Thanks
Vitali

 

Re: Please share experience on Levemir use_Very concerned w/

Do they have half unit markings? That helps.

I an nearsighted, so I take off my glasses to see the markings. Others use a magnifying glass or one of those magnifier lights (where the magnifier is in the center).

 

Re: Please share experience on Levemir use_Very concerned w/

Deb,
Yes, ReliOn syringe has 0.5 units marking.


Sheila,
What gauge of BD lancet do you use? Do you use a launching device with it? I tried to draw a blood twice this morning. Did not work. I’m not sure I’m aiming for the right spot :cry: . Do I have to aim for the vein or between the vein and the edge of the ear?
Many thanks

 

Re: Please share experience on Levemir use_Very concerned w/

reading through this now- Vitali, Sheila is VERY knowledgeable.

Something that I had to wean myself off of- giving Sneakers milk. When I had my tea she was used to a tiny slurp of milk in her bowl. Believe it or not that raised her BG level. It took both of us almost 16 weeks cold turkey- no tea, no milk, for her to not expect it. Of course I was a cranky bear since I didn't have my morning cuppa but that was only a problem for the people I worked with :lol: So check the carbs on you milk. JJ might not be as carb sensitive as my Sneakers but she might be.

Also- ditch the dry. Boil her some chicken instead.

Also- the dose on levemir should be the same. There is no reason to have a dose at one time and another one the next. that keeps the body guessing and filling/shedding the insulin depot that lev has.

 

Re: Please share experience on Levemir use_Very concerned w/

You aim between the vein and the edge of the ear. There is a great picture and lots of tips here: https://docs.google.com/document/d/13c_CPZVKz27fD_6aVbsguadJKvjSrSAkD7flgPPhEag/pub

Heating the ear up first with a rick sock or vigorous rubbing helps to get the blood flowing.

Shining a flashlight from underneath can give you a hard surface to poke against and highlights the area to see better.

 

Re: Please share experience on Levemir use_Very concerned w/

Heather:
We ditched the dry food almost completely. I had to give JJ five pellets after insulin injections just to keep her happy. Those are Raw Instinct with 7% carb content. Hope it does not make a huge impact on BG.
If I understand Sneakers SS right, you also switched from initial insulin to Levemir, correct? One thing that I’m confused with on Sneakers SS is the amount of units you’re treating him with. Is it 15 units per injection now or I’m reading something wrong.
Where do you buy Levimir at?
PS. We had to give up on our coffee if JJ is around. She bags for milk as soon as coffee smell is in the air.

Deb:
Thank you for the link. I managed to do a first BG test this evening. BG is high at 394. I increased a dose of NPH to 1.5u versus 1 prescribed. Will try to get a prescription for Levimir tomorrow.

 

Re: Please share experience on Levemir use_Very concerned w/

First BG test! Welcome to the vampire club.

Sneakers is a high dose kitty because he has acromegaly, a pituitary gland tumor, that makes the BG numbers go high.

If you look at the signature , you'll see Acro which is short for acromegaly.

 

Re: Please share experience on Levemir use_Very concerned w/

Vitali-
Sneakers has acromelegy, which is a pituitary brain tumor that makes them grow big, eat loads of food, and have diabetes that needs huge amounts of insulin to control it. Unlike normal FD kitties they have a working pancreas but the tumor sends out so much of the GH-1 hormone and it overpowers the pancreas and causes the diabetes. DO NOT follow my dosing scale . And currently we are at 13.5u BID, down from her top of 33u BID last Thanksgiving. Believe me, I'm happy with it :lol:

We started out 2011 with humulin N- as per my vets research. I don't know what research he did as it didn't involve a computer and the internet. I pressed for PZI and got that around January of 2012. As her dose went up I wanted to switch to a better insulin that I had read about here and there was already an inkling that she was possibly acro. Switched to lev in March 2012 as that is better for high dose kitties- no stinging factor, but hard to get in AR since lantus seems to be the only insulin doctors dole out here. I buy mine from Canada as I can get more for the same amount of money.

Now- I switched vets March 2012 last year as my current vet did nothing about learning anything with FD and I was quit frankly fed up with him telling me high ketones aren't troublesome with cats. Apparently he had never heard of DKA. So, I took all my research into the new insulin and interviewed a new vet, then took Sneakers to him and he agreed to prescribe it for me even though he is a canisilin vet. He knows I do my research into all things FD and that had led to a little contention when he wanted to give her metacam on a daily basis for pain management (brain tumor= hurts/headaches). I refused. In fact, he said to me... "You've been researching again, haven't you?" Shoot yes! I want to know exactly WHAT goes into my baby girl! :lol: With her having FD- which is tough on the kidneys- and acro- which makes her soft tissue organs to grow larger- I didn't want anything that could be harmful and cause CKD.

For the lev- get a prescription for the PENS- higher upfront cost- around $250, but there is a link to a $50 off coupon somewhere, plus $25 each off the next 4 packs you purchase. There are 5 pens in the pack and you use each one as a little vial. Take that pen out of the pack and keep it in a plate or a box on a middle drawer- not in the door. The reasoning- if you happen to drop the pen and it breaks you still have the other pens as back up. If you contaminate the pen accidentally and it goes bad you still have another pen. Once you stick a needle in the pen/vial the clock starts ticking down. Now the papers say throw it out after 42 days of being 'opened' but lev lasts longer than that if taken care of properly- the life of a 3ml pen sometimes. Not so with a 10ml vial- it has 3 times the amount in it but the same count down. There is a greater chance it will poop out before you get to the end.

Good job on the BG test- first successful one is always a blessing! :razz:

 

Re: Please share experience on Levemir use_Very concerned w/

Vitali, good job on the BG test. yay!

Now, read this for future information:

Using NPH, you CAN adjust the dose based on the preshot test to some extent. I would not recommend doing it though until you have that data to show how low she goes mid cycle. It may be the case I posted yesterday where the preshot tests are high, but she drops low mid cycle to a number that is below where you want her to be for both safety sake and so as not to induce rebound. (there is a good explanation of rebound on the petdiabeteswikia site I linked above.)

However, on levemir (or lantus) you do NOT want to change a dose based on a preshot - especially not to raise the dose. The mid cycle numbers are much more important to determine doses.

The reason for the difference is that with a faster insulin like NPH or vetsulin there is a lot of variability from cycle to cycle AND the insulin is all gone from the system by the next shot. With lev and lantus, the cycles will be fairly stable (once a good dose is found) and the duration can be quite long (over 12 hours) so the onset, duration and fade out of each dose overlap each other.

Once you get data on her, you will be able to make dose decision like a pro. Don't worry it will come. Just be cautious now and don't try to rush the process. Since Cami went back on insulin I have been chasing her numbers all over. They don't make sense to me now so I have not found her best dose even after 3 weeks (and over 6 years doing this dance with 3 cats).

 

Re: Please share experience on Levemir use_Very concerned w/

The BD Ultra Fine II are 30 gauge. The BD Ultra Fine (no "II") are 33 gauge. I prefer the 30s.

I do not use a device with them. Beau learned to anticipate the click and flick his ear. Once day he flicked his ear too early and I tore the edge of it. I was horrified! And I never used the device again. I just hold the lancet in my finger tips. I also find it is much easier to aim without the device holder thingy.

Aim between the vein and the ear edge. If you hit the vein it will bleed a great big drop (and if you are like me you will freak out the first time it happens). Just get your strip filled and staunch the flow with some tissue or a cotton ball.

Here is Jeddie's ear modeling the "sweet spot":

 

Re: Please share experience on Levemir use_Very concerned w/

Any suggestions on good syringes with easy to read marking and smooth plunger movement?
many thanks

 

Re: Please share experience on Levemir use_Very concerned w/

This is the kind I get (and where I order from):

http://www.hocks.com/diabetic-suppl...edle-1-2-unit-markings-gnp-brand-100-box.html

One thing I always do before drawing the dose (and before sticking the syringe into the vial or cartridge) is to pull the plunger down and push it back up to zero. That kinda gets it "unstuck". The other thing is to twist the plunger with very slight pressure on it to fine tune the position.

 

Re: Please share experience on Levemir use_Very concerned w/

Thank you for the info on syringes! Still had a heck of the time drawing blood from the ear again. Unless we hit the vein (using 30G ReliOn lancet), no blood is coming out from any area between the edge of the ear and the vein. JJ gets very nervous during the process so do we to the point that we are upset with each of mishandling pricking. But, it has to be done one way or another. We’ve updated the spreadsheet with our measurements. Hope it can be viewed by others as well. Please let me know if not.
V&N

 

Re: Please share experience on Levemir use_Very concerned w/

Whoa!

Jill, I hope you are still awake and can test a few more times tonight. That is a HUGE drop from 430 to 97 in 3 hours. I am a little concerned for her over the next few hours.

This is one of the problems with NPH - it is a very harsh, fast, "take to prisoners" insulin in cats.

I would suggest dropping back to 1u and getting some more spot checks in. Are you using the heated rice sock to warm her ear? I use the rice sock, then message the ear just a few times, then poke two quite pokes just next to each other. Wait a second and then pulse my fingers on the ear BELOW the pokes.

It does take practice and it does seem to take time to teach the ears to bleed. I know about being upset and nervous and having the kitty pick up on that and get upset too. Just be calm, speak softly to her and always give a treat after each attempt - successful or not.

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
We’ve dropped dead last night. Could not do any more testing. 5-6hrs of sleep a night piled up a fatigue, unfortunately. We've decided not to use a sock with rice this morning. As soon as JJ sees the sock, she starts growling. Managed to hit a vein again and BG measured at 355. Gave her 2 units.
Will do more testing in the evening. Keep pushing our vet for levemir. Do we have to roll and mix levemir and feed JJ before the shot as we do with NPH or it is more forgiving?
Thanks
V&N

 

Re: Please share experience on Levemir use_Very concerned w/

No- levemir is late onset (2-4 hours after instead of 30 minutes) so you test and feed right away. By the time the food spike is going the lev will hit and should start to pull it down.

You do not roll it- there is no suspension formula and no need to roll the insulin. Do not keep in the door (too bumpy), on the top shelf (too cold/could freeze), do store on the second or bottom shelf...

We don't to the sock- I just massage the ear to get it warm- and Sneakers usually purrs through that.

 

Re: Please share experience on Levemir use_Very concerned w/

Please, drop the dose to 1u. It is the insulin that is causing the 300s. The fact that she dropped from 430 to 97 in 3 hours and then was back to mid 300s is indication that she is rebounding from too much insulin.

Even when at the vet, her numbers were better on .5u and .1u.

With the faster insulin you do NOT want a rapid drop early in the cycle. It ALWAYS caused rebound because of the rapid drop and the wearing off of insulin well before 12 hrs is up.

Rebound can happen when the BG drops too fast, too far, or too low - meaning the end low number does not have to be a sub-normal number to cause it. The body senses the speed of the drop or how much it is dropping and panics releasing hormones and stored glucose to prevent a hypo. The hormones keep the BG higher for up to 48 hours. Continue giving the dose that is causing this and the process keeps repeating.

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
do you mean to drop both doses to 1u (morning and evening) or just the morning one?
Thanks

 

Re: Please share experience on Levemir use_Very concerned w/

JJ likes lettuce and grass, especially this time of the year. Can she still have it?
thx

 

Re: Please share experience on Levemir use_Very concerned w/

Sorry - just getting back now. Yes, drop both does - they should always be the same anyway.

I would look up lettuce and make sure that is safe to feed a cat. I'm just not sure as I have never had a cat that liked it. Some grasses are ok. Like Wheat grass. A little won't hurt her or her BG.

 

Re: Please share experience on Levemir use_Very concerned w/

We will be picking up Rx for levemir later today. Out vet agreed to change the medication. Planning to start close monitoring of BG on Saturday since new insulin will be used.

Thank you for comments on the lettuce and grasses

 

Re: Please share experience on Levemir use_Very concerned w/

That is excellent.

I strongly suggest starting at no more than .5u bid. The reason for that is that JJ has had some low number on NPH lately and there can be a significant response to lev anywhere from the 1st to 3rd dose. Look at Beau's SS for an example. He was started at .5u and dropped into the 30s on the 3rd shot.

After that initial two days, continue to monitor well and let the dose settle another 1-3 days (for a total of 3-5 days). Then you can assess if a dose change is needed. From .5u, do not make changes more than .25u. Less would possibly be better, depending on the numbers you are getting for her.

I realize this is most likely not what the vet suggested, or will suggest for starting dose and raising dose. IMO, many vets do not have the day to day hands on experience with treating diabetic cats with levemir. Your vet certainly doesn't since you had to convince them to Rx lev.

You might want to start a new thread when start the lev.

 

Re: Please share experience on Levemir use_Very concerned w/

Good luck with the lev!

 

Re: Please share experience on Levemir use_Very concerned w/

We picked up levemir this evening. Bought 5 pens. Vet instructed to do 1u injections. twice as much as Sheila suggested.
We will be lucky if we could do BG with JJ's attitude every 6 hrs. Will try 3 but it will be a nerve rack for all.
How long one pen can be used since open (pharmacey said 28 days?)?
Should we store it in the fridge?
Very nervous....

 

Re: Please share experience on Levemir use_Very concerned w/

I very respectfully say, your vet doesn't know what s/he is talking about with the dose. Most vets don't.

Please do not give 1u. Please. Especially when you feel you can't test her "whenever" you need to. It just isn't safe.

You will get there with the testing. Part of it is building your confidence and determination, part of it is practice, part of it is JJ learning that it can be a pleasant experience, and so on. It takes time. Even for experienced testers with a new cat.

Yes, store the pens in the fridge. Put hem on the second shelf where they will be out of the direct air from the freezer and won't get jarred every time the door opens (which is why you don't put them in the door). The pen will last until it is gone. I have had one last 8 months I think.

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
We've started levemir this morning. All data are in SS.
Thanks
Vitali

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
In Cami's SS, can you tell me what does LCk, Pp, SQ? Did she reversed from OTJ again?
Thx
V&N

 

Re: Please share experience on Levemir use_Very concerned w/

Does anyone takes blood sample from the paws? please share your experience and what gauge if lancet is good for that? Tried with G30 after 20 sec warm up - no lack.
Thank you

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
please take a look at SS. Should we go with 0.75u in pm? thx

 

Re: Please share experience on Levemir use_Very concerned w/

Half unit. .5u. Please.

The fact that she dropped from a whopping 587 to 119 on 1u of lev is proof enough. And really scary to me in a cat just switched to lev, with a mom who has just begun to gather data.

If she is lower than 119 at PS, I would really be tempted to shoot only .25u. Finding the right dose is a "start low, go slow" process of systematically increasing the dose in small amounts until you find the right one. In JJ's case, her best dose may well be between .25u and .6u based on some of the number you have gotten in the past few days.

I really wonder, too, where that 587 came from. Numbers like that in a cat eating low carb canned food are almost always from rebound.

 

Re: Please share experience on Levemir use_Very concerned w/

Cami has a lot of serious (and expensive) health issues going on. Probably has ever since I got her last October. Dx were/are pneumonia, acute and/or chronic abdominal inflammation (pancreatitis, nephritis, hepatitis, IBD), mega colon. For the past three months she has been on prednesilone (steroid) and for the past 5 weeks, lacutose (a sugar-based stool softener). Steroids are notorious for causing diabetes and the lacutose is supposed to have such large sugar molecules the intestines can't absorb them. Yeah, right. Together they have bumped her off the OTJ wagon big time (although I really didn't have issues until she went on lactulose). I am having a really hard time managing her numbers right now.

Over on the right of her SS are the notes about the abbreviations:

L= latulose
C= cisapride (motility med)
k= potassium
P= prednesilone
p= pepcid
SQ= subcutaneous fluids

 

Re: Please share experience on Levemir use_Very concerned w/

JJ is at 162 at +12 or pm. We will go with 0.5u unless other suggestions are given.
thanks

 

Re: Please share experience on Levemir use_Very concerned w/

Sounds like a plan.

 

Re: Please share experience on Levemir use_Very concerned w/

injected 0.5 u. Do we test again in +3hrs?

 

Re: Please share experience on Levemir use_Very concerned w/

If you are still up, that is a good idea. A regular before bed test is nice to have to see where the numbers are going. I know that Levimir has a later onset than Lantus does, with onset around +4. Nadir, or lowest point is around +8 to +10.

Every cat is different (ECID), so you will need to do some more testing to find out how YOUR cat reacts to the insulin.

 

Re: Please share experience on Levemir use_Very concerned w/

Thank you Deb,
will try to do as much testing as we can

 

Re: Please share experience on Levemir use_Very concerned w/

Yes, .5u looks good to me. And a +3 or before bed test is good too.

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
at +4 BG is at 51!!! Shoulds we do anything now? We gave her a teaspoon of higher carb Nature's choice chicken and lamb
Please let us know. Hope you're still there

 

Re: Please share experience on Levemir use_Very concerned w/

Sorry - just saw this.

Have you retested?

51 is safe. But it is early in the cycle.

Drop to .25u tomorrow (Sunday) am. Easier to work "up" than down with the dose.

 

Re: Please share experience on Levemir use_Very concerned w/

Feeding the higher carb is good for now. And retest.

If you ever need immediate help, post on Health where there are more eyes.

 

Re: Please share experience on Levemir use_Very concerned w/

will plan on 0.25 in am. thanks

 

Re: Please share experience on Levemir use_Very concerned w/

update:
+8 : 136

 

Re: Please share experience on Levemir use_Very concerned w/

I see you shot .75u on that 456. That was probably ok. The 456 is rebound from the low last night. She just isn't used to those numbers and it is possible that she was lower at +3. Bouncing to 456 is a huge response to a low number. Did you give her any syrup last night? That adds to the bounce effect.

Now, the thing is to stop the roller coaster ride for her. What you shoot tonight is really important in that respect. If she doesn't drop lower than 150 today, probably .5u will be ok. But is she drops lower than that or is lower than 150 at tonight's preshot, then going to .25u would be a good idea.

You want to stop these swings, even if it leaves her in the 200s. Once you get flatter numbers, you can slowly raise the dose (in something like 20% amounts) to bring the entire curve down together instead of creating deep valleys and high peaks.

Lev is a much gentler insulin than NPH so it's action is slower. It's onset is later, duration longer and it overlaps with the next shot. That is how it can maintain overall lower numbers. One shot is wearing off as the next begins to effect things. There is never a "zero amount of insulin" in the blood stream. So seeing those rapid fall-offs in BG in the first few hours is a really good indication that the dose is too high. So .75u is too high a dose, It worked today where you had really a high rebound BG that needed to be brought down. However, this is not the best way to dose this insulin. Making dose changes based on the preshot number works only for fast insulins like NPH and vetsulin. With lev and lantus you have to find the dose that shot consistently keeps the BG in a low, shallow curve. That is the difference in using long duration versus short duration/fast insulins.

 

Re: Please share experience on Levemir use_Very concerned w/

that is the plan. to find consitent dose.

 

Re: Please share experience on Levemir use_Very concerned w/

I shot something inbetween 0.5 and 0.75u. It is very subjective to say exact due to so small lines/space available plus plunger seal seams to be not ideally horizontal. Additionally, air buble always present and we had a hard time to get rid of it.
We did not give her any syrup last night when we saw 50. We gave her canned food with higher carb content than her low carb diet. Just one tea spoon plus fed her additionally with low carb wet food (another tea spoon). Just measured BG at +8. BG=74.

 

Re: Please share experience on Levemir use_Very concerned w/

Since you shot late tonight, make sure tomorrow am is also 2 hrs later (12 hours after tonight's shot).

Moving shot times earlier with lev (and later) is not as easy as with NPH because of the overlap. In general, shooting late = and dose decrease and shooting early = a dose increase.

Will you be trying to move her shot time back to what it was for Tuesday morning? You can do that, but would need to decrease her dose a bit to shoot earlier than 12 hrs. It's hard to say how much without data to show how she is tending to respond to lev. Just don't skip a shot if you can avoid it as that messing up the numbers for several cycles.

I will be interested to see how she handles the .25u shot later . Hopefully you won't have really high numbers again tomorrow - and no real low tonight.

 

Re: Please share experience on Levemir use_Very concerned w/

We'll try to go back to the same schedule, also, worried about reaction to low dose and morning #s
There was no need to inject at +12 tonight but later BG started to move up again.

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila.
BG was 282 at +4 and BG=274 at +8 (after 0.25u shot). What do you think?

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
we injected 0.5 u earlier at +10. Dose was not lowered. We need to get back to work week timing. BG at +10 was 341 at the time of shot.

 

Re: Please share experience on Levemir use_Very concerned w/

at +4.5: BG=98

 

Re: Please share experience on Levemir use_Very concerned w/

Vitali,

I know you are new to this insulin and don't yet have a good feel for how it works. This is why I am trying to explain the reasons for my suggestions.

It is really important to drop the dose to .25u and shoot that on a 12/12 schedule no matter what her numbers are (assuming they are above 100-120). Lev works by keeping the numbers lower. So last night, when she was at 129 there WAS a reason to shoot insulin. It was to keep the numbers lower. And remember, that was supposed to be .25u so it was already a big decrease from the previous dose. If you are hesitant about giving insulin below 180 from you experience with NPH, that is normal, but there needs to be a plan to address the situation as you learn a new way of using insulin.

While it is yet an unknown to shoot a full dose on JJ when her numbers are lower, if you are home you can go ahead and do it and monitor, feeding if needed on a number that drops below 50-60. If you won't be home, then reduce the dose a bit. You can reduce a bit if you are really uncomfortable with the number she is at - until you have data showing that it is safe. Always, if you skip the shot you lose momentum. and BGs may stay higher for a few cycles.

Why isn't that happening with JJ today? Because you double increased the dose on her. Remember that shooting early = a dose increase. You increased from .25u back to .5u and shot 2 hours early - double increase.

Please try to forget everything you learned about using NPH. Lev does not work the same. I know, I had this problem with the switch from vetsulin to lev. Vetsulin is very similar to NPH in how it works.

You, and JJ, are going to have to weather some higher numbers (like those nive, even yellow last night) to let the rebound hormones leave her system and the lower dose settle. She will stop swinging from high to low if you stay with .25u for about 3 days.

 

Re: Please share experience on Levemir use_Very concerned w/

Hi Sheila,
Just measured BG at +8. BG=79. We tried to follow your suggestion: shoot earlier = dose increase. If tentative for +12 was supposed to be 0.25u, we've dosed the shot at +10 from 0.25u to 0.5u. Did we do it wrong?

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
it is easy for us to forget NPH. we had no time to learn it.
here we're at +12 (8-00pm) and BG =143. Do we monitor more?

 

Re: Please share experience on Levemir use_Very concerned w/

You have data now that she climbs from +11 to what would be +1 - so shoot .25u at +12. Youalso know that the +11 is a climb from +8. That means it is safe to give her insulin even on a 143 or 129 because her BG is on the way up.

She is going to be all over the place until you are shooting consistently at +12. Every dose change (in amount or timing) effects her entire cycle. When you shoot late like you did again tonight it gives her BG a "head start" in climbing higher. Then you shoot too high a dose (.5u) and she will drop again - probably lower than she did two nights ago - and that will cause a climb to higher numbers by the morning, just like on the 26th.

Please do not shoot more than .25u in the morning even if she in in the 400s. I know it will be a +11 shot because of work schedules. Let that earliness work on the higher BG and let things settle out - or she will just keep swinging like this. Right now you WANT nice even (flat) numbers in the 200s to stop the swings.

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
just measured at +6 and BG=182. Just looking at the previous cycle, do you think 0.5u in the morning would be a better choice than .25u?
Thank you

 

Re: Please share experience on Levemir use_Very concerned w/

No. .25u. I hope that is what you gave her this morning. I am afraid to look.

She is on a BG roller coaster ride because of too much insulin. The only way to stop that is reduce the dose and let things settle.

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
We gave 0.5u. at +4.5hr BG=175
Compared two syringes. 0.5u from ReliOn=0.25u from BD. Scarry....

 

Re: Please share experience on Levemir use_Very concerned w/

How did you compare them? You can't just hold them up, the barrel interior diameters are probably different.

 

Re: Please share experience on Levemir use_Very concerned w/

Wejust filled each of them up to the 0.5u markand released the content on a flat metal surface, drop by drop, side by side and BD was consistently a drop or 1.5 drop more.

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
if we introduced the air in the levemir pen, is this pen wasted and we need to through it away?
nerves and getting tired...

 

Re: Please share experience on Levemir use_Very concerned w/

One more thing, do we need to warm up in hands the insulin dose prior injection? I've seen somewhere that is needs to be room temperature when injected?
Also, what is typical shelf life for the pen in use? thanks

 

Re: Please share experience on Levemir use_Very concerned w/

Don't worry about the air. Those pens have a second stopper that moves with the decreasing insulin quantity to hold a vacuum in the pen. I had a pen where that failed and the insulin was still good until I finished it up even though there was a lot of air inside.

Refrigerated you can use the pen until it is empty. I think I posted about that before.

You don't need to warm it. You are shooting such a small amount - it probably hits room temp immediately anyway. The guidelines that come with the pens are for human use with large doses using pens that last 2 weeks or less because they are used up.

As for the syringes, if that is the case, pick one brand and stick with it. BDs are NOT the best. They get lots of air bubbles. Not sure about the Relions.

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
Thank your comments on Levemit pens. What syringes that you've used draw the minimum or no air? We noticed that ReliOn draw some air as well.

 

Re: Please share experience on Levemir use_Very concerned w/

I posted that on the first page of this thread.

Vitali, please start a new thread (new topic). This is getting too long now.

 

Re: Please share experience on Levemir use_Very concerned w/

Welcome Vitali!

Since you started in the Levemir forum, I didn't see you join us. I've found you now! :smile:

In general, we want the glucose level of a cat on insulin to stay above 50 mg/dL for safety reasons. Please do not increase the dose based on the pre-shot test you get. He is going too low.

Levemir is a slow and steady insulin. It is like steering a big cruise ship - make a little turn of a few degrees, and a few days later, you're going in a different direction. Similar concept using Lev - make a small dose change, and 3 or more days later, see the full effect.

My signature link Secondary Monitoring Tools, has some other assessments you might wish to note on your spreadsheet, such as the 5 Ps (also called the "Whole Cat Report").

I see you are in Ohio, as am I.

 

Re: Please share experience on Levemir use_Very concerned w/

Hi BJM:
thank you for the tips. Should the dose be decreased if a pre-shot test is below certain BG level so we would not to put BG's into very low numbers and what is the BG level? Based on what you see on JJ's SS, are we high on the dose should level it down?

 

Re: Please share experience on Levemir use_Very concerned w/

Hi Vitali

We recommend you not give insulin if the pre-shot is < 200 mg/dL until you have enough data collected in the middle of the cycle to show it is safe to do that.

When the pre-shot is < than your no shot level (currently 200), without feeding, wait 20 minutes and re-test to see if the glucose is rising. This is called 'stalling'. If it is rising, it may be safe to shoot. You may want to post a request for feedback at that time in the main Feline Health forum with the question icon selected as the Levemir forum doesn't have as many folks checking it.

And, we usually ask new members to post an introduction in Feline Health, so everyone gets to meet you and say Hello.

There is a Tight Regulation protocol developed for using both Lantus and Levemir described in the sticky posts in the Lantus TR forum. You may find it helpful to read that over if you haven't done so yet.

 

Re: Please share experience on Levemir use_Very concerned w/

Vitali, a quarter unit only. (unless she is below about 130 at PS or, on a quarter unit, drops below 50 during the cycle).

I disagree about using 200 as a do not shoot number at this point. I think you have data showing she rises from +11. However, that suggestion is based on only shooting .25u. I think a safe do not shoot number is 130, but certainly 150.

Why are you not dropping the dose to .25u? That is the ONLY WAY to stop these swings from 400s to 30s. The only way.

 

Re: Please share experience on Levemir use_Very concerned w/

I wrote 200 as a no shoot number because there is not much data at the same dose and I am concerned because of Lev's longer action and build up. I tend to be on the cautious side.

You hold the syringe, Vitali. Up to you what you want to set as your no shot number.

I do agree about sticking to the 0.25 dose. You won't really know how Lev is going to work if you keep switching the dose.

 

Re: Please share experience on Levemir use_Very concerned w/

Thank you for your comments.
Our vet's initial recommendation was 1 u. That where we've started.
We could not hold to that dose because BG dropped to double digits too quick in day 1...
We decided to stick with 0.5 u and try to hold the dose (as per TR protocol recommendations) till BG #’s tells us otherwise. Today in the morning BG was 543. It could’ve been a fluke because it is not easy to assure the exact amount of insulin in syringe (we’ve wasted 5 syringes yesterday in trying to pull the less than 1u dose). It’s almost impossible to get rid of all air bubbles within such a tight dosing and it’s possible we’ve injected less than targeted. We very afraid that 0.25u will keep JJ in triple digits for sure all the time from what we’ve seen on the second run and question is what does more harm those swings or constant high BG’s. Since it is day 6 of levemir use, based on TRP (on FDMB) we are in phase 2 holding stage. Based on University of Queensland or Tilly’s we are in increasing dose scale. Our preshots are over 200 but nadir drops to double digits. Where do we go at such conditions? We do not see the match in either protocol. Should we stick to 0.5u dose and watch her for another 3 days? We can do additional BGs’ at +6 and can try to do more frequent tests over weekend, say every 3 hrs.

 

Re: Please share experience on Levemir use_Very concerned w/

Hi Vitali,

I don't know the answer to your question. I think Sheila may be at work so I will post over in the ISG Lantus TR and see if another experienced Levimir user is around to give some advice to you.

Sheila has been doing a fantastic job advising you so far. She knows a ton about the Lev.

 

Re: Please share experience on Levemir use_Very concerned w/

Would you please keep the dose consistent? Last night you gave 0.5, this morning and yesterday morning you gave 0.75. Unless and until the nadir goes high, keep it the same. Your dose adjustments are based on the nadir, not the pre-shot. If your nadir goes below 50, you earn a dose reduction, never mind the pre-shot levels.

After you are stable at the same dose for the 3 full days or more, then we can look at ways to address large swings. Some cats may have large swings between pre-shot and nadir. This may happen due to bouncing (reacting to a fast drop, or a lower than usual level, or too low of a level). Some cats just do that. There are some finagles that may be tried after you've kept the exact same dose for at least 3 full days/6 shots, if that is still ocurring. Many cats swings level out as you continue with the same dose.

 

Re: Please share experience on Levemir use_Very concerned w/

Will try 0.5u over weekend, starting tonight. BG=49 at +6

 

Re: Please share experience on Levemir use_Very concerned w/

Vitali, if you do not have u100 syringes, 3/10cc with half unit markings you need to get them. Drawing .5u is a piece of cake - the line is right there. Even drawing .25u is easy when you have a zero line and a half unit line - you aim for right in between. stay away from the BD syringes - they are terrible for air bubbles. You might try getting Walgreens house brand - again: 3/10cc u00 with half unit markings. I used to get those and they were fine. They will sell you a 10 pack without a script (if your state requires one). Yes, more expensive per syringe than a box of 100 at W-mart, but you need the right ones.

It sounds to me like you have syringes that have only whole unit markings - and possible are for more total units than 30 (3/10cc is a 30 unit syringe). If you have a 5/10cc for 50 units max dose those lines are really tiny - and I think they are 2unit markings? Not positive as I have never used them.

JJ's nadirs are consistently telling you that .75u is too much. I am sure that .5u is too much as well, which is why I keep suggesting you shoot .25u.

Swings are bad. They make her feel crappy. High numbers are bad. They make her feel crappy and can allow ketones to develp. They don't do real damage (barring ketones, which are very bad) until a lot of time has past.

The thing is, if you drop the dose to .25u, you stop the swings AND stop the extreme climbs to 400s and above, maybe even to the 300s and above. Flat 200s would be better than 543 to 49 to 400-500s again. It is the insulin that is causing the high numbers right now.

As for you vet's dosing recommendation, it is useless. You vet is not looking at these numbers swinging from 500s to below 50 and back. Your vet is not managing her 24/7 and there is a good chance s/he has NEVER managed a diabetic cat 24/7. Vets are not taught to think in terms of unit fractions, especially not less than a half unit. When Beau was first diagnosed, he was started at 2u, increased to 3, than 4, than 4.5 and up to 7u. I was not testing him at home. He got ONE blood sugar test a week at the vet's office. It's a wonder I didn't kill him with doses like that. The only thing that saved him was the dry food I left out all the time.

When I started testing him I dropped his dose to 2.5u. His BG was in the upper 300s to over 500 all the time, sometimes higher. But after a month his dose was below 1u, his BGs were in the 100s and 200s and he was eating only canned food. My vets thought I was a crazy cat lady. They aren't laughing now though since he is off insulin and has been for over 3 years.

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
I use ReliOn 3/10cc syringes 31 G with 0.5u marking. Still the space (in my opinion) between 0.5 and 0 lines is too tight. It's only a guess that 0.25u is measured when the plunger is half way between the marks. Plunger itself is not parallel to the bottom. Also, I looked at Beau's SS, and noticed you've started with 0.5u as well. We will try to inject slightly less than 0.5u over weekend and take some more measurements. Thank you for sharing your experience!

 

Re: Please share experience on Levemir use_Very concerned w/

Yes, Beau started levemir at .5u - and dropped to 37 on the 3rd shot. I then reduced the dose to .3u. What I found over the next few weeks was that his 300s were from too much insulin, not from too little. What I did, eventually, with his dose was NOT what I was being told here and not what the protocol said to do. It was out of pure frustration at having .5u drop him into the 30s and .4u leaving him high and flat as if it wasn't enough. I figured out that he was rebounding on BOTH dose. They were BOTH too high. So I started reducing his dose. And it worked. I have been trying to share that experience with others here since then, especially when their cat's patterns so closely mimic Beau's, like JJ's does.

If you look at Beau's SS you will see that I raised him back up to .5u - and that that was wrong because he dropped into the 30s again. If I had dropped him to 3u and stayed there (or .25u) I think his numbers would have come down even faster. I am trying to prevent you and JJ from repeating my mistakes and frustrations.

All that I posted above about vet recommendations and Beau's starting doses was in regard to his vetsulin dose after he was diagnosed and then after I found FDMB and started testing and taking control of his treatment, but it doesn't matter what insulin it is. Vet's just don't know enough about treating this disease "in the trenches". Most of what they know is probably learned from treating dogs and applying that to cats as if they were small dogs. They are not.

It's just what I have been reading here time after time from dozens of people over the past 5-1/2 years.

 

Re: Please share experience on Levemir use_Very concerned w/

Just eyeball it as best you can.

You might take 1 syringe and mark it to use as a comparison reference to help you be consistent.

 

Re: Please share experience on Levemir use_Very concerned w/

Bough new syrineges at Walgreens. Will check if they any better than ReliOns.

Just measured BG at +12 (pm), BG=49?!!
scary to think were she was at +6 or +8. I came home at +7 but JJ behaved normally, nothing unusual.
Will need to pick up another BGmeter to double check if one we use doing good measurements.

Sheila:
What Great Choice flavours are you using now while OTJ? Are you using any dry food at all?
Thank you

 

Re: Please share experience on Levemir use_Very concerned w/

I think we need to drop that dose again to 0.25U. What does Sheila suggest?

Looks to me like he is still bouncing from some very low numbers. We usually give a mandatory 0.25U dose reduction if the BG drops below 50 on a newly diagnosed diabetic cat. New is diagnosis date less than one year ago.

 

Re: Please share experience on Levemir use_Very concerned w/

Please do another BG test ASAP. I want to know if the number is rising or falling.

You did not give any insulin right?

 

Re: Please share experience on Levemir use_Very concerned w/

no, we did not. We're out of test strip. will have to go to pick more up. JJ is doing ok. Ate 1/2 can of Chicken feast.

 

Re: Please share experience on Levemir use_Very concerned w/

I'm concerned that JJ could drop even lower than that 49 you got. Do you have some high carb food, something with gravy in it to help raise the numbers a bit?

Can you get more test strips tonight?

ETA: good , very good that you did not give any insulin tonight.

 

Re: Please share experience on Levemir use_Very concerned w/

This is how Levemir and Lantus can act because they build up in the body.
Levemir builds up more slowly and takes longer to dissipate.

You will need to check about every 30 minutes to make sure he is rising and not continuing down.
If you get a two or more rising in a row, he is likely on his way up.
Once he is gets above 100 or so, you can relax.

 

Re: Please share experience on Levemir use_Very concerned w/

tested at +14, G=343. Injected 0.25u

 

Re: Please share experience on Levemir use_Very concerned w/

Wow! He popped back up really fast, in only 2 hours.

Did you feed him some food?

 

Re: Please share experience on Levemir use_Very concerned w/

Could be a bounce from getting really low.

Maybe he doesn't need insulin? Or Prozinc might work better because of the lower concentration and lack of depot?

 

Re: Please share experience on Levemir use_Very concerned w/

Do you mean me?

I use their pate flavors, mainly Turkey & Giblets and Poultry Platter. Really, any pate one is ok, but I stay away from fish flavors except Wellness Turkey & Salmon. The only dry food they get is as a treat once a day and no more than 12 kibbles. I use PetSmart Simply Nourish Kitten Cat food. But some cats are very sensitive to carbs and even 12 kibbles might be too much.

Now for JJ's numbers: I bet she was down below 49 earlier and that caused the very fast rebound bounce to the 300s. She may be high again tomorrow morning, but don't increase the dose. Lev needs consistency to work and she needs to come off the rebound hormones. Really, her numbers are classic for rebound on long acting insulins. If you haven't read about rebound, this page has good info:

http://petdiabetes.wikia.com/wiki/Somogyi_rebound

I had to read through it many times before it really made sense, but the BG patterns are high numbers punctuated by drops to very low numbers - sounds like JJ, right?

BJ is right, she may not need any insulin, or may need very little - even less than .25u. When cats are heading OTJ, they sometimes just need a little assist and only when above 140 or so. Something like .1u shot when they go above 130-150 (depends on the cat).

 

Re: Please share experience on Levemir use_Very concerned w/

Sheila,
Sorry for typo! We're trying to stay with 0.5u dose for another day. 0.25 was injected late yesterday. This morning BG was again up to 427
Will do more measurement during the day

 

Re: Please share experience on Levemir use_Very concerned w/

Hi Sheila,
We've done some testing over weekend. Results are posted in SS. What do you think?
thank you
Still having a kick measuring those microdoses and trying to move the cyringe plunger to where the dose should be at.