7/7 Bagheera - Struggling to find the right treatment - I just need to give it time??

[Nicole Haner]

After three months of Novolin N with dosage increases, I requested that the vet switch us to Levemir - despite the cost - ouch bank account! I am hoping to get him regulated on this, because the Novolin just seemed a dead end street. We ended on 2-2.5 units of Novolin before switching and starting 1 unit of the levemir.

We are checking him regularly, during the day, with an Alpha-trak meter. We are also feeding Friskies Pate due to the low carbs.

He overall seems healthy, but he is still so obsessive with food - have to hide any in the house or else he is in it! And I really worry about neuropathy and other health issues from prolonged high BG! I know we can get him regulated and that it's going to take time but I'm frazzled and wish I could do more, quicker for him.

I have started a spread sheet - hopefully to get some help from those of you with experience!

https://docs.google.com/spreadsheet...JzJAt-tqaSRIBSRJUnw6HbIglk-VcLtyK9OX9/pubhtml

 

[Sienne and Gabby (GA)]

Welcome to Lantus and Lev Land!

Thank you for getting your spreadsheet (SS) set up so quickly. We tend to be rather numbers oriented and being able to follow along with Bagheera's progress is very helpful.

A couple of pieces of information as you start this journey.

• Lev is VERY different than Novolin (we refer to it as "N"). Lev has a later onset and a much longer duration. N is in and out of your cat's system in approximately 6 -8 hrs. Onset with Lev is at around 4 hrs and it lasts 12 with nadir at around +8.
• Lev is also a depot insulin. The depot is what gives both Lantus and Lev their duration. It also means that you usually don't see fast results, does need time for the depot to "catch up," and doses have a cumulative effect.
• You will need to hold doses rather than make rapid changes.
• Dosing is based on the nadir and not on pre-shot values.

There is a tremendous if not overwhelming amount of information in the sticky notes at the top of the board. Reading the New to the Board and deciding on a dosing strategy (Tight Regulation vs Start Low Go Slow) are good places to begin.

Please let us know if you have questions. The members here are very generous with their time and knowledge. We're here to help.

 

[Wendy&Neko]

Hello and welcome, good for you on testing and getting the spreadsheet set up. Are you giving insulin once or twice a day? The spreadsheet just shows onenin the AM. We find dosing Lev is best given twice a day. Also, we take the dose of the previous insulin in mind when starting Lantus or Levemir, so would have suggested a higher starting dose, especially with the DKA history. Are you testing daily for ketones?

As for cost, some people buy their Lev from a Canadian on line pharmacy called Mark Marine.

And yes, regulation will take time. We say this is a marathon, not a sprint. Seeing some blues or nadirs below 200 on two units of N is a good sign.

 

[Nicole Haner]

Thank you!

We are doing twice a day - same as the feeding-, I didn't think to fill it in, since we weren't testing at night. I updated it.

The vet I am seeing has never used levemir, and didn't want to go too fast since it was a long acting. He was concerned it would potentially make him too low. I think we will keep it at 1 unit for at least the 3 days, and go up from there. I am seeing, albeit high, a lot more stability in his number. Slow drop, and not the rapid increase like we were before.

The PM pre shot number will be a while after he eats - per the instruction from the vet with the N. We are trying to keep the same schedule. Not sure if this is right? He typically eats around 730am and gets the shot within 15-30 minutes. He eats again around 530-6p and then gets his insulin about 745-8p. The insulin is pretty strictly 12 hours apart.

My mom checks his BG when I'm at work, and also administers the insulin Sunday-Friday AM, and I do the PMs every day, and the AM on Saturday.

I am not testing daily for ketones. Are you using dip sticks? Will it work with a BG meter that measure ketones?

 

[Wendy&Neko]

Due to the way Lev works, onset isn't typically until four hours after the shot. Plus or minus for different cats of course. Because of that, you can shoot right after you test, as long as you know your kitty will eventually eat and get a good amount of food in within 3-4 hours. As long as you get the shot in by 15 minutes or so of the test, you are fine. n has a much quicker onset, so it's more imortant to get food in quickly.

Thanks for updating the spreadsheet. Can I ask a favour of you? Could you put a blank line in after the last Novolin shot and before the first Lev shot. And you could of something like start Levemir on that line. That makes it easy at a glance to see when you changed.

Another question, is there a reason you aren't testing at night? Many cats go lower at night. We determine dosing based on how low the dose takes the cat, so getting a night time test in is very helpful. Even just a quick test before bed is a great start.

For ketone tests, you have one of two options. One is to buy Ketostix or equivalent and dip it in the urine flow. Or catch the pee somehow with a spoon, or piece of foil or put plastic on the litter. Or use aquarium gravel or other no absorbing material such as lentils The second option is to buy a special purpose blood ketone meter. The strips are pricier, but for some people, they just can't catch the pee.

 

[Nicole Haner]

Due to the way Lev works, onset isn't typically until four hours after the shot. Plus or minus for different cats of course. Because of that, you can shoot right after you test, as long as you know your kitty will eventually eat and get a good amount of food in within 3-4 hours. As long as you get the shot in by 15 minutes or so of the test, you are fine. n has a much quicker onset, so it's more imortant to get food in quickly.

Thanks for updating the spreadsheet. Can I ask a favour of you? Could you put a blank line in after the last Novolin shot and before the first Lev shot. And you could of something like start Levemir on that line. That makes it easy at a glance to see when you changed.

Another question, is there a reason you aren't testing at night? Many cats go lower at night. We determine dosing based on how low the dose takes the cat, so getting a night time test in is very helpful. Even just a quick test before bed is a great start.

For ketone tests, you have one of two options. One is to buy Ketostix or equivalent and dip it in the urine flow. Or catch the pee somehow with a spoon, or piece of foil or put plastic on the litter. Or use aquarium gravel or other no absorbing material such as lentils The second option is to buy a special purpose blood ketone meter. The strips are pricier, but for some people, they just can't catch the pee.

This sounds lame, I know, but I go to bed not long after he gets his insulin. I get up early for work, and so am in bed early. I would change his food/dosing schedule to be able to test more after his PM dose, but when away from the house, my mom has to manage it. It's easier for her to do it later in the morning/evening than super early. We compromised on that. I may have to get up a tad earlier and try to get one in the morning - I'm just afraid that he'll have already peaked and gone up by then because it will be about +9 at that point.

Is there a reason it is typically lower in the evening?

Yeah, it's hard with 5 cats to follow him to the litterbox for urine. I have a meter that measures ketones, but am unfamiliar with ranges typical for a cat vs DKA (I'm on a ketogenic diet, and I know low carb will product to an extent, ketones as well). I will likely try that route although he is annoyed and infuriated with the amount of ear sticking that's been going on - nearly every hour today...

 

[Wendy&Neko]

Here is a post on DKA, ketones and blood test meters, than includes reference ranges.

A +9 is better than no test. We have had members before, who for various reasons, cannot get tests at night. You just do what you can. Not sure on why they go lower at night, unless it has to do with them being nocturnal creatures by nature. Just make sure your cat has access to plenty of food at night to keep him safe.