Switch from prozinc to levemir

[SashaV]

Hi guys!

https://felinediabetes.com/FDMB/threads/mauer.241074/
My thread in the prozinc forum.

I'm thinking about switching to levemir. I have two pens in the fridge, they've been stored there since April or May last year in the fridge door, so hopefully they're still good.

When I was a newbie Mauer was on levemir witch didn't go well. She stopped eating, was vomiting and nauseous. Ended up in the ER twice. She was on caninsulin first - witch my spreadsheet doesn't show, then levemir, back to caninsulin for a week until we started prozinc.

ECID is very relevant, Mauer usually does the opposite of what's expected. Just when I think we're on the right track she climbs back up and starts to bounce.

The reason I'm considering switching is because - to be honest... I don't have a life.
I'm afraid to sleep through the night without testing. I can't be away from home more than 5 hours, and still I'm nervous about what's going on at home. Even when her BG seems safe when I leave, it might not be when I get home. She drops lower at night even at a high PMPS so it never feels safe. I can't see into the future of course, neither can you, but I think levemir would give her a more steady curve. Hopefully without the fear of leaving, sleeping and simply living.

I absolutely hate shooting on lower numbers and my biggest fear about levemir is the depot. And also the reason I want to switch and why I haven't. Gosh it's confusing...
I like on prozinc that we almost start from scratch on every shot, but that's what causing my fears..

I want to have a life, I want to be able to sleep through once a awhile, I want to be able to leave home knowing she's keeping steady. Can I get that on levemir? Am I unrealistic?
If not, what dose would be appropriate for Mauer?
If I understand this correctly, levemir is a U100 insulin, so in my U100 syringes 1U would be 1U?
I'm almost out of prozinc so now might be the time....

Hope it wasn't too confusing! English isn't my first language as you can see

 

[Sue and Luci]

Hi Sasha, I can't promise that you will have much more of a life on any kind of insulin with a diabetic cat - however you can use food to steer the numbers -keep Mauer in a safe range when you're away.

I use an auto feeder for that - provides food - of various carb contents based on what Luci's numbers are looking like. Although I have to admit, there have been times when she was too low for me to leave the house and my plans had to change based on those numbers...but once I got a better handle on which carb foods she would respond to it was a bit easier to manage.

You might want to look around and study spreadsheets of folks who are on Lev/Lantus to see how often they're testing and what happens when the numbers get lower.

Shooting low numbers is a mantra around here - shoot low to stay low - and we've all had to test our medal to see if it was appropriate to shoot to keep the kitty in the lowest possible range safely! Check out the cats who are currently in OTJ trials and you'll see how they got there...it wasn't from being shy about shooting low numbers.

It's a process...and it takes time...but it is doable.

It's a good time to switch since your'e almost out of Prozinc. Give it a trial and see what you think. btw, a trial in my book is about three months - if you're unhappy with what's going on then you can consider other options - but of course as you said ECID...

Have you posted in another forum previously? If so, could you add that url (copy/paste) it to this condo (above)...

In this forum you'll need to add the date/cat name/AMPS to your title each day. It helps folks keep track of when the condo was posted and it'll help get more eyes on your condo.

I hope this helps to answer your question.

 

[SashaV]

@Deb & Wink and I have talked about switching for long now, every time we do Mauer does her thing and all is good

Food doesn't do much, I've been trying to not feed her in her AM cycle and that makes her BG more steady and lower PMPS. So I can shoot low to stay low, as you say.
During the night she has free access to food, still she dives down, even though it's the same food

I've been stalking spreadsheets for some time now to prepare myself

I'm thinking that levemir has a much later nadir than prozinc. That would make a huge difference!

 

[Sue and Luci]

@Deb & Wink and I have talked about switching for long now, every time we do Mauer does her thing and all is good

Food doesn't do much, I've been trying to not feed her in her AM cycle and that makes her BG more steady and lower PMPS. So I can shoot low to stay low, as you say.
During the night she has free access to food, still she dives down, even though it's the same food

I've been stalking spreadsheets for some time now to prepare myself

I'm thinking that levemir has a much later nadir than prozinc. That would make a huge difference!

Please add the link to your previous conversations with Deb. Thank you

 

[SashaV]

Please add the link to your previous conversations with Deb. Thank you

I did. In my first post.

 

[Hercule's mum]

Hi Sasha! Nice to see you!
I hope Levemir works well for Mauer. The transition to Lantus although not perfect (yet!), has been better for Hercs.

 

[Hercule's mum]

Don't want to get your hopes up too high... I think the new insulin is better for Hercs, but I still wake up in the middle of the night every now and then.... and have not been awy from home for more than 5 hours either.... Thankfully is the lockdown, so perhaps I have not missed too much

On the other hand, bounces and dives are a bit less dramatic, and that gives me hope that we are making some progress towards a more boring state of things....

I have some friends that keep telling me, that they just shoot cats without BG testing, and their cats lived for years flying in the dark....It might be because not being in low carb, they are erring on the side of high versus low. I tell myself that if life gets too complicated, I can always move to that at some point, but I'll make the best of lockdown to try and get him "more regulated".

It is tough. But you know it. You have been around the block a few times. I think it is always worth a try!

 

[SashaV]

Hi Sasha! Nice to see you!
I hope Levemir works well for Mauer. The transition to Lantus although not perfect (yet!), has been better for Hercs.

Hi Karen
I think it worked just fine the first time she was on it, I just didn't understand the depot effects at the time, or that diabetes is a marathon not a sprint so I literally did everything wrong.
I just thought she'd be regulated by now, I can live the way I do now, but ideally it would be AWESOME if I could get more sleep, less worry and spend more time with the twins. I still haven't given up on remission, but if it doesn't happen it simply doesn't...

If I get a migraine I can't take my medication when needed because I need to be ready if she drops. I'd really like to be able to see further ahead than just a few hours!
And if on rare occasions I can't get home, she'd still have a depot. We doesn't need to start completely from scratch.

I don't know if it's just me fantasizing about something that's never going to happen.
I don't mind getting up at night, I just wish it wasn't every single night.

Nice to hear it's been a good switch for Hercules

 

[Sue and Luci]

I have some friends that keep telling me, that they just shoot cats without BG testing, and their cats lived for years flying in the dark.

Thankfully we have learned here that there is a better/safer way than that...I've heard of it too and it gives me the shudders just to think about it.

I don't think many people brag about the time they gave their cat insulin and came home to find the cat had died... it's sad and just didn't need to happen...but they will never know that... I mean what's the point of beating them up - usually they just don't know any better...but then on the other hand, maybe they do and just don't care?

This is a labor of love...no doubt about it.

 

[Hercule's mum]

hankfully we have learned here that there is a better/safer way than that...

Indeed! But Sasha, and me are "single moms" and I work full time. I really despair when I try to think what is going to happen when I have to be physically at work full time again... so better not to think about it....

 

[Sue and Luci]

Indeed! But Sasha, and me are "single moms" and I work full time. I really despair when I try to think what is going to happen when I have to be physically at work full time again... so better not to think about it....

I can understand being anxious about that! Plenty of us have to leave our kitties at one time or another - and lots of people here work fulltime and have diabetic kitties on the juice. Here's a sticky that talks about that: https://www.felinediabetes.com/FDMB...ion-possible-with-a-full-time-job-yes.129378/

IMHO the very best thing you can do it adjust your schedule a bit so you have time to get at least a 1+ before you leave for the day, a 2+ is even better and an auto-feeder. The auto feeder can be set up to turn every 2-3 hours and based on how low your kitty typically goes during the day (from what you have already learned about their cycles) you can fill each slot with the appropriate foods. It will help ease your mind to know there's a fresh serving of whatever food will help prop them up until you can get home to check on them. Some people have the option aka luxury of running home at lunchtime, not always an option for everyone - but there are ways to make it work.

 

[Wendy&Neko]

Hello and welcome to LBL. I thought I'd stop in so you have another Levemir spreadsheet to look at. Neko had several conditions going on, which made her a bit more "complicated". But as long as one or the other of them wasn't flaring, it was pretty easy to keep her regulated. She nadired usually between +9 and +12, which I loved! Yes it meant shooting low, but I was always home at shot time. Late nadirs meant I could shoot, feed, load up the autofeeder, and go out at night. You remember that thing we used to do before Covid? Similarly, I had several hours in the morning I could do errands.

Neko was also much flatter on Lev, so that even if she was dancing the low greens overnight, I could usually set the alarm for every 3 hours, instead of every hour. Note that it does take a cat a while to adjust to the new hormone (insulin), so it can take up to three months to see all the changes. Thankfully Neko was really working it after a month. Her second cycle of Levemir was solid blue - I was sold in it right away!

Your Levemir pens shouldn't be in the fridge door, too may temperature fluctuations with the door opening and closing. Some people use a cup on a shelf in the back of the fridge, I had a small plastic container I rested my current cartridges in.

Since you are seeing greens on 3 units, you might want to back the dose off to 2.75 units or 2.5 units to start. Depends how much you can monitor. Usually a cat needs around the same amount of insulin, but they can have a rather strong initial reaction.

 

[SashaV]

Hello and welcome to LBL. I thought I'd stop in so you have another Levemir spreadsheet to look at. Neko had several conditions going on, which made her a bit more "complicated". But as long as one or the other of them wasn't flaring, it was pretty easy to keep her regulated. She nadired usually between +9 and +12, which I loved! Yes it meant shooting low, but I was always home at shot time. Late nadirs meant I could shoot, feed, load up the autofeeder, and go out at night. You remember that thing we used to do before Covid? Similarly, I had several hours in the morning I could do errands.

Neko was also much flatter on Lev, so that even if she was dancing the low greens overnight, I could usually set the alarm for every 3 hours, instead of every hour. Note that it does take a cat a while to adjust to the new hormone (insulin), so it can take up to three months to see all the changes. Thankfully Neko was really working it after a month. Her second cycle of Levemir was solid blue - I was sold in it right away!

Your Levemir pens shouldn't be in the fridge door, too may temperature fluctuations with the door opening and closing. Some people use a cup on a shelf in the back of the fridge, I had a small plastic container I rested my current cartridges in.

Since you are seeing greens on 3 units, you might want to back the dose off to 2.75 units or 2.5 units to start. Depends how much you can monitor. Usually a cat needs around the same amount of insulin, but they can have a rather strong initial reaction.

Exactly what I mean! Nadir +9 and +12 means I need to be home to shoot anyway, but that means I can sleep through without the fear of her dying on me.

I know they shouldn't be in the fridge door, so I've moved them some time ago. They're good until July this year.

I'm a nervous wreck so would it be wrong to start on 2U?
She has a tendency to surprise Deb and I, she does the unexpected on a regular basis..
But I plan on testing as much as I do now, and on some occasions have a day out, and possibly getting 8 hours of sleep in a row. But only when I know her new pattern and she's regulated. Until then I'd probably go crazy testing

 

[SashaV]

@Wendy&Neko what do you think about starting with 2U?

 

[Wendy&Neko]

Any history of ketones? It's a larger step back than I suggested. If you want to start at 2 units, that's OK if you are regularly testing for ketones. If you post regularly and see high numbers, we might be able to get you increasing faster than you normally would.

 

[SashaV]

Any history of ketones? It's a larger step back than I suggested. If you want to start at 2 units, that's OK if you are regularly testing for ketones. If you post regularly and see high numbers, we might be able to get you increasing faster than you normally would.

I've never tested for ketones. But I do have the strips for my meter, so I can if necessary.
She's a weird cat, so I'm expecting the unexpected all the time. She's been on 2.5U not too long ago, so I'd rather start low.
I'm gonna post regularly..... I'm gonna need a lot of hand holding

 

[SashaV]

I'm planning on starting levemir this Saturday morning. I just do the prozinc like usual Friday PMPS right? Then 2U levemir Saturday AM?

 

[Marje and Gracie]

I also used Lantus for a year and switched to Lev and loved it. So another SS for you.

I’m with Wendy that it looks to me like 2.5u is a better starting dose for her. If you are going to do TR, it might take a little time to get her back to a dose where she’s showing some BGs below 100; if you do SLGS, it would take even longer and you don’t want her to build up glucose toxicity. Of course, she might also get with the program quickly!

Regarding “shoot low to stay low”, we do not shoot below 50 and IMHO, the first time you get a green PS, I’d hold off feeding her and post to get a member to help walk you through it. You haven’t shot many BGs below 100.

Usually, we would suggest giving an insulin six months before you think about trying a different one so give Lev some time. I remember my mentor, Jill, telling me when we switched that sometimes it can take 2-3 months just to start looking better. As you said, FD is a marathon, not a sprint, so I’d give her some time.

I've been trying to not feed her in her AM cycle

Do you mean you feed her no food in the a.m. cycle or just no extra to manage the curve? If it’s no food at all, that is not the way to work any insulin and can cause large dives to occur. We recommend with Lantus and Levemir to feed several mini meals in each cycle. On Levemir, we fed at PS, +2, +3, +6, +7 in the a.m. and PS, +2, +3, +4, +4 in the p.m. but that was just her. Other Lev cats have different schedules and we each have to figure that out. But she needs food both cycles.

 

[SashaV]

I also used Lantus for a year and switched to Lev and loved it. So another SS for you.

I’m with Wendy that it looks to me like 2.5u is a better starting dose for her. If you are going to do TR, it might take a little time to get her back to a dose where she’s showing some BGs below 100; if you do SLGS, it would take even longer and you don’t want her to build up glucose toxicity. Of course, she might also get with the program quickly!

Regarding “shoot low to stay low”, we do not shoot below 50 and IMHO, the first time you get a green PS, I’d hold off feeding her and post to get a member to help walk you through it. You haven’t shot many BGs below 100.

Usually, we would suggest giving an insulin six months before you think about trying a different one so give Lev some time. I remember my mentor, Jill, telling me when we switched that sometimes it can take 2-3 months just to start looking better. As you said, FD is a marathon, not a sprint, so I’d give her some time.


Do you mean you feed her no food in the a.m. cycle or just no extra to manage the curve? If it’s no food at all, that is not the way to work any insulin and can cause large dives to occur. We recommend with Lantus and Levemir to feed several mini meals in each cycle. On Levemir, we fed at PS, +2, +3, +6, +7 in the a.m. and PS, +2, +3, +4, +4 in the p.m. but that was just her. Other Lev cats have different schedules and we each have to figure that out. But she needs food both cycles.

I know she needs food, but if I feed her she doesn't go down. I'm not kidding, she flies down the roller-coaster with food in her PM cycle, but in her AM cycle she just rises and she doesn't drop too fast as I would expect or as I'm seeing other cats do. It's really no joke that she's difficult and regularly does her own thing, doing the exact opposite of what she should be doing.
Taking that into account I'd rather start slowly with 2U, maybe 2.25U. I want the absolute best for her, so it's not because I don't want to follow your advice, but she's shown me so many times that she doesn't fit into the standard protocol.

 

[Marje and Gracie]

I know she needs food, but if I feed her she doesn't go down. I'm not kidding, she flies down the roller-coaster with food in her PM cycle, but in her AM cycle she just rises and she doesn't drop too fast as I would expect or as I'm seeing other cats do. It's really no joke that she's difficult and regularly does her own thing, doing the exact opposite of what she should be doing.
Taking that into account I'd rather start slowly with 2U, maybe 2.25U. I want the absolute best for her, so it's not because I don't want to follow your advice, but she's shown me so many times that she doesn't fit into the standard protocol.

I can only advise you that you need to be feeding her both cycles. Honestly, a kitty is not all about their BGs and even if she weren’t diabetic, she needs food during the day. The patterns you are seeing are not attributable to whether you feed or not. Where are there days where you fed her in the a.m. cycle?

Also, there’s pretty much not a pattern that we haven’t seen here so I doubt she’s actually different from other cats.

 

[SashaV]

I can only advise you that you need to be feeding her both cycles. Honestly, a kitty is not all about their BGs and even if she weren’t diabetic, she needs food during the day. The patterns you are seeing are not attributable to whether you feed or not. Where are there days where you fed her in the a.m. cycle?

Also, there’s pretty much not a pattern that we haven’t seen here so I doubt she’s actually different from other cats.

I usually do feed her during the day, around +5 usually. That's when she reaches nadir and she'd go up anyway. If I leave the house I always put some food out. She really isn't that hungry during the day.
I've just noticed the days where I don't feed her, she stays in decent numbers.

Well I hope she isn't that different! It would be nice if she was just a cut and clear case, no complications or hoops to jump through.
That's definitely what I'm hoping for.
And I did see nice numbers on levemir, I just had no clue when to test so I probably missed the "fun" part all along. I know better now, so I'm ready to run a marathon, and give levemir a real chance! Although I'm scared

 

[Deb & Wink]

Scared is normal Sasha. But you'll have some good people helping you here.

Different style of posting here. 1 new post a day, and link your old post in at the top, when you start the levemir.

Mauer still need to lose weight?

 

[Wendy&Neko]

One thing you'll have to wrap your head around with Levemir, is that you have to learn how Mauer behaves with it and food. I felt a bit like a newbie when we switched to Levemir for the first couple weeks. Don't count on the feeding schedule that did one thing for Prozinc doing the same for Levemir. With the L insulins, we find it better to feed the same as possible in the AM and PM cycles. You might have to change the timing a bit for the later onset. One thing I really like with Levemir and it's later nadir, was that I could feed later in the cycle and not impact the duration. Feeding around onset can slow any fast drops, feeding after nadir can shorten duration and give you higher preshots.

One thing I really liked with Levemir is that it broke Neko's 3 month long habit of diving at night and bouncing during the daytime. I finally got a bit more sleep. She still dove some night times, but also some day times.

 

[SashaV]

@Marje and Gracie if you have time, and it isn't too much trouble, could you do the orange switch thing on my ss?

Gosh I'm excited about tomorrow!
If I do see a reaction, when will it be?

 

[Wendy&Neko]

A reaction would likely be the first one or two cycles.

 

[Marje and Gracie]

@Marje and Gracie if you have time, and it isn't too much trouble, could you do the orange switch thing on my ss?

Gosh I'm excited about tomorrow!
If I do see a reaction, when will it be?

You mean add a line to show you are switching insulins? Yes, I’d be glad to.

 

[Hercule's mum]

Hey Sasha! Looking forward to see how Mauer gets along after the switch. Fingers crossed he slides down gently!

 

[SashaV]

You mean add a line to show you are switching insulins? Yes, I’d be glad to.

Exactly! Thank you Marje