6/11 Fred It's Levemir Day! Specialist "visit" yesterday

Purrberry

Purrberry

Member Since 2020
"It's the day of the show, y'all". (I hope there are some "Waiting for Guffman" fans out there!)

Stated Fred on Lev this AM. His Lantus dose was 8u, recently increased, so I started him at 5.5 of Lev. (70% of his Lantus dose) Should this turn out to be way low, are there any fast track protocols to get him back up to his previous Lantus dose? @Wendy&Neko

And, yesterday was Fred's much anticipated virtual visit with an IM specialist at Animal Medical Center in NYC. Unfortunately, I was disappointed....the bottom line was, keep doing what I'm doing, and switch to Levemir. The specialist was extremely nice, and I'm sure very knowledgeable. I didn't expect a magic bullet, but I was hoping for something innovative or more insightful than what we basically already know.

Thanks to being on this board, I had a lot of data, as well as the knowledge to get good workups for high-dose conditions. So in fairness to her, a lot of what she would have suggested has already been done. She can see that Fred has "pseudo-Somogyi" as she termed it, when he gets into lower-normal numbers.

I asked about Bydureon, an incretin that has been studied in cats who have a great deal of glycemic variability. (what we call bouncing) It works to help reduce the liver's glycogen dump. I was really optimistic that this could be something to help Fred, but while she had heard of the studies, it's not something she's ever used. I also asked about Toujeo, and she said that she's only used it in two dogs, rather unsuccessfully. She suggested I could just try and "regulate" Fred in 300-400s, but I rejected that outright due to kidney concerns. She said that because animals do not live as long as humans, the effects on organs do not really appear, as it takes a long time to damage them. But still....no.

Something she DID say I could do is to use Regular insulin, with great caution, for the times Fred is "really high". (a relative term, I know) I was hoping to hear that! So I'm hoping that @Suzanne & Darcy and @Liz & Minnie might be able to help me with that, as I know you both use it on your babies. And of course, @Wendy&Neko.

Fred had labs done on Tuesday, and for the most part, all good, thank goodness. Some signs of inflammation, but his fPLI came down to just a tich over normal. All the vets felt it was a good overall report.

So..to Levemir we go. I'm nervous about it, mostly due to the different nadir timing and the slower onset. I will have trouble getting any PM nadir readings. I'll also have to gird my loins to learn to shoot lower numbers!

Sorry for the long post! Hope everyone has a great start to their weekend!
 
Good luck with the Lev! I really hope it helps Fred. :bighug::bighug::bighug:

I think you're right to be cautious about the kidneys. Things can turn around really quickly with CKD--Ruby's kidneys were fine until they weren't, and her diagnosis came a few months after she became regulated.
 
Good luck with the Lev today. I hope he's one of the (many) cat who get flatter on Lev. So far looks good. :) But hard to tell the first couple cycles as you've got the Lantus depot depleting as the Lev builds.

You know I'm not a big fan of R just to help bouncing, especially since we don't know why Fred needs so much insulin and he's not a ketone kitty. I rather we solve the bouncing problem by getting him used to normal numbers.
 
Purrberry said:
"It's the day of the show, y'all". (I hope there are some "Waiting for Guffman" fans out there!)

Stated Fred on Lev this AM. His Lantus dose was 8u, recently increased, so I started him at 5.5 of Lev. (70% of his Lantus dose) Should this turn out to be way low, are there any fast track protocols to get him back up to his previous Lantus dose? @Wendy&Neko

And, yesterday was Fred's much anticipated virtual visit with an IM specialist at Animal Medical Center in NYC. Unfortunately, I was disappointed....the bottom line was, keep doing what I'm doing, and switch to Levemir. The specialist was extremely nice, and I'm sure very knowledgeable. I didn't expect a magic bullet, but I was hoping for something innovative or more insightful than what we basically already know.

Thanks to being on this board, I had a lot of data, as well as the knowledge to get good workups for high-dose conditions. So in fairness to her, a lot of what she would have suggested has already been done. She can see that Fred has "pseudo-Somogyi" as she termed it, when he gets into lower-normal numbers.

I asked about Bydureon, an incretin that has been studied in cats who have a great deal of glycemic variability. (what we call bouncing) It works to help reduce the liver's glycogen dump. I was really optimistic that this could be something to help Fred, but while she had heard of the studies, it's not something she's ever used. I also asked about Toujeo, and she said that she's only used it in two dogs, rather unsuccessfully. She suggested I could just try and "regulate" Fred in 300-400s, but I rejected that outright due to kidney concerns. She said that because animals do not live as long as humans, the effects on organs do not really appear, as it takes a long time to damage them. But still....no.

Something she DID say I could do is to use Regular insulin, with great caution, for the times Fred is "really high". (a relative term, I know) I was hoping to hear that! So I'm hoping that @Suzanne & Darcy and @Liz & Minnie might be able to help me with that, as I know you both use it on your babies. And of course, @Wendy&Neko.

Fred had labs done on Tuesday, and for the most part, all good, thank goodness. Some signs of inflammation, but his fPLI came down to just a tich over normal. All the vets felt it was a good overall report.

So..to Levemir we go. I'm nervous about it, mostly due to the different nadir timing and the slower onset. I will have trouble getting any PM nadir readings. I'll also have to gird my loins to learn to shoot lower numbers!

Sorry for the long post! Hope everyone has a great start to their weekend!
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Yes. You should be able to fast track him back up if this dose is too low. You can look at my spreadsheet when I first switched to Lev. Under Wendy's guidance, I raised his dose back up pretty quickly after making sure that he wasn't going to have a strong reaction to Lev.
 
Oh, and so glad you had a good report on Fred. That is very encouraging. Be happy for the good stuff! Having good labs is the most important thing. You will be able to find a good dose for him, I am sure. I have used R when Darcy is high, especially because he is prone to ketones (not so much anymore, but when he was high all the time) and had DKA. The idea of the R is to have it bring their BG down by about 100 points over a period of about 4 hours (it's usually worn off or nearly worn off after 4 hours) and then the long-acting insulin will have lower numbers to "latch on to," if you will. My kitty is not very bouncy. If Fred is, then it could be extra tricky using R, but there could be times when it is appropriate.

I'm totally with you on the 300s - 400s! That's crazy!
 
Wendy&Neko said:
So far looks good
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So far, yes! Almost a little too good. I had to be out for a bit this afternoon and tested him at just before +7 when I arrived home. +7 or +8 was usually his AM cycle nadir time on Lantus...he was always a little later than most. Anyway, he's down to 170 already. So of course being the first day, I'm not sure how much further we have to go until his nadir, but we'll find out. I don't need him to make it TOO interesting on the first day! I know there's some Lantus at play there as well. He is, of course, acting like I've sucked the life source out of him, as he always does when he goes under 200. :rolleyes:

PerfumedCatMom said:
Things can turn around really quickly with CKD-
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I know...I pretty much constantly worry that will happen, especially since his left kidney is already a bit shrunken. Cats and kidneys...they are their weak spot, it seems. :(

Wendy&Neko said:
You know I'm not a big fan of R just to help bouncing, especially since we don't know why Fred needs so much insulin and he's not a ketone kitty. I rather we solve the bouncing problem by getting him used to normal numbers.
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I know. I understand. Her thoughts were that it could be used only when he gets really high, i.e. over 500, for both ketones and quality of life. He's pretty miserable when he's up that high.

Liz & Minnie said:
I use the R because Minnie is susceptible to ketones - vet started it when she was having a DKA. Now I have it on hand, but I'm pretty cautious with it.
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Fred always seems to have a small number of ketones floating around...usually from .1-.3 I think I got a "LO" once. So I do worry he does produce them, though thankfully not at a large rate at this time. Hopefully, we stay that way. I have deep respect for what insulin can do (bordering fear!) so I'm very cautious by nature.

Suzanne & Darcy said:
Oh, and so glad you had a good report on Fred. That is very encouraging. Be happy for the good stuff!
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Thank you...I am...or at least try to be..lol!

Thank you all for the encouraging words!
 
Howie was on ProZinc for about 5 months and I switched him to Levemir and I am so glad I did ad it really flattened his numbers out. I also use R occasionally if he gets higher than his normal. I havent found a dose (yet) that has brought him down the 100 points, but it does drop him 40-60 which is helpful. Keep asking questions! That’s the only way we all learn! Good luck!
 
Hmm. Hmm. Hmm. Just did a +9. He's on his way back up at 224. So, either he may have a nadir pattern similar to Lantus, or he's bouncing up from that 170. Oooooorrr....5.5 won't be enough. Too soon to tell!
 
First part of the cycle was probably the Lantus depot talking. Let's see what the next couple cycles show in terms of onset/nadir - too early so far. Neko's second Levemir cycle was solid blue - I was sold!
 
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