Levemir for 5 years, still wildly unstable

[SnowKat]

Edward

NOTE: My color-coding is slightly different than the original spreadsheet; I changed the formula to colors that made more sense to me, after all these years.

It doesn't seem to matter how low or high the dose, I've never been able to get Edward even remotely stabilized. I seem to get random numbers at at any dose. And recently, he has been giving more readings in the 400s and 500s than usual. Even with bounces in the past, 400s were rare and he almost never went over 500.

I will add that lately he has been very needy and prone to incessant meowing and occasional yowling. He gets all the best food and treats and love, but it's like he's trying to tell me something that I'm just not getting.

Am I overdosing? Should I reduce and if so to what? Is he just getting older and therefore less stable (even though he was never really stable)? He is 16 years old, and I know he has some arthritis – could that be contributing to higher numbers? His recent bloodwork and dental were fine. I just can't figure this cat out. Advice is welcome.

 

[kitten68]

Edward
View attachment 74089
NOTE: My color-coding is slightly different than the original spreadsheet; I changed the formula to colors that made more sense to me, after all these years.

It doesn't seem to matter how low or high the dose, I've never been able to get Edward even remotely stabilized. I seem to get random numbers at at any dose. And recently, he has been giving more readings in the 400s and 500s than usual. Even with bounces in the past, 400s were rare and he almost never went over 500.

I will add that lately he has been very needy and prone to incessant meowing and occasional yowling. He gets all the best food and treats and love, but it's like he's trying to tell me something that I'm just not getting.

Am I overdosing? Should I reduce and if so to what? Is he just getting older and therefore less stable (even though he was never really stable)? He is 16 years old, and I know he has some arthritis – could that be contributing to higher numbers? His recent bloodwork and dental were fine. I just can't figure this cat out. Advice is welcome.

i only know so much, but is changing the insulin again an option see how it goes? Lantus was tried can I ask what happened?.. (and numbers that high I can imagine might be the reactions w the yowling, etc you're seeing.. it don't feel great generally. wut u think?..) ..

(note: just looked at SS.. and from what I can maybe see, +2-6 tests are extremely important if possible to do.. test as often as u possibly can.. tests will tell u what's going on. otherwise it's blind.. you're not gonna get a clear picture of what may be going on.. also maybe look into front loading if have yet to.. if u can maybe do, might be helpful..)

(also, if he's eating dry food, unless its like a low sugar one/low carb, controlling numbers is more of a challenge and unpredictable..)

 

[tiffmaxee]

From what I see you aren’t following TR. With a long term diabetic you only reduce if under 40 or 3 times in the 50’s if not holding reductions. In a Quick Look I can’t tell with the dose changes and the colors you use. I don’t have time now to figure this out to be of any help. Although small amounts , I see too too many changes so hard to know if not holding reductions because you need to give them time to see. Someone will be around to offer help.

 

[Wendy&Neko]

Any chance of doing a separate spreadsheet for the last couple weeks with out colour coding? After so many years looking at spreadsheets, those of us who help with dosing are hard wired to look at patterns in the data colours. I just can't see the patterns that make sense in your spreadsheet.

Where are you getting your Levemir from? You've just reminded me I should repost this over on the .com version of the board. If you weren't around, we had to use a backup board for a while, which is what this link is to:

PSA: Levemir phasing out, by region of the world​

You may be forced to switch insulins soon anyway due to lack of availability.

 

[SnowKat]

i only know so much, but is changing the insulin again an option see how it goes? Lantus was tried can I ask what happened?.. (and numbers that high I can imagine might be the reactions w the yowling, etc you're seeing.. it don't feel great generally. wut u think?..) ..

(note: just looked at SS.. and from what I can maybe see, +2-6 tests are extremely important if possible to do.. test as often as u possibly can.. tests will tell u what's going on. otherwise it's blind.. you're not gonna get a clear picture of what may be going on.. also maybe look into front loading if have yet to.. if u can maybe do, might be helpful..)

(also, if he's eating dry food, unless its like a low sugar one/low carb, controlling numbers is more of a challenge and unpredictable..)

Hello – He was super unstable with Lantus, which prompted the switch to Levemir. He did relatively better on Lev for several years, but lately his numbers have me completely stumped on whether to increase or decrease dosage.

I just got a script for ProZinc, but I have found out that it is prohibitively expensive compared to Lev. I'm going to give it a try, just to see if it makes a difference, but I don't think I will be able to keep him on Prozinc long-term simply due to cost. Also, I won't be able to start him on Prozinc for about a month, as I have trips planned over the next few weeks and I'm loathe to start a new insulin when I won't be around to monitor him.

He gets a small spoonful of low carb dry food once a day. Trying to phase that out. He really does eat 95% super low carb wet or whole meat like steak and fish.

 

[SnowKat]

Any chance of doing a separate spreadsheet for the last couple weeks with out colour coding? After so many years looking at spreadsheets, those of us who help with dosing are hard wired to look at patterns in the data colours. I just can't see the patterns that make sense in your spreadsheet.

Where are you getting your Levemir from? You've just reminded me I should repost this over on the .com version of the board. If you weren't around, we had to use a backup board for a while, which is what this link is to:

PSA: Levemir phasing out, by region of the world​

You may be forced to switch insulins soon anyway due to lack of availability.

Sorry about the unusual color coding. I'm an information / graphic designer, so I changed it as follows: colder colors = low numbers and warmer colors = higher numbers. Like a rainbow. The color coding is up at the top just like the standard spreadsheet. I need to remember how I changed it so I can change it back... might take me some time.

I've been getting the Levemir from CVS pharmacy. I know it has been or will be discontinued, but I have about a year and half worth stockpiled in my fridge.

I will note that as of yesterday, I have decided to try a reset down to 1/2u for a week just to see what happens. Is that a mistake? Maybe. I just don't know with him anymore. I'm stumped.

 

[SnowKat]

I just duplicated my 2025 spreadsheet and changed the color coding back to the original colors. Look for the tab named "2025-originalcolors"

 

[SnowKat]

Any ideas? I reset him down to 1/2u to see what happens.

 

[Lauren & Esse]

I just duplicated my 2025 spreadsheet and changed the color coding back to the original colors. Look for the tab named "2025-originalcolors"

Just FYI--blue and green are swapped on your 'original colors' tab. Blue is 100-199 and green is 50-99. I can't give dosing advice but I can imagine how frustrated you are. I hope other folks are able to see any patterns more easily once the colors are aligned with how our brains work around here.

 

[SnowKat]

Just FYI--blue and green are swapped on your 'original colors' tab. Blue is 100-199 and green is 50-99. I can't give dosing advice but I can imagine how frustrated you are. I hope other folks are able to see any patterns more easily once the colors are aligned with how our brains work around here.

DOH! Good catch – just fixed that

 

[Wendy&Neko]

The "original colours" still has under 100 as blue and 100-199 as green. Green is good, blue close but not quite right.

He gets a small spoonful of low carb dry food once a day.

That means you can't follow TR for dosing. TR requires an all low carb wet or raw food diet. This is for safety. Wet and dry foods metabolize at different rates in the cat. With TR, there are reduction points that have been studied and known to be safe and work but rely on just the wet/raw diet. The second thing with TR, is that you need at minimum 4 tests a day, the preshots and at least one other per cycle. That is the only way to know low a given dose is taking him.

Resets aren't a good idea. Please test him daily for ketones if you continue with a 0.5 unit dose.

 

[Wendy&Neko]

I wrote the above yesterday, didn't hit post. . Since you've been at 0.5 units, his numbers have been awful. I'm ignoring the first cycle which was influenced by the depot of the previous dose. I'd go back to 1.0 units immediately, test for ketones, and get some night time tests.

 

[SnowKat]

I wrote the above yesterday, didn't hit post. . Since you've been at 0.5 units, his numbers have been awful. I'm ignoring the first cycle which was influenced by the depot of the previous dose. I'd go back to 1.0 units immediately, test for ketones, and get some night time tests.

Thank you Wendy. I'll go back to 1u and eliminate the dry treat. I tested for ketones earlier this week and he was at .3. I do night tests occasionally, but not every night. I did EXTENSIVE testing day and night for the first 2 years after diagnosis, but reduced the number for my own sanity.

 

[Wendy&Neko]

It's good to put the ketones test results in the spreadsheet, maybe the Remarks section. Or we will keep asking.

Night time tests can be 2-3 hours after preshot, or what we call a before bed test. They don't always require getting up in the wee hours. Also best to do when trying to figure out what dose you should be giving.

 

[SnowKat]

It's good to put the ketones test results in the spreadsheet, maybe the Remarks section. Or we will keep asking.

Night time tests can be 2-3 hours after preshot, or what we call a before bed test. They don't always require getting up in the wee hours. Also best to do when trying to figure out what dose you should be giving.

I do have the ketones in the spreadsheet – far left column I haven't tested ketones in ages until recently, with the 400s and 500s.

I'm usually in bed about 2 hours after PM shot. Isn't that a bit early to see any significant movement?

 

[Wendy&Neko]

OK, hard to see the title of the column later in the year. Regardless, that ketones test was before you lowered the dose. It's the lower dose that made me worried about ketones.

+2 is a great time to get a test. If he's dropping quite a bit by then, that's when a later test is a good idea.

 

[Lauren & Esse]

Isn't that a bit early to see any significant movement?

I have this saved in my notes--I can't remember who wrote it specifically but it's good general wisdom to have:

General Guideline regarding pre-shot number and +2 relationship.

If +2 is a lot more than the pre-shot, it's probably going to be an inactive cycle. You probably can head off to sleep or work.
If +2 is similar to pre-shot, it's likely to be a normal, active cycle Lantus cycle. You probably want to get a +4 and a +6. Leave out some extra food if you go to work.
If +2 is much less than pre-shot, it's likely to be a very active cycle, with possibly an early drop. More testing and monitoring required. Definitely leave out some extra food, maybe even some higher carb food, so your cat has something to eat if they drop really low.

 

[SnowKat]

OK, hard to see the title of the column later in the year. Regardless, that ketones test was before you lowered the dose. It's the lower dose that made me worried about ketones.

+2 is a great time to get a test. If he's dropping quite a bit by then, that's when a later test is a good idea.

I'll start adding +2s!

 

[SnowKat]

I have this saved in my notes--I can't remember who wrote it specifically but it's good general wisdom to have:

Helpful – thank you!