? 08/24 Eddie AMPS 266 +2.5 302 +5 256 PMPS 410 +5 283

I finally heard back from the IM vet about changing to Levemir. He said,

"Insulin no prescription required for cats? Are you talking renewal, start or both?
That is news to me and seems not right as Insulin is a deadly drug if abused by humans.
I have no problems trying Detemir, I want medication as smooth as possible with the least amount of discomfort for the animal.
In people some experience discomfort as well when I looked in to the side effects.
Decrease insulin dose as you start the new insulin. For example by 50%."
 
@Wendy&Neko I have a question. The protocol in FDMB/TR is to change insulin using 70% dose of original whereas the IM vet (see above #4) suggests 50%. Is there any reason you can think of for the difference? I mean he does say "For example by 50%...
 
With my vet it was more the fact he had never used Levemir/detemir before and wanted.l to be careful. He also said 50% so it's possible it's out there in literature (there's a study nagging in my brain where it said patients on Levemir tended to require a smaller dose by some %, so perhaps that's it - but I couldn't say if that was humans or cats, and I'd have to dig to find it)
 
Apparently Levemir is much stronger in dogs. News flash, Eddie is a cat not a dog. :rolleyes: Your IM vet is not the first one to get caught up in this. Our findings here is that the doses don't end up being a lot different for most cats. But enough have a strong initial reaction it pays to have that initial reduction to 70%. In other words only switch when you can monitor closely for a couple cycles.
 
I’d also add that if you’re going to switch to a human meter, as you mentioned you’d like to do, you might want to do that ASAP, before you move to Levemir, so you don’t have multiple variables at play.

Or … stick with the AT until well after you’ve worked through the Lev transition.

I’m curious what Eddie has in mind for tonight.
 
JL and Chip said:
I’d also add that if you’re going to switch to a human meter, as you mentioned you’d like to do, you might want to do that ASAP, before you move to Levemir, so you don’t have multiple variables at play.

Or … stick with the AT until well after you’ve worked through the Lev transition.

I’m curious what Eddie has in mind for tonight.
Click to expand...
I'm sticking with the AT for the time being. Too many variables.
I thought Eddie would be trending down tonight. Silly me.
 
Wendy&Neko said:
Apparently Levemir is much stronger in dogs. News flash, Eddie is a cat not a dog. :rolleyes: Your IM vet is not the first one to get caught up in this. Our findings here is that the doses don't end up being a lot different for most cats. But enough have a strong initial reaction it pays to have that initial reduction to 70%. In other words only switch when you can monitor closely for a couple cycles.
Click to expand...

I can switch tomorrow morning. I have to be out only for one hour @ +4 to +5.
My question now is he seems to be in a prolonged bounce (or he just needs an increase). Is it ok/reasonable to make the switch tomorrow morning given these current high numbers? I ask because I am not sure what to expect from a 70% dose. Then, as I'm monitoring, how do I manage the increase which is sure to follow (i.e. from 15.5 to 10.85 [that's cutting it fine])? ie, in what increments will I in all likelihood be increasing. I will, of course, be posting here but my first question...is it ok to switch with his BG so high?
 
Ah,.found it on AAHA -
However, cats receiving detemir require a lower median maximal dose than cats receiving glargine (1.75 U per cat for detemir versus 2.5 U per cat of glargine).

https://www.aaha.org/aaha-guidelines/diabetes-management/treatment/insulin-therapies/

And the study it cites for that particular excerpt -
Roomp K, Rand J. Evaluation of detemir in diabetic cats managed with a protocol for intensive blood glucose control. J Feline Med Surg 2012; 14(8):566–72.

Interesting that it's Roomp and Rand, and based on data from the Katzen forum. I don't have access to full article but I'd hazard a guess there's more at play re:dose % in terms of data analysis.

Anyway all that to say I suspect that's where your IM vet got that number, but of the few transitions I've seen 70% hasn't done any harm yet!

Edit: I need sleep. 1.75U is 70% of 2.5U so that study confirms. Now I'm not sure where your vet got it, but I know I remember reading something about 50%
 
Gah sorry for spam here it is:

https://www.dovepress.com/managing-...ves-peer-reviewed-fulltext-article-VMRR#ref65

Cats can exhibit an initial increased sensitivity to detemir for 24–48 hours; thus, if changing from glargine or other insulin, start with about half the dose of glargine and increase dose within 48 hours if insufficient glucose lowering occurs.

And that specific excerpt cities -

Roomp K, Rand JS. Management of diabetic cats with long-acting insulin. Vet Clin North Am Small Anim Pract. 2013;43(2):251–266.

Bloom CA, Rand J. Feline diabetes mellitus: clinical use of long-acting glargine and detemir. J Feline Med Surg. 2014;16(3):205–215.

(I'm mostly just doing this in case someone happens to search the forum later on)
 
FrostD said:
Ah,.found it on AAHA -
However, cats receiving detemir require a lower median maximal dose than cats receiving glargine (1.75 U per cat for detemir versus 2.5 U per cat of glargine).

https://www.aaha.org/aaha-guidelines/diabetes-management/treatment/insulin-therapies/

And the study it cites for that particular excerpt -
Roomp K, Rand J. Evaluation of detemir in diabetic cats managed with a protocol for intensive blood glucose control. J Feline Med Surg 2012; 14(8):566–72.

Interesting that it's Roomp and Rand, and based on data from the Katzen forum. I don't have access to full article but I'd hazard a guess there's more at play re:dose % in terms of data analysis.

Anyway all that to say I suspect that's where your IM vet got that number, but of the few transitions I've seen 70% hasn't done any harm yet!

Edit: I need sleep. 1.75U is 70% of 2.5U so that study confirms. Now I'm not sure where your vet got it, but I know I remember reading something about 50%
Click to expand...
The vet probably didn't get it from Roomp and Rand because he, the vet, wasn't really hip to TR so I'm not sure where he got it...
Hope you get some good sleep...:D
 
FrostD said:
Gah sorry for spam here it is:

https://www.dovepress.com/managing-...ves-peer-reviewed-fulltext-article-VMRR#ref65

Cats can exhibit an initial increased sensitivity to detemir for 24–48 hours; thus, if changing from glargine or other insulin, start with about half the dose of glargine and increase dose within 48 hours if insufficient glucose lowering occurs.

And that specific excerpt cities -

Roomp K, Rand JS. Management of diabetic cats with long-acting insulin. Vet Clin North Am Small Anim Pract. 2013;43(2):251–266.

Bloom CA, Rand J. Feline diabetes mellitus: clinical use of long-acting glargine and detemir. J Feline Med Surg. 2014;16(3):205–215.

(I'm mostly just doing this in case someone happens to search the forum later on)
Click to expand...

Hmmm. When they say "increase dose within 48 hours if insufficient glucose lowering occurs", the question is increase by how much? 1u? like how often? cycles? Eeek. Now it's Roomp and Rand who say half the dose?? I'm getting a bit confused.
 
Jodey&Eddie&Blue said:
Hmmm. When they say "increase dose within 48 hours if insufficient glucose lowering occurs", the question is increase by how much? 1u? like how often? cycles? Eeek. Now it's Roomp and Rand who say half the dose?? I'm getting a bit confused.
Click to expand...
Wish I had access to the studies to answer that for you! Lol

I didn't mean to add confusion, just trying to explain why the difference between FDMB and your IM vet since that was original question.

His numbers are high enough and you have cushion, I would go the 70%. If he were more tightly regulated then I'd think a little harder about it, but moot point.

The rules are still same as TR by the way, in terms of dose increases and timing. If it were me I'd round up to 11U and start there, I do believe you still have to give it a week for Levemir depot to form and Lantus depot to dissipate, but Wendy can confirm/correct. At that dose it's roughly 0.5-1U increases, I'd let the numbers guide you there (i.e. if he's higher/flatter I'd lean more towards a larger increase), but see what Wendy says.

Based on trends/numbers, he cleared a bounce last night and looks like possibly headed into another one today (nice, Eddie :rolleyes:).

So I guess you could wait to start until the cycle after the bounce clears if you're worried about timing...but his nadirs are high enough, even with the switch factored in, that I personally would just do it tomorrow (but again we know I'm a little more cavalier with these decisions!).
 
FrostD said:
I do believe you still have to give it a week for Levemir depot to form and Lantus depot to dissipate, but Wendy can confirm/correct.
Click to expand...
With TR, there is the ability to fast track if numbers are high and flat, or kitty is prone to ketones. Which reminds me, best to be on top of testing for ketones with a dose reduction for new insulin. Since you'd be starting at 11 units, dose increases are by 1 unit at a time. And yes, with help here and depending on his reaction, you may need to start increasing after 48 hours.
 
Wendy&Neko said:
With TR, there is the ability to fast track if numbers are high and flat, or kitty is prone to ketones. Which reminds me, best to be on top of testing for ketones with a dose reduction for new insulin. Since you'd be starting at 11 units, dose increases are by 1 unit at a time. And yes, with help here and depending on his reaction, you may need to start increasing after 48 hours.
Click to expand...
Just home in time for a +5 283. Y'all won't believe this but I had to take my dog, Max, to emergency hospital tonight with vomiting. Go figure. Seriously, though, we've just about had enough here with the emergency vet. Stop already.

But thanks @FrostD and @Wendy&Neko : really helpful. Will be starting Levemir in the morning...
 
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