10/19 Howie’s switch to Levemir-feedback requested

I am just finishing up Howie’s 3rd day of a switch to Levemir from Prozinc and would love some feedback on his results. I made a conservative choice to start him at 6 units instead of the 6.5 units he had been on with Prozinc to see how he would do (advice I got from FDMB members). My plan is to move him to 6.5 units tomorrow for the next 6 cycles unless people recommend differently. Luckily I’m working from home this week so can get tests in. Also, I’m getting stressed trying to really figure out dosing under TR, especially when he goes between 150-200 and even when he starts dropping into the low 100s at night and I’m going to bed. Any helpful hints/tips are appreciated. I’m trying to read through various posts on here and people’s sugar kittie numbers and their dosing seems all over the place. Thanks!

 

You do have to wait for the Levemir depot to build before seeing what this dose can really do. However, given that you started a little low, I think you'll be OK going to 6.5 units tomorrow, provided you don't see anything blue before then.

With TR, dosing is based on nadirs, or how low he is going. Getting a good idea of his onset and nadir will really help you be strategic about when to test. I would start mixing up the test times a bit. I've seen Levemir nadirs from +3 to +5, so getting tests at slightly different times will help you decide how much testing you need to do at night. Figuring out his nadir will tell you important times to either test or feed at night (presuming you have an autofeeder). Generally, if you see a good sized drop at onset, you'll need to either set an an alarm to get up later, or make sure he'll have food available then. Also note that right now he's pretty flat, onset and nadir will be easier to figure out when he gets more of a curve going.

Here's the link to your last post here, which we ask you to include so it's easy to go back and see the history: https://felinediabetes.com/FDMB/threads/switching-to-levemir-tomorrow.236972/

 

Typically are nadir sat about the same time in each cycle? I do give him food in an auto feeder 3 times each cycle +2, +3.5, +5). On Prozinc they recommended to feed on the early part of the cycle. On Levemir would I feed him later in the cycle (depending on his nadir)? Also, will the dose increase get more of a curve going? Thanks!

 

ECID. And even for more regular cats, it can change a bit depending on whether a bounce is breaking, they are thinking about a reduction, etc. Neko's "typical" nadir was from +9 to +12 on Levemir, though I did see it as early as +5 and late as +13. She onset later at +5. Typically Lev cats onset at +4, nadir around +8. Some Lev cycles can be a lot flatter, when in lower numbers too, making "spot the nadir" an interesting game.

As for food, yes, you can feed up to nadir, whatever that ends up being.

Getting to better numbers will give you more of a curve, not sure whether it's this dose increase, or the next,.... Antibodies don't play by the rules either.

 

For Levemir, how early or late beyond normal test-feed-shoot time can I stray? On Prozinc I could waiver by an hour either way if I absolutely had to. I couldn’t find info about Levemir. And if i give it early or late in one cycle, can I go back to the normal time in the following cycle or does it have to be exactly 12 hrs apart?

 

With the L insulins, we say you can vary 15 minutes per cycle, or 1/2 hour once per day. Getting back on a 12/12 shot schedule

I had a monthly meeting that was 15 minutes away and and started at 11.5. I'd move Neko's shot up for a couple days before hand, then shoot later afterwards. I also had some races and trips with Neko that required schedule changes of several hours. If you know about something, you can plan for it. Over time you will also find out how sensitive Howie is to time changes. I could do an hour late and not be too bad.

 

I’m trying to determine if I need to switch Howie’s auto feeder times now that we have more data. It appears his nadir is around +8. Is there benefit to not feeding him until onset and then feeding up to nadir? Right now, he gets mini meals at +2, +3.5 and +5 based on his Prozinc data. I was thinking of going to +3, +5 and +7 which I think is fine during the day. I’m not sure what he will do with those time changes overnight.

also, today is the last day of 6 cycles at 6.5 units. Am I correct in reading he should go up to 6.75 and not straight to 7 units? I don’t know how all this works with IAA kitties! Thanks!

 

Over 5 units total dose, unless you are seeing greens, increases are by 0.5 units. So tomorrow it's up to 7 units. With IAA kitties you have to be a bit on the aggressive side and you test enough to show this is a safe move.

I think you can still feed a bit of food at preshot, if he's used to eating then. I also suggest feeding a bit before onset, so he has fresh carbs on board and processed. I'm not sure you have enough data yet to say when onset is for Howie. There probably isn't a rush yet to change his feeding schedule.

Of course it was +7 today.

 

Tomorrow morning you could go up to 7U. At 1U, a .25 increase is a 25% increase in dose. Even going up from 6.5 to 7 is only about 8%

 

He gets the larger part of his food intake at shot times and then I spread his calories out throughout the day with his auto feeder. There is no grazing with him...he literally runs to his food spot when I get it ready (it makes my day each day!) I moved his times today but it through off his napping times I’ll go back to normal times.

It’s been a blessing to work from home since Tuesday so I could get all these tests. But I go back to the office next week so am gone his +1 through +9. So not sure how I’ll really capture his nadir data.

 

That's what weekends are for.

 

It’s been a week that Howie has made the switch to Levemir. Can someone give me some feedback on his SS results so far? Is this to be expected? How do you know if the depot is filled up? Also, tomorrow is when I should increase him to 7.5units. However, I have to work at the office tomorrow but then will work from home Tues-Wed. I know on TR I’m supposed to adjust after 6 cycles. Am I ok making the switch after 8 cycles so I can be home to test him more often or are just a couple of midcycle tests toward the end of his first cycle OK on day 1 of the switch?

 

It's fine with TR if you want to wait a day to do that increase. You don't want to hold a lot longer, especially if his numbers are overall high, and in your case because of the antibodies. One thing sticks out at me with the spreadsheet, and that's the night time testing. Is it possible to get either a later than +2 test or earlier in the morning occasionally? Since Howie was down at +2 last night, and looks like he's bouncing today, I rather suspect he might have seen some blues last night. If a Lev cat is going down at +2, that's before onset and in some Lev cats is an indicator of a cycle with a little more action. On the up side, if he did see blues, TR says to hold the dose a little longer so those 8 cycles is fine.

That's also an option with Levemir cats. Many Lev cat nadir later in the cycle and Howie seems to be in the +8 to +9 range, so getting a test around then or a bit later also works.

And I just saw the ketones level of 2.8 on your spreadsheet. That's concerning. Anything above 2.4-2.6 warrants a call to the vet. How is Howie acting? Eating OK? Drinking? You do want him hydrated.

Lastly, a little housekeeping. Due to the number of cats on this forum, we ask that you start a new thread each day you have something new to say. So next time, go ahead and start a new one and link to this one. Making the Most of your Lantus, Basalgar, Levemir ISG Experience

 

He has a history of ketones (I posted a separate question in the main forum about it this morning). He is totally fine...eating, playing, energy, etc. I had previously tested him with the urine sticks and don’t find anything about what is considered “trace or small” amounts (or when #s are alarming) when using a blood meter. Someone sent me some info that ketones for cats show up On meters at 2.4-2.5.

As for the link...thank you for the info. I just keep seeing people keep using their same post for several days with different topics embedded in them.. I thought I was asking questions about his changeover to Levemir so it was appropriate to use this same thread.

 

I test him at +2 In the PM as that is right before I go to sleep. When he was on Prozinc and had blues in the night, I tried to stay up. It just wreaked havoc on my body. There is no one else but me to do any testing. The sad story of the single life with a full time job and an FD kittie who has been challenging.

 

We'll have to see where Howie's nadirs end up. I was fortunate that Neko's nadirs on Lev were often very close to preshot, so a +9 or +10 was a valuable test for me.