12/3 Klinger on ProZinc Looking for input on Levemir

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Marcy & Klinger (GA)

Marcy & Klinger (GA)

Member Since 2010
Hello,

Where to start...there is a lot that's happened...

Klinger was dx in Feb 2010 with a number of 570, he was eating FF grilled varieties and the vet switched him to FF kitten canned turkey. He was put on Lantus 3 u BID. Vet had us test him on the weekends only. I think she was trying not to overwhelm us. When the vial was done, he had gotten up to 6u BID without improvement (only based on weekend testing ohmygod_smile ). We switched to ProZinc, which he has been on since 5/22. Again with only testing on the weekends he got up to 7.5 u's BID. That is when I found this wonderful website and started testing him before each shot and here and there throughout the day. It was also recommended that starting him out at 3 u's and increasing by a full 1 u - I could have missed his dose. So, we started over at 1 u BID. We switched his food to FF Classic varieties. Klinger would through me a blue here and there or a low pre shot number. Vet would tell me that it could be his teeth are in bad shape, but she was reluctant to do the dental fearing that he wouldn't come out of the anethesia. I finally had enough of fighting a losing battle of trying to regulate him while his teeth were so bad and got her to schedule the dental. On 10/23 Klinger had eight teeth extracted and since then he has been solidly in the blacks, reds, and pinks. Of course today he gave me a yellow AMPS.
On 11/15 introduced Nature's Variety Frozen Raw into his diet and some days still give FF Classic Chicken. Currently at 3.8 u's BID. I give him pepcid for chronic p'titis.

Anyway, it's been suggested that Levemir might be a better fit for Klinger, since he bounces a lot and usually zooms up after +10. Right now I shoot a 12/12 schedule - I test between 3:50 a.m. and 4:00 a.m., feed, and shoot at 4:30 a.m., DH does the same for the pm shot. The problem is, we both work and won't be able to get a lot of tests in during the day. I am home on Friday - Sunday and can get as many tests in as I can on those days....
I should also mention that Klinger MIGHT (he has not been tested) be a high dose kitty and Lev apparently doesn't sting as much in higher doses and it would cost less.
I guess I'm wondering if Lev would work for my schedule with not being able to test other than pre shots and up until +4 at night Mon-Thur; and then as often as I can Fri-Sun?

Any thoughts would be greatly appreciated.
Marcy & Klinger
 
Marcy, Hi, my name is Pam and I am listed as "Pam & Alley" you might want to look at my spreadsheet as I, too, am having huge numbers, not quite 500 yet, but close. My Alley is currently on N and he is switching to Lev tomorrow for the first time.
My vet called Purdue to get the scoop on Lev and it is more potent, lasts longer and no big drop. If I were you I would do the switch on Friday when you have a couple of days off to monitor. Also start with a lower dose. Not sure what you would be comfortable with, but you can always add after a few days. Give it time to work and adjust, that is the key to all of them.
Hopefully, this will work for both of us to get our kitties in check.
Keep an eye on my ss, I will keep it up to date.
Good luck to us both,
Pam
 
Hi Marcy. Wow, you have had a lot going on with him over the past year.

I do not know ProZinc, but I think it is a good insulin for many cats - just not all of them and it doesn't have the duration of lev or lantus. Yes, lev is supposed to sting less in larger doses (than lantus), but I think that lev is a good gentle insulin and may give you (well, Klinger) a more gentle curve.

I would hazard to guess that he is rebounding on the higher doses. I say that because he does get some decent numbers now and then, but zooms way high again. Swinging from very high to very low and back, especially when the cat is eating a very low carb diet is classic rebound.

I do note from his SS that you feed high carb when he goes below 100, or at least below 80 or so. You might try feeding regular food at those numbers. Really, it isn't a "high carb" emergency at those numbers especially after about +5 ot 6 (you would worry more if it was early in the cycle). Cats are usually very safe down to 40-45, and even below. Many of us have had our cats in the 30s and just fed regular food to bring them up in a nice gentle way.

If he truly is a high dose cat do you mean because he has acromegaly or cushings? I don't really see that in the numbers, but I could PM someone with high dose experience and ask her to look over his numbers if you think that would help? You could also post on the high dose ISG, but I don't know haw active it is these days.

So, bottom line: I can highly recommend levemir.
 
Pam & Alley said:
Marcy, Hi, my name is Pam and I am listed as "Pam & Alley" you might want to look at my spreadsheet as I, too, am having huge numbers, not quite 500 yet, but close. My Alley is currently on N and he is switching to Lev tomorrow for the first time.
My vet called Purdue to get the scoop on Lev and it is more potent, lasts longer and no big drop. If I were you I would do the switch on Friday when you have a couple of days off to monitor. Also start with a lower dose. Not sure what you would be comfortable with, but you can always add after a few days. Give it time to work and adjust, that is the key to all of them.
Hopefully, this will work for both of us to get our kitties in check.
Keep an eye on my ss, I will keep it up to date.
Good luck to us both,
Pam
Click to expand...

Thank you Pam for welcoming Marcy! Real quick - I think it's interesting your vet spoke to someone at Purdue about Levemir. There have not been very many published studies in the US on Levemir's use in cats (only 1 that I know of, from 2008 and the University of IL vet teaching hospital), but it seems word is getting around.

What I'm curious about is the term you used, saying Levemir is more "potent." Is that a direct quote from your vet or just how you understood how it works when he explained what he'd been told by Purdue?

I ask because I call Levemir the Gentle Giant. It has to be potent in order to maintain level blood glucose over a wide period of time like it does, but it also is very safe to use for feline diabetics, whereas you run a greater risk of symptomatic hypos on those faster acting insulins like N or Vetsulin. So I want to make sure Marcy understands the context of "potent."

Does it mean the cat needs less Levemir than it did it's previous insulin? No, in fact Gandalf's optimum Levemir dose is about the same as his best dose on PZI but we caution that the beginning dose of Levemir should be lower than previous insulin because that way you have room to increase the dose and Levemir just seems to work better for some cats so they use less of it and it's best to be safe when you're not sure how well it could work for your cat.

Can a cat hypo on Levemir? Absolutely, but it probably would have to be an actual overdose or the cat has a sputtering pancreas like Sheila's Beau had as she witnessed him having momentary confusion when he went low. If Gandalf had swinging numbers like Alley has on his spreadsheet, I would hold my breath every day that he would go hypo by +4, on even that little bit of N. Swings like that can happen on Levemir, but they are rare and usually caused by extenuating circumstances such as incorrect dose or switching doses too often, not because Levemir is more potent. In terms of bringing down blood glucose levels, it is actually less potent than faster acting insulins.

Hope that helps clarify the term "potent" in regards to Lev.

So Marcy, hi, sorry for the rambling there. Regarding scheduling, I think Levemir is a fantastic insulin for those with wonky schedules. And one of the reasons is because of what I wrote above - I truly believe it is safer to use in cats because there is a lessened risk of hypo on the optimum dose. So finding that dose is the most important part. With a schedule that will allow you 3 days to get started, I think that's doable. By day 3 you should know whether his peaks are within range (say 80 to 150) and safe on the beginning dose. You could hold the dose till the next period you have time to do more testing or try to check that evening +4 the first week.

I am frequently gone 10+ hours a day. I am confident when I leave that Levemir will do its job and not put Gandalf in danger, as long as I don't screw up and give him the wrong dose.

Sorry that Klinger had to have so many teeth removed. Has your vet told you about an antibiotic called Clindamycin? It comes in either liquid or small tablet form and can be given for short periods like 5 days once monthly to help keep down oral bacteria. I use it for 2 of my cats, Gandalf being one, and I think it helps a lot. I go to an AAHA accredited hospital which specializes in pet dentals and Clindamycin pulse therapy is standard protocol for cats with poor oral hygiene there. Thankfully it's very cheap.

Hope this info was helpful. Do you plan on getting the acro-cat test before you decide to switch insulins?
 
I also do not know Prozinc but have used Lantus and Lev. I do prefer Lev, and Shadoe reacts better to Lev than Lantus. Shadoe has more 'urine issues' when on Lantus, but I don't know why.

On potency, I do know that often the dose for Lev is less when switching from Lantus, some have mentioned 70%, just to be sure you are not switching at too high of a dose. I don't know about the switch from ProZinc to Lev though.
Remember: you can always give more insulin, but you can't take back too much.

Hypo can happen with high dose, and acros have functioning pancreas, so more care is taken to keep numbers above the 100mark. A healing pancreas is fairly predictable; an acro's insulin needs is not predictable, ever.

Even though you have not tested Klinger for acro/IAA, you can still take the same precautions -feeding an acro with a low number does NOT bring the number up.

Lantus & Levemir: What’s the Difference?


I am so glad you pushed to get the teeth problems out of the picture; I am sure that some of Klinger's numbers were due to the bad teeth, so let's hope we see some better numbers with the switch to Lev. Give the shed some days to build up, and then you will be able to see how Klinger likes the Lev. Watch for signs other than the BG because I noticed changes with both of mine but moreso with Shadoe.
 
Vicky and all: You are absolutely right, the "potent" term came from my vet and I did question her about it, mainly because after 3-1/2 years on N, to hear her say more "potent" scared me. I should have explained that term, sorry. No problem though, my vet said she meant it was more potent as it lasts longer, up to 12 hours, which my N was good for maybe 4-5 and then his numbers would start to shoot up. So, potent in her terms is longer lasting and very gentle. I started today at .7 as recommended by my vet. Will give it a few days to see how it works for him, but I am sure he will need more gradually, he was on 2.5 of N 4 weeks ago!
Thank you, Vicky, for your input on Lev.

Pam
 
Thank you all so much for answering my questions and more.
Good luck Pam & Alley. I'll be watching your ss. :smile:

I've been working with a high dose mom and she has been amazing. I don't know if we would have survived these last months without her support and dosing suggestions and just keeping me grounded. It's her suggestion that I look into Lev and that it might be a better fit for Klinger. She's not convinced that he's high dose either, but because he did get up to 7.5 units...if we end up reaching or exceeding 10 units Lev would be the better option. I don't plan on getting the acro-cat test before I switch. I was going to get it done when he went in for his dental and at the last minute there was a miscommunication and they used the sample for his pancreatitis test instead. It still a sore spot with me, but I won't go there. I plan on switching to Lev when I run out the current vial of ProZinc, which will be within the next month or so.

My vet hasn't told me about Clindamycin. I will definitely ask her about it and pulse therapy.

So, I'm used to posting pretty much every day...is there a lot of traffic on this site or do some of you post your numbers on the Lantus ISG?
Thanks again for the information and warm welcome. :-D
 
Oh Boy! I did state somewhere yesterday that I had a long talk with Alley, he really looked at me and listened. We all know our cats do this right? We decided that since his PMBS was 500 that his first dose of Lev would be .7, a reasonable starting point, our vet agreed. OK, Alley was listening because his numbers after food (1 hour passed) were 380, then we prepared everything for the new vile of Lev, lo and behold the bottle did not look right. The box was sealed and so was the vile, but it looked funny. Bubbles all over inside the bottle and it was not even swirled! Looked like a separation of some kind. Called the pharmacist at City Market and she said it could have possibly been frozen at one time, although it seemed unlikely, but she asked us to bring it in. (50 miles round trip!). She looked at the vile and agreed that it somehow did not look right, the bubbles never went away and they looked gooey. Ok, of course, that was their only bottle. Getting anxious here, the pharacist called Wal-Mart (our Wal-Mart is the smallest one in the US) and they had 2 viles only. Ran over there and picked up another one, looked fine. Flew back home (now 10:45) and checked him again before the shot. Now he is at 263. Ok, he has never hit 263 without a shot first. He also free feeds most of the day and his plate was emptied while we were gone. He is full. Confused? I am sure this is a fluke, but it is good to get a small reprieve. We have decided not to shoot him today, especially since it is getting so late in the day to track the next 12 hours with Lev. So I will still take some readings today and post them, back to square one tomorrow.
Didn't want you to see his ss thinking Lev is a miracle in just 2 hours!!!
Pam
 
Klinger listens to me all the time, trouble is he doesn't always do what I ask of him though. :lol:
That was a great catch, Pam. I'm curious to see what the rest of today's numbers bring for him. Have you changed his food recently?
Will you still start him on .7?
 
Hi, the vet wanted me to start him on K-D for his kidneys, but even mixing it with the EVO brought his numbers way up.
I am afraid he is a carb junkie. SO I decreased his K-D way down just today. His numbers (for him) are good.
Not going to post them until tomorrow, need 2 more readings tonite, he just ate, then I will try 2 hours after what would have been his shot time to see where we are. 8:23 am- 380; 10:52 am 263; 1:02 pm - 319; and before food - 6:10 - 379.
Tomorrow I will take the advise from this site and start him at below .5. He is still on U-100 syringes, the pharmacy did not have any other kind with a lower dose reading, again, small town.
And the drama continues....
 
mars72 said:
So, I'm used to posting pretty much every day...is there a lot of traffic on this site or do some of you post your numbers on the Lantus ISG?
Thanks again for the information and warm welcome. :-D
Click to expand...

I will address just this part for now. I am behind here (family visiting) and need to catch up. :)

To answer your question, most of us here don't post on the Lantus ISG. Even though we follow the Tilly protocol for the most part, it is more loosely followed for our individual cats. You won't see us posting everyday here since most of us have been doing this for a number of years just like some of the longtimers on the lantus ISG that also just check in periodically.

So you are welcome to post here everyday if you want and we will get back to you in a timely matter, or if you want a lot more eyes you can post on the lantus ISG. :)

I like how Melissa explained it recently:

"We are just more casual in the Lev forum.

I think the general concensus here is that there is no ONE cookie cutter way to work with Lev, so this forum has kind of been adopted by those that might "work outside the box" a little more than others or have more challenges or different ways of working with FD.

Neither way is good or bad, just different. It is up to the bean to find the forum that works for them and their kitteh!..."
 
Well, we have our appt scheduled for Sunday, 1/2/11. Anyone want to chime in with any helpful tips if I run up against resistance to the vet wanting to prescribe Lev?

If she does prescribe Lev...I'll start it this coming Friday, so I'll be home to test/monitor Klinger.

Wish us luck!
Marcy & Klinger
 
Good luck Marcy & Klinger!!

My vet was VERY relunctant to prescribe Lev but I told her I went to the Novo Nordisk (sic?)website and read all about it and that was the one I really wanted. She finally caved, but kept telling me she had little or no experience with Lev and wanted me to go on ProZinc, which she happened to sell.

Best of luck, start very low on Lev, I made the mistake of too much at the start.
Not yet where Alley needs to be, he is a work in progress. Really happy I switched.

Pam & Alley
 
Thanks, Pam. I'm hopeful that she won't be too reluctant because she has prescribed Lev to a drooler.
I've been following your posts. You're doing a fantastic job with Alley. :-D
 
Marcy, you will find some great information here: http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=681

Read through so you have your "talking points" clear in your head, and in case you want to ask us any questions. Maybe print out some of the articles to share with your vet.

Because she Rx's lev for canines, she should be open to using it for cats. I don't have experience with ProZinc, but I can say that Beau responded to lev 150% ( :mrgreen: ) better than he did to vetsulin. I feel it is the long action and the way it works that allowed him to achieve normal blood glucose levels long enough to get his pancreas out of glucose toxicity and allow it to heal and "re-boot". My vet calls him the miracle kitty because he has overcome so many odds - not the least being that he went into diabetic remission on lev after over two years on another insulin. The longer they are diabetic and on insulin, the less likely they will go into remission.

Good luck! Let us know how it goes.
 
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