12/7 Noodle 311 Lantus vs. Lev. dose ?, also Ketone advice

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Christianna

Member Since 2014
Noodle was switched from Lantus to Levemir approx. 2 weeks ago after during his hospitalization for DKA. Since his Lantus dose was 3.5U, I asked on the forum and was advised to start the Lev. at .70 of that dose, which I did, so he has been on 2.5 U Lev. Then my buddy developed a URI, probably from all the stress and germs at the vet. Vet said hold off on dose increase till he was well, which is today. Emailed her and she said go up to 2.75. I did that this morning. My question is, why is Lev. dosed at roughly 3/4 the amount of Lantus? Is it "stronger"? Does it stay in the body longer? Was the 2.5 U a good place to start based on his former 3.5Lantus? He never did get in the blues, even, on 3.5U Lantus. Well, maybe a couple times :?
Also, I had migraine yesterday so DH took over Noodle's feeding throughout the day. I had been watering Noodle's food with a T. or so of water every feeding. DH forgot to do this and this morn. Noodle showed between neg and trace ketones so a red flag went up and I'm loading him up with water. My question is--IF he ever gets regulated, will I continue to water his food just as a safety measure and was the seeming disappearance of the ketones for the past 2 weeks phony, since they started to come back after his water was reduced? After he went from trace to large ketones overnight a couple weeks ago, I'm terrified about the ketone issue. Any advice would be very welcome and thanks so much! Hope everyone else's kitties are having a smooth Sunday. And, Nadine, I'll be your main competitor for the "lost my mind" award ;-)

Christi
 
Re: 12/7 Noodle 311 Lantus vs. Lev. dose ?, also Ketone advi

Well, assuming you are entering your numbers into the spreadsheet correctly, I see an inverted smile curve on his numbers between shots, generally, unless he is just flat altogether. He gets lower preshot, then spikes between shots. This is not a normal reaction. I would love to see some tests at about +3 or so to see if he is even dropping at all when insulin begins to act in his system.

I know you are not going to like my advice, and your vet will like it even less, but I think this cat is getting way too much insulin. His poor body is working hard to counteract all that insulin.

I am going to ask some other experienced people to come have a look at your situation and get some more opinions, okay?
 
Re: 12/7 Noodle 311 Lantus vs. Lev. dose ?, also Ketone advi

Hi Linda,
Actually, the suspicion that he is getting too much insulin is really bothering me. I've been wondering that myself. I even brought it up last time and the vet was very emphatic that Noodle needed MORE insulin not less. So you can see why I'm confused, especially in these early days of Lev. I will try to get some more tests in. The vet told me I was testing "way too much" and should back off until curve day which will be later this week, unless I get some strong advice to back off, which I'm tempted to do. I REALLY wondered if I should have just started the Lev. at maybe 1U twice a day but after the DKA episode I didn't think I was in a position to argue. Since Noodle is on the higher dose, he's RAVENOUS. Does this mean I'm overdosing him too? Thanks for any thoughts :?

Christi
 
Re: 12/7 Noodle 311 Lantus vs. Lev. dose ?, also Ketone advi

Christi & Noodle said:
My question is, why is Lev. dosed at roughly 3/4 the amount of Lantus? Is it "stronger"? Does it stay in the body longer? Was the 2.5 U a good place to start based on his former 3.5Lantus? He never did get in the blues, even, on 3.5U Lantus. Well, maybe a couple times :?
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when switching to lev from lantus we generally suggest the initial lev dose to be 70% of the prior lantus dose in most cases because we've seen far too many kitties take nosedives in their first or second cycle of levemir. *most* kitties who have switched end up increasing the dose within 6 cycles. however, when i suggested this dose, i also suggested stabilizing noodle on lantus before making the switch to lev because of the all too recent problems with ketones. imho, your vet jumped the gun by putting him on lev before being stabilized, but that's water under the bridge at this point. i also think waiting for a URI to "be over" before increasing the dose is crazy in a ketone prone kitty. you want to get those BG numbers down and keep them down.

honestly, if i had known about the switch to lev while noodle was hospitalized, my recommendation would have been different. i would have suggested a higher initial starting dose of lev... equal to his last lantus dose.

Christi & Noodle said:
Also, I had migraine yesterday so DH took over Noodle's feeding throughout the day. I had been watering Noodle's food with a T. or so of water every feeding. DH forgot to do this and this morn. Noodle showed between neg and trace ketones so a red flag went up and I'm loading him up with water. My question is--IF he ever gets regulated, will I continue to water his food just as a safety measure and was the seeming disappearance of the ketones for the past 2 weeks phony, since they started to come back after his water was reduced? After he went from trace to large ketones overnight a couple weeks ago, I'm terrified about the ketone issue. Any advice would be very welcome and thanks so much! Hope everyone else's kitties are having a smooth Sunday. And, Nadine, I'll be your main competitor for the "lost my mind" award ;-)
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i absolutely agree with your vet. noodle is under dose. if noodle weren't so darn prone to developing ketones, i would suggest getting nighttime data (every night) to *see* if you're missing any lows. however, you wouldn't be seeing ketones develop if he were getting enough insulin. you're not off the nighttime data duty though. you're missing half your data right now. it's data collection that becomes more important than ever when you have a ketone prone kitty.

adding a little water to kitty's food is good for any cat whether they have diabetes or not. my "civvies" get some water mixed in their food at every meal. cats have a low thirst drive. adding water to their meals helps cats to stay hydrated.



just my thoughts...
 
Re: 12/7 Noodle 311 Lantus vs. Lev. dose ?, also Ketone advi

Hi Jill and Alex,
I think when I posted before about Noodle being switched when he was in the hospital, unfortunately it had already been done and was underway when I received your advice. The vet's thought was that he hadn't really responded after 4 months of lantus and so "why not" try lev. after he was stable. S-I-G-H. I still don't know why he crashed overnight. Have even wondered if the Lantus was losing potency and I wasn't aware. I know I need more nighttime tests and will try to get them in. I just ran and tested him at 3.5 hours in and he has dropped ONE POINT, to 310. For some reason I can't get my SS to open but will go back and work on it later. Maybe it was due to Noodle's "weird" non-response to insulin, plus all the infections and coming off DKA that made the vet decide 2.5 U on Lev.was where we should start. IDK. I just don't know what to do but do you think I should raise Noodle right now(meaning tonight) or give the 2.75 six cycles now that I've started it? To complicate things, Noodle badly needs a dental which is tentatively scheduled for the 18th if he doesn't have any more complications and I really hope that makes a difference. I'm a basket case with all this! Thanks for your help.

Christi
 
Re: 12/7 Noodle 311 Lantus vs. Lev. dose ?, also Ketone advi

((((((( Christi ))))))
I'm right there in the basket with you. We can keep eachother company.
:YMHUG: :YMHUG: :YMHUG: :YMHUG: :YMHUG: :YMHUG: :YMHUG:
 
Re: 12/7 Noodle 311 Lantus vs. Lev. dose ?, also Ketone advi

Christi & Noodle said:
I just don't know what to do but do you think I should raise Noodle right now(meaning tonight) or give the 2.75 six cycles now that I've started it? To complicate things, Noodle badly needs a dental which is tentatively scheduled for the 18th if he doesn't have any more complications and I really hope that makes a difference. I'm a basket case with all this!
Click to expand...
if i were in your shoes (and have been), i would stick with the 2.75u dose for at least a total of 4 cycles (unless doodle tells you otherwise). at the end of 4 cycles @ 2.75u, i would re-evaluate. this is where that nighttime data is important. it's tough to evaluate where he's at if you don't know how low he's dropping on this dose.

because of his history with ketones, i'd make sure he's eating his normal amount everyday, continue mixing water in his food, and test for ketones daily. when alex was in this position, i'd test for ketones twice a day when possible. one more thing... if he throws ketones, please post for help immediately.

i know easier said than done, but try to calm down a little. cats pick up our stress. :-D


i'm hoping things change greatly for noodle once he gets that dental done...



ETA: my comments in this thread are for christi and christi only... because of the recent insulin switch, noodle being under dose, and a ketone prone kitty. please do not duplicate.
 
Re: 12/7 Noodle 311 Lantus vs. Lev. dose ?, also Ketone advi

Thanks, Nadine :smile: It's nice to know I'll at least have company in the rubber room :shock:

Christi
 
Re: 12/7 Noodle 311 Lantus vs. Lev. dose ?, also Ketone advi

Thanks so much, Jill and Alex. Noodle is eating way more than usual and has actually regained most of the pound he lost during the DKA episode. He never drinks, but then I had been watering his food so much I think he was getting plenty of water. Does make the pee spots larger though :shock: I will start getting more readings, especially at night and re-evaluate in 4 cycles. If poor Noodle can pick up on my stress, it's a wonder he's doing as well as he is :o Thanks again, I really appreciate your dose of sanity and your calm analysis :-)

Christi
 
Re: 12/7 Noodle 311 Lantus vs. Lev. dose ?, also Ketone advi

:YMHUG: :YMHUG: :YMHUG:
 
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