copying and pasting my response to barb's PM here:
((((( barb )))))
first of all, let me assure you.... you are doing everything right. i don't want you to think for one minute that there's something else you should be doing. it's checkers. every once in awhile we see a kitty like checkers who can hit every color of the rainbow in one cycle. a cat like that is
extremely hard to work with. it takes a whole lot of experimenting and trial and error to figure out what will work best.
i like how you used karo today. he still bounced, but he spent a good 6+ hours under the renal threshold! for the time being, i'd continue to use karo to try to control his drops because it seems to be working pretty well.
about switching insulins...
yes, i think it would be a good idea to try levemir whenever you can make the switch. lev has a later onset which would allow you to get food on board before the insulin kicks in. it could very well help with those early cycle dives. take a look at gracie's levemir ss:
https://docs.google.com/spreadsheet...Gs1aXhwSVZCLWRTR0NWUGxTR2xfbnc&hl=en_US&gid=8. lev has certainly helped!
do you know if your vet is familiar with levemir? most aren't. i know my vet wasn't. once i convinced him to prescribe it i not only had to spell it for him... i had to tell him exactly how to write the script...
a box of five 3ml Levemir FlexPens. if you want to make the switch, print out the "Lantus & Levemir: What's the Difference?" article linked in my signature to show your vet. take checker's recent numbers with you. show him the early cycle drops and explain how the onset of lev isn't generally til around +4 and nadir approximately +8 or +10. being able to get food on board before onset should help with those early drops. also explain how the rapid drops are causing horrific bounces. i'd also mention the fact that many of the diabetic cats on the FDMB use levemir with great success.
you might also want to print this out for your vet:
EVALUATION OF DETEMIR IN DIABETIC CATS
MANAGED WITH A PROTOCOL FOR INTENSIVE
BLOOD GLUCOSE CONTROL
K Roomp1, JS Rand2.
1. Max Planck Institute for Informatics, Germany. 2. Centre for
Companion Animal Health, Uni of Queensland, Australia.
There are no reported studies of long-term use of detemir in
diabetic cats. The aim of this study was to report outcomes
using detemir and a protocol aimed at intensive blood glucose
control with home monitoring in diabetic cats, and to compare
the results to a previous study using the same protocol with
glargine.
Eighteen cats diagnosed with diabetes mellitus were
included in the study. Cats diagnosed with acromegaly were
excluded. Data were provided by owners who joined the
online German Diabetes-Katzen Forum, and followed an
intensive blood glucose regulation protocol for a minimum of
5 months or until remission was achieved. Detemir was
administered twice daily and a low carbohydrate wet food diet
was fed. The insulin dose was adjusted aiming to achieve
euglycemia (50-100 mg/dL as measured using a portable
blood glucose monitor calibrated for human blood). Owners
performed an average of 5 + 2 blood glucose measurements
per day in the stabilization period, and supplied spreadsheets
recording daily insulin dosages, blood glucose concentration
and clinical information.
Seventeen cats in the cohort were initially treated with
another insulin type (16 with porcine lente insulin) for a
median of 9 weeks, but failed to achieve remission prior to
switching to detemir. Most (15/17) of these cats were fed a
low carbohydrate diet while on the other insulin.
The overall remission rate was 67% (12/18). For cats that
began the protocol within 6 months of diagnosis, the remission
rate was 81% (9/11) and for those that began 6 months after
diagnosis, the remission rate was 42% (3/7). The median time
to remission was 1.7 months after beginning the intensive
protocol (range = 10 days to 5.3 months). Nine cats of 12 cats
(75%) achieving remission remained off insulin, and the
median duration of remission was 12.3 months (range = 6.4
months to 2 years). Three cats (25% of remission cats)
relapsed and required insulin again. Only one of these relapsed
cats achieved a second remission.
Six of 18 cats (33%) in the cohort required insulin
throughout the study to control blood glucose concentrations
and did not achieve remission. The median length of time on
the protocol was 10.3 months (range = 5.4 months to 1.2
years). The majority (83%; 5/6) of long-term diabetics were
considered well regulated with a median blood glucose
concentration of ≤150 mg/dL and 17% (1/6) were moderately
well regulated (median blood glucose ≤200 mg/dL). Clinical
hypoglycemia was rare, with only a single event in one cat
which had mild signs. The median maximum insulin dose
administered to cats in the study was 1.75 IU twice daily.
These results are comparable to those of the glargine study.
No significant differences were identified between outcomes
for glargine and detemir, with the exception of a lower
maximal dose for detemir (p-value = 0.045). The median
maximum glargine dose was 2.5 IU (range = 1.0 to 9.0 IU)
compared with a median detemir dose of 1.75 IU (range = 0.5
to 4.0 IU).
http://www.acvim.org/websites/forum/File/docs/2009ACVIMForumAbstractsFinal.pdf
the study above will show him the use of levemir has shown positive results... similar results to that of lantus.
hope this helps...
