3/19 Munchie 500's

[ewest]

Hi All, Well Munchie had a flatter cycle today---in the 500's (wah!) I'm hoping she will get out of the 500's and have a lower flatter cycle. My vet agreed with trying a reduced dose and then a switch to Lev if that doesn't help. My concern, however, is my vet knows Lev may last longer in the body so she wants me to only start her on once a day- should I show her the Roomp/Rand article to show 2 times a day is fine? In terms of reducing- tomorrow's AM cycle will be 6 on the 1unit. I won't be home during day to get her numbers on that. Not sure if I should hold it longer or reduce her down more yet after that? I will see how tonight goes...don't want her staying in the 500's...

 

[Vicky & Gandalf (GA) & Murrlin]

Unfortunately your vet doesn't understand how Levemir works in the body. Dose must be twice daily for cats, I cannot stress that enough. Because of their faster metabolic rates, there is no once a day insulin for cats.

Please explain that Levemir works by establishing a reserve or depot rather than using only the current dose as with Prozinc, so unless the shots are maintained every 12 hours, the system has to draw on that reserve, reducing it and you will never establish the stable numbers which are Levemir's hallmark. I believe that is explained in the Lantus vs. Levemir article. It is very difficult to overdose with Levemir, unless it is a true overdose such as 2 members of family thinking the cat needs a shot and 2 doses are given. That happened to Pamela's Tigger once, he got 9U and he was fine!! HIs usual dose was 4.5U then.

You could probably go up to 1.25U with Lantus now without causing rebound. She was going kind of low on 2U but with the numbers she's had on 1U I don't think that's enough. I don't think you should reduce the dose further, unless someone else sees something I'm missing.

 

[ewest]

Am confused...I thought folks were saying higher flat numbers could indicate too much and that her numbers might get higher temporarily once her body stops getting too much insulin. My understanding was we should hold the dose for a minimum of 3 days to allow the body to adjust. Of course, I don't want her sitting in the 500's either. Also, note that I ended up at 2 units because she saw no improved numbers at 1.25, 1.5, or even 1.75 really- though the 1.75 did get at least one blue. I dropped her some at the first black on 2.00 but that didn't seem to produce much better results. What I'm noticing is that on the 1.00 back in early Feb she got blue and pink and then it became blue and red after about a week. Then on the 2.00 it seems like the same, she didn't bounce as much until she'd been on the dose for awhile. If I were going to increase, by the protocol it'd be by .5 unit because of how high her numbers are- though in the past I usually do increase by .25.

 

[Vicky & Gandalf (GA) & Murrlin]

Sorry, I should have explained. Initially I thought to increase to 1.5U would be best given the high BGs, but then I looked at SS again and noted greens on even 1.25U, several times in fact in January. That makes me cautious about telling you to increase so much.

I am just not fond of large dose increases. A dose change from 1U to 1.5U is a 50% increase, too much for Levemir at least. Larger increases may work for some on Lantus, but the experience we've had here with Levemir says to us that smaller dose increases give the best results. And it may be the same for some on Lantus.

As good of job as you've done getting tests and holding doses for several days there does not seem to me to be any good solution beyond changing insulins. I think Mel experienced the same things with Musette, I believe Sheila had pointed that out already. Why it might be that one long acting insulin creates too strong of reaction in one particular cat, and the other does not, I don't know. But Musette is evidence that there is a difference between the two insulins that may matter to some cats.

 

[Sheila & Beau GA & Jeddie GA]

She is eating only raw, right? So very low carb? When I see numbers that range from 50s to over 600 it just has to be rebound. I saw the "greens" on 1.25u, which is why I thought 1u or even .75u would shave off the top and bottom of those curves - hoping for lows in the low-mid 100s and highs no higher than 300.

I don't know what to tell you at this point. It might be that numbers from 50-60 and up to 350-400 are the best you can get with lantus - so 1.25u would be what you have to go with. It's where she got the "best" numbers.

Lev won't last longer in the body (of a cat). It has a different method of producing the "time-release" effect than lantus does, so you can't expect a given cat to respond the same to lev as to lantus dose for dose (IMO, thank God!). The concern for lower numbers is handled by switching with a reduced dose until you get some data on it. Then you start dose adjusting systematically. Lev and lantus have very similar action profiles with almost identical duration.