3/4 Sid update- need help with feeding

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Lydia & Sid & Jake(GA)

Lydia & Sid & Jake(GA)

Very Active Member
Hi everyone,

Sid is doing as good as can be expected considering everything he has going on. His breathing is still heavy so I have been giving him lasix to help reduce the fluid in his lungs but he also gets SQ fluids to make sure the lasix doesn't remove too much fluid and make him dehydrated.

I've been testing him for ketones every day and so far he has been negative on the urine strips. I tested him on the ketone meter and he was 1.1. This was yesterday because I had a problem with the first batch of ketone strips where they were out of the control range so the company had to send me a new batch and I just got them yesterday. That 1.1 range means take action but it isn't to the emergency vet visit stage yet.

I have not been happy with his levels lately so I've been doing a lot of reading about levemir since we already tried lantus, prozinc, and briefly humulin n. I read all of the case studies and the stickies on the board. It sounds like many of the cats who did well on levemir had a similar experience to Sid with lantus with the dropping and bouncing rather than steady control. Sid is very bouncy even when I feed him frequent small meals (as I did on lantus also). On lantus he had many low numbers that caused a bounce but on prozinc he would bounce even in the 100s. The bounces on levemir are supposed to be short lived and only last hours rather than days. I know ECID but I hope that Sid responds to the levemir better than the other insulins we have tried.

WCR: eating well on his own, breathing fast due to the pneumonia, talkative with everyone but not playing, purry, peeing a fair amount (but on lasix and SQ), having a bit of soft stool.

http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=65024
 
Re: 3/4 Sid update- switch to levemir

I know ECID but I hope that Sid responds to the levemir better than the other insulins we have tried.
Click to expand...

Hi Lydia, I wish you and Sid lots of luck on Levemir. Maggie is on lantus, so I don't have experience with Lev, but it seems the several I have seen swich from Lantus to Lev had good results. It sounds like Sid is stable, thanks to your wonderful care. I love the talkative part. Sending good thoughts and prayers for Sid and you.
 
Re: 3/4 Sid update- switch to levemir

Good luck with the new insulin. We like Levemir.
You're going back to BID?
Sid is in my prayers to keep getting better and to beat this pneumonia.
 
Re: 3/4 Sid update- switch to levemir

Lydia, I can't figure out which ss to look at. I tried the Sid's TID ss and I don't see anything on 03/04 and the Sid's ss keeps timing out on me. :-|
 
Re: 3/4 Sid update- switch to levemir

Lydia & Sid & Jake(GA) said:
Hi everyone,

I've been testing him for ketones every day and so far he has been negative on the urine strips. I tested him on the ketone meter and he was 1.1. This was yesterday because I had a problem with the first batch of ketone strips where they were out of the control range so the company had to send me a new batch and I just got them yesterday. That 1.1 range means take action but it isn't to the emergency vet visit stage yet.
Click to expand...

Lydia, what kind of ketone meter do you have? Mine is a Precision Xtra and it's my understanding that any reading up to 3.0 is "safe." 3.0 is where it starts reading "small" on the pee stix. If you are going by the instructions that came w/the meter, throw them out. 1.1 definitely warrants watching, making sure he doesn't keep heading for the 3.0 stage tho. Check out some of Sharyn & Fiona's old posts, she is the expert in the BBK meter vs. pee stix arena.

It is important to remember that bbk meter readings tell you what's going on right now & urine ketone sticks could be telling you what was going on as much as a few hours ago b/c you don't know how long the urine has been sitting in the bladder.

I am so glad Sid is eating on his own and doing as well as he is. You are such an incredible bean! I hope his breathing gets better soon and he does famously on the Lev.

Desi
 
Re: 3/4 Sid update- switch to levemir

@Dyana - I tried to create tabs on Sid's SS and obviously messed something up. I am still trying to fix it. At the bottom there are two tabs that can be clicked to switch between the SS. However if it is not working, I will just make the SS separate again. Yes I doing levemir BID to start. Though I did find someone who did a TID with it.


@Desi - Sid's meter is a Nova Max Plus. It gives a range of below 0.6 is normal; 0.6 to 1.5 is development of a problem; and above 1.5 (1.5 to 8.0) is critical. Sid pees a lot because he is on lasix and subcutaneous fluids so I hope that means the urine in his bladder is relatively fresh. However I realize the urine strips can't totally be relied on. I base my judgment on the readings I get on the meter and urine strips but also his behavior. As long as he is eating and acting relatively normal (considering his conditions), i think things are ok. However if he stops eating, starts hiding, and starts to look bad and dehydrated, starts vomiting, then I know we have ketones no matter what any other tests display.
 
Re: 3/4 Sid update- switch to levemir

Lydia --

You might want to try to correlate the blood and urine ketone readings. If you can get a urine reading and then get a blood reading, it may help you to figure out what the range is. While the urine reading won't be a 'to the minute' reading, it will be in the ballpark. The only other way to calibrate would be either with a Precision Xtra or with the vet's reading. Basically, you want to know when you're above vs. at or below trace on the Ketostix.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

I updated Sid's SS this morning to reflect what is going on with the levemir. His numbers are creeping up rather than down. Now at +5 he is HI and has been at the water dish all morning or in the litter box.

Another thing to be aware of is that I started to wonder if my relion was giving accurate readings because I have not done a control test. Walmart does not stock the control solution so I had to order it and it has not arrived. Honestly I didnt realize this had to be done because I've never seen any control solution at walmart to purchase (later learned they don't stock it) until I got my new Nova meter that came with solution. So I've been testing with both meters - Ill note the differences on the SS because I was able to do a control test on the nova to verify it is in range.

I started him at 0.5U because I wanted to start lower and increase, but I'm beginning to think that I should have started him at 1U. He was on 1.2 U of Prozinc/TID. *edited to add that based on weight, his starting suggested dose is 1.5 but I was worried that might be too high based on what happened with lantus. Maybe I shouldn't have assumed that.

The other issue is that he did not respond to insulin shot subcutaneous so I was injecting IM, but the wiki said not to inject levemir IM so I did it SQ. I hate to have him high all day waiting until +8 or a later nadir to see if he responds. Now I regret switching him.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

if you just switched this morning, it may need more time. neither L is a fast-acting insulin. it may be that he simply hasn't gotten enough insulin yet.

his ss is backwards date-wise and the most recent date i can see when i'm looking at it is 2.18. did he start on lev today?

sorry to not be more helpful - you're doing so well with Sid, i'm sure this is stressful.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Laurie, the latest numbers are at the bottom of the Sid's TID SS. Lydia, I would rename that spreadsheet Sid's 2012 SS or something, so we know which one to click on. It was confusing to me at first.

The Levemir needs to build up a shed, and that can take 5 to 7 days. Maybe you should have started with a little higher dose. Let's see what others think..
Be patient. I know it's hard to see those numbers and your cat drinking and peeing.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

We just switched to lev with Weezer's Wed. PM shot, so we are still in transition. We aren't at the right dose yet, but other than numbers higher than desired, I'm pleased with the way she has responded. Her numbers are flat and she even seems to feel a little better. I don't know anything about prozinc. Does it form a shed like the Ls do? If not, until the lev shed is established Sid will probably be higher than you would like to see. I'm thinking that could take 2 or 3 days, but others with more experience may be able to give you a better idea. Do you have any experience with R? That could be a possibility to bring him down until the lev shed is in place. Again, please wait for more someone with more experience to comment on that.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Hi Lydia,

I know you hate to see him high, and I don't blame you. Levemir is a depot insulin, like Lantus, so it takes time to build the depot/shed. When switching from another insulin, the dose of the previous insulin is taken into consideration when deciding on a starting dose, the weight based formula is not used when switching. I'm thinking that you probably need to go up on the dose...but let's see what others say too. It's too soon to tell if Lev will work for him...please try to breathe... :YMHUG:

I am looking for the info about BK/ketostix comparison that Sharon posted, just to give you a starting point for comparison. As Sienne said, the best way to get a good idea is to build your own comparison chart with testing. I just reinstalled my OS, so I'm having trouble finding things...if anyone else finds it first, I hope they will post it!
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Lydia

Please look at Gracie's SS when I switched her to lev. She was on .75u lantus and I started her on .5u of lev. I left her there for two cycles and then increased to .75u for four cycles and then increased to 1u. The protocol allows for quicker increases if you are switching insulins.

Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours).
Click to expand...

It took her several days to start responding. Also, until you can get the shed filled and see what he's doing, then you can't assume he'll nadir at +8. Gracie nadirs at +14/+15. Alex nadirs at +12. Levemir is a great insulin...we have bee
N very happy with how much it has flattened her cycles. She does still bounce but not like on lantus. I hope you can give it some time. It can take weeks or longer to see how well it's working for Sid.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Hi Lydia,
Don't forget that Levemir, like Lantus, needs time to build a shed. Until the shed gets built, most of the insulin that you are giving is going into the shed, and is not having much of an effect on Sid's bgs. As I understand it (someone correct me if I am wrong), Prozinc does not build a shed. If you were switching from Lantus to Lev., there would still be some Lantus shed active while Lev. was building a shed. With Prozinc, this would not be the case. Maybe you should have started Sid on the Lev. dose that is recommended for his weight? In any event, give the new insulin a chance to work and for Sid's body to get used to the change.

The nadir with Lev. is not always as late as +8. ECID. Rusty usually onsets at around +4, but then a nadir-like surf is usually in action from about +5.5 and extends well into +9 or thereabouts, then a gradual climb up to PMPS. But this doesn't happen every day. There is variation in the "pattern". My advice would be, give Lev. a chance to work.

Good luck.

Hugs,

Ella
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Sid is constantly at the water dish - much more than when he was HI on prozinc. That is why I'm worried that the subcutaneous injections aren't working for him. If they aren't working, then he wont be building up a shed at all... I hope I'm wrong. If he shows no response at all and is constantly HI for 2-3 days, then I will have to put him back on an insulin he can have IM. He has gained weight so I was hoping he would respond to SQ injections.

I gave him a drop of R just now to bring him down. I will keep a close eye on him. He can't be high all day and constantly at the water dish - that's all there is to it.

So tonight I should increase his dose of levemir to 1U?
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Here's the info from Sharon's profile:

Precision Xtra Readings for Cats

**'Normal' for cats is 0.0-0.3 (Fiona's normal is 0.1, D & Shadow's normal is 0.3)

**3.0 is aproximately when ketones start showing on urine ketodiastix strips at a trace - at least that is the case for Fiona.

**As BG's go down so will ketone levels (in most cases). If I can get Fiona's BGs under 250 for even a couple of hours her ketone level will go down.

**Other than being DKA at dx, the only other time Fiona has had ketones above 1.0 was when she had some kind of infection. The first time (Aug 2008) was occult and we never figured out what it was but four rounds of different ABs finally took care of it. The second time (Dec 2008) was tooth problem even though she had an extensive dental in April '08. She had a pocket behind a canine and a broken tooth. Neither of which could be seen by the vet until she was under.

**Other cats get elevated ketones for other reasons, too high BGs for too long, etc...
Here's a post that says kinda the same thing but has some other info too. http://www.felinediabetes.com/phorum5/r ... ?8,1684726

Please do notice that this is based on her experience and on the Precision Xtra meter. I don't know how the NovaMax compares...and I don't have direct experience with either one. It's my understanding that the trend is important and that's what I would be watching, not just the numbers themselves...which way they are heading.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

thank you Laurie :-D
the information about the ketone testing is helpful. I did do the urine test in close proximity to the ketone meter test yesterday.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Lydia & Sid & Jake(GA) said:
I updated Sid's SS this morning to reflect what is going on with the levemir. His numbers are creeping up rather than down. Now at +5 he is HI and has been at the water dish all morning or in the litter box.

Another thing to be aware of is that I started to wonder if my relion was giving accurate readings because I have not done a control test. Walmart does not stock the control solution so I had to order it and it has not arrived. Honestly I didnt realize this had to be done because I've never seen any control solution at walmart to purchase (later learned they don't stock it) until I got my new Nova meter that came with solution. So I've been testing with both meters - Ill note the differences on the SS because I was able to do a control test on the nova to verify it is in range.

I started him at 0.5U because I wanted to start lower and increase, but I'm beginning to think that I should have started him at 1U. He was on 1.2 U of Prozinc/TID. *edited to add that based on weight, his starting suggested dose is 1.5 but I was worried that might be too high based on what happened with lantus. Maybe I shouldn't have assumed that.

The other issue is that he did not respond to insulin shot subcutaneous so I was injecting IM, but the wiki said not to inject levemir IM so I did it SQ. I hate to have him high all day waiting until +8 or a later nadir to see if he responds. Now I regret switching him.
Click to expand...

I found Sid's numbers for Lev on his TID ss, and wondered if you have read the info on the shed filling for the L insulins.
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
You are starting on EMPTY, so you need fill up the shed before you are going to see results.

I don't agree with IM, I have heard that it's painful, so I have rejected this method.

You are giving .5u BID of Lev, which is less than had been advised, so I would imagine you would need to increase the dose.
How long ago did you switch to Lev, only today? The dose at the last insulin... 1.3u P given TID? If that previous dose is correct, giving a daily total of 3.9u P, I would think that only .5u Levemir BID for a daily total of 1u Lev is not going to give you great numbers. Going from 3.9u down to 1u is not going to be sufficient at all.

A late nadir can be a good thing; my Oliver was a late nadir cat, so his ps numbers were usually his nadir. If Sid has a nadir around +8 or 9, I think there should not be a regret for a rise in curve upfront because you know a late nadir has a curve like a mountain.... if you don't see rising numbers upfront, you will need to worry about dropping too low on the other side of the mountain curve.

With other health issues involved, you need to factor them into the results you are seeing. Despite what many say, there ARE very noticeable differences between Lantus and Levemir, with a smoother curve being just one of them. I noticed a sharp change for the better with my Shadoe, switching from Lantus to Lev.

I know that the two Ls are very similar, but similar is not identical. Those tiny differences may be just what is making one L better for a cat than the other L, and it CAN go both ways.... nothing stopping a cat from doing better on Lantus than Lev.

I came across the below info when I was looking for differences awhile ago.
In addition to the below info, there's a diff in how the two insulins act once injected.
Levemir is made with insulin detemir. Insulin determir is created by recombinant DNA technology just like glargine, but is produced by baker's yeast instead of E.coli. It's a clear solution that contains, in addition to the insulin detemir, some zinc, mannitol, other chemicals, and a bit of hydrochloric acid or sodium hydroxide to adjust its pH to neutral. Insulin detemir differs from human insulin in that one amino acid has been omitted from the end of the B chain, and a fatty acid has been attached to the spot instead.
Unlike glargine, detemir does not form a precipitate upon injection. Instead, detemir's action is extended because its altered form makes it stick to itself in the subcutaneous depot (the injection site), so it's slowly absorbed. Once the detemir molecules dissociate from each other, they readily enter the blood circulation, but there the added fatty acid binds to albumin.

More than 98 percent of detemir in the bloodstream is bound to albumin. With the albumin stuck to it, the insulin cannot function. Because it slowly dissociates from the albumin, it is available to the body over an extended period.


So what's it all mean? Well, that there are differences, and for that very reason, some cats will do better than others on one or the other.

Just like with Lantus, you must build up the shed for Lev. You are not going to see great numbers on the very first day on the switch from P to Lev. I do think you started too low, and I am betting that you could easily start at 1u BID with the Lev.

I think I would try to go with 1u BID of the Lev and hold it for a few days to get that shed built up.

We'll see what others have to say.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

sending you and Sweet Sidster our love and support, Lydia!!!

cats-in-love.jpg
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

I can't see his lev SS but give him two cycles at .75u .5u before you increase him.

I can't overstate that it takes time just like Ella said. I would be cautious with using "R" ....you do not know when he onsets or nadirs. Because Gracie nadirs so late, her +5 is usually higher as she does not onset until after +6 or +7 so just because Sid is going up at +5 does not mean anything right now. He may be a late onset/late nadir kitty (I mean later than the "typical" lev curve).

I don't know about the IM shots....I would give the lev time. It is not going to work immediately...like Ella said, PROZINC has no shed so you are back to shed filling for a bit.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

@Gayle - thanks for the info but I disagree with you about IM and Sid's response says it all. He did AWESOME on IM injections. He never cried or jerked away. The insulin syringe is very small as you know and Sid never even flinched when getting injected. However on lantus with the sting, he would often cry and run away. Of course then he stopped responding at all to subcutaneous injections because he lost too much weight and I had to do it IM or he would probably be dead right now.

If he shows no response to levemir even at 1U BID for several days, then I am going back to a different insulin and I will be shooting it IM.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

I wonder if you can rename your Sid's TID ss to say PZI TID / Lev BID ss or something along those lines because I first went into the other ss to look for the Lev numbers, but it stops at mid Feb.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

edit to remove dupe posting
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

@Ella I know :-D I'm glad about that. I just wish I could give it IM. Then at least I would know he was getting it the same way as the prozinc and I would be better able to judge whether or not it is working or if it isn't because of the method of delivery (does that make sense?)

@Gayle I'm sorry about the confusing SSs. Others have mentioned that too. I did rename them.

I am very careful when using R. I usuallly end up giving Sid too little and then he doesn't go below 350 and then within an hour he is back up again because of the duration being so short. If my vet had his way, Sid would be getting R every 4-6 hours. However I don't like that idea as I've told him. My goal is to have him on a long acting insulin that keeps him steadier than he would be on something like R or N. I just hope levemir is the answer. I am willing to give it a chance but I am not willing to let Sid be high for any extended period of time.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Lydia

We're discussing how much you can increase him for tonight and would like to get Jill and/or Libby's input as they have also used levemir. So hang tight on the dose for tonight until we can get them ok? I think we agree he needs more but we need to figure out how much and when.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Lydia:

Do you have any lab values for Sid's albumin? Has he continued to gain weight?
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

I do not have the recent lab values. He just had bloodwork done about 2 weeks ago. His weight as of wednesday 2/29 was 5.8.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

@Sienne I just realized you wrote "any" values. FWIW On 1/6/12 his value was 3.0 (2.3-3.9).
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Thanks, Lydia. It sounds like Sid is gaining back some of his weight. I was wanting to make sure his albumin was in normal range given that Lev binds to albumin.

I'm going to post again in a bit. We've been doing doing some back channel brainstorming. I want to summarize our thinking so it's all in one place rather than you're having to sort out several posts.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

thank you - i appreciate the help. I've updated his SS. At +9 his bg was still going down a bit. I'm not sure if that is from the R (+3) or the levemir (+9). Typically on R his peak is 2 hours and then he starts going up. Also, he has not been back to the water dish since I gave the R. I'm happy about that. I also gave fluids so maybe that had something to do with it.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Lydia, have you been feeding this drop? I would give him something to try to slow him down. I suspect this is because the R nadired just as the Lev was starting to grab onto the BGs and he might continue dropping for a while.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

I think he's bouncing because he came down 140 points the first hour and 60 points an hour for the next 3 hours.
My cat would bounce from that. The Levemir might have helped a little once he got down to numbers where the Levemir could do it's job. I just think he came down too fast.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Lydia:

As promised, I’m summarizing our thoughts.

We all understand how you are trying to juggle all of the factors regarding Sid’s health. I know it’s tempting to want to do something to intervene and get Sid’s numbers down. However, we want to urge you to have a strategy since Lev is different than PZI.

  • First, Sid needs more insulin.

  • If Sid was throwing ketones, this is probably not the best time to switch to Lev. It may be best to continue with the TID PZI dosing and increase the dose. (Laurie, or the members on the PZI forum, are best able to help you with a PZI dose recommendation.)

  • If you are committed to switching to Lev, increase the dose to 1.5u. Given that Sid was getting 1.3u of PZI TID (or almost 4u daily), his 0.5u dose of Lev just isn’t enough to have an effect on his numbers.

  • We can fast track dose increases. But, it’s important to give the Lev a chance to work. You will need to let doses settle and a shed needs to form. You're not going to see results in one cycle.

  • R can be used to help manage Sid’s numbers. However, if you want to use R, you need to wait to see how the Lev is working. You gave R at +5 and it’s looking like Sid’s numbers have dropped from “Hi” to 282. That’s a huge drop. Right now, it’s not clear if this is due to the Lev, the R, or both. Keeping Sid safe is everyone’s first priority.

  • If you use R, for now, it would be best if you timed R with the beginning of a bounce. This should prevent the bounce from getting going and keeping numbers lower. For example, when Sid hit the 414 today, the R could have counteracted the bounce and Sid wouldn’t have gone into black numbers.

  • Just like with any other insulin, the nadirs of R and Lev should not overlap. Again, you need to see how the Lev is working. You will need to get a Lev curve so you know onset, nadir, and duration. You will then have better data for using R.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

I did feed him with the R. I forgot to add the food to the SS. He drops like that every day and he has done it on every insulin so it is not just because of the R.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Lydia...can you get another BK test? The last one was over 24 hours ago, it would be very helpful to see the current number and the trend.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

I had to open a new container of strips so I had to do another control test - I did 2 and both were out of range. I tested the ketones anyway and it came out 2.9 which is high. If he is developing ketones, I can't continue the levemir and have to go back to prozinc until he is stable. That at least brings him down consistently.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

lydia, my internet service is sporadic at best so i haven't been posting because i can't rely on service to follow up with anyone. in light of this latest reading... we're seeing an upwards trend in blood ketones. imho, now is not the time to switch to lev. i agree with you. go back to prozinc tonight.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Now I'm really worried. He is at 493 so I gave him 0.25U of R. I will give him the prozinc in an hour to 1.5 hours. That usually has a 3 hour delay before it onsets for him. I will also feed him at +1, +2, +3. Thankfully he has a good appetite right now.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

He just peed and I was able to get a keto stick test - that shows negative. I know ketones appear in the blood first so I will get another urine test later tonight just to check.

I was thinking about this whole thing and I should probably wait to switch him until he is cleared from the pneumonia. I just want him to be regulated so much - I don't even care about OTJ right now. I will try to be a little more patient.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Hugs to you Lydia. We want whats best for Sid, too. You can try Levemir another time.
Right now let's get rid of that pneumonia and get some more fat on him. (((more hugs))).
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Yes, I would go back to PZ and increase the dose. You'll need to monitor, but I would go up to 1.6u or 1.7u. You have HC handy, right? What do you think?

ProZinc usually has an onset between +1 and +2 for Sid...I don't think you want to give it so close to the R. I would wait until he's at least +2 after the R.

ETA: You may need to back off a bit tomorrow on the PZ dose, since you can't monitor.....but I think that's better than doing a smaller increase tonight and then increase more tomorrow. It would be a good idea to post on PZI and get more feedback on dose...that's JMHO.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Thank you Dyana :-D

Laurie, I agree about increasing the dose. What time should I give the Prozinc? I gave the R at 4:45 EST and he was 493. I just checked him at +0.5 5:15 EST and he was 471. He ate about 1/2 can of food with the R.
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

laurie said wait to give the PZI until the +2R.

lydia, i just want to give you a big hug. i hear your desperation and devotion to Sid. it's so understandable - i would feel the same way about punkin. i think going back to the PZI so you are having quicker responses and waiting until he is out of the pneumonia and stable ketone-wise is a good idea.

at the point where you want to try the lev again, how about posting so folks who are experienced in the switching can help you make plans before you actually make the change. might be a good thing to do in the future, but not while he's sick.

:YMHUG:
 
Re: 3/4 Sid update- switch to levemir - maybe a bad idea?

Laurie and Mr Tinkles said:
Yes, I would go back to PZ and increase the dose. You'll need to monitor, but I would go up to 1.6u or 1.7u. You have HC handy, right? What do you think?

ProZinc usually has an onset between +1 and +2 for Sid...I don't think you want to give it so close to the R. I would wait until he's at least +2 after the R.

ETA: You may need to back off a bit tomorrow on the PZ dose, since you can't monitor.....but I think that's better than doing a smaller increase tonight and then increase more tomorrow. It would be a good idea to post on PZI and get more feedback on dose...that's JMHO.
Click to expand...

just to make sure you see all of laurie's advice.
 
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