4/21 Dimi - AMPS 172, +7 337, +9 366, PMPS 392

Bobbi Kraham

Bobbi Kraham

Member Since 2022
Spoke with the Vet Tech while she changed Dimi's libre sensor today. She had thought the Vet was going to propose switching him from Lantus to Levemir, but instead, the Vet mentioned Toujeo or Prozinc as options for reducing his extreme spikes and dips.

After his second DKA hospitalization, I signed on to their 3-month diabetes monitoring program, wherein they analyze his sensor data twice weekly and propose changes based on the data. They had hoped to get him regulated within that period. We're 10 weeks into the program on lantus, and she wants to see if one of the other types of insulin could smooth out his curve in our two remaining weeks in the program. I'm torn, because I know the recommendation here is to stick with one type of insulin for 6 months. However, after the three month period ends, they'll start charging to review his data and make changes. I've never even heard of Toujeo and no very little about Prozinc. Ugh, so stressful.

Previous thread: https://felinediabetes.com/FDMB/threads/4-20-dimi-amps-346-relion.262255/#post-2939980
 
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@Bobbi Kraham
Have you read the 2 dosing methods for lantus
https://felinediabetes.com/FDMB/thr...-low-go-slow-slgs-tight-regulation-tr.210110/

SLGS: You hold a dose for 7 days (unless a reduction is earned). You decrease the dose when the BG falls below 90. The aim of this protocol is to keep the cat in the 90-150 range. This is more suited for caregivers who can't test as much as TR requires. You do a weekly curve with SLGS.

TR is a more aggressive protocol with increases as often as every 3-5 days. Reductions are earned when the BG falls below 50. The aim is to keep the cat in the range of 50-100 (which is the normal BG range for cats). To follow TR, you would need to get at least one more test per cycle in addition to the pre-shot one i.e. 2 tests per cycle or 4 tests per day. You would also need to be feeding only LC canned food and no dry food.
 
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Toujeo is U300...I personally would not be messing around with that in an animal as small as a cat, and with syringes that don't come as small/finely marked as we ever seem to need them to.

I would not use ProZinc, that is a bit of a step backwards in my opinion. It tends to be harsher than Lantus and often not enough duration in higher numbers.

Additionally, 2 weeks on an insulin is really not enough time for anything significant to happen - especially when you're waiting part of that time for the Lantus depot to drain and trying to figure out the other insulin dose.

I suspect a large part of the issue you have is that darn Libre. It looks like it may have been misleading you to reduce when you didn't need to. I'd give it at least another month of double- checking numbers under 90.

We also know low potassium can really mess with things, so hopefully getting that under control helps as well.

I'm sorry if Ive asked - what all lab work has he had done since diagnosis? Thyroid? CBC? Hematology, etc?

There is no harm in trying Levemir really, I know she didn't mention it but you thought she might. Just realistically I think you'll see more of the same on it, for more money. If it's a curiosity you need to satisfy, I get it. I tried all the insulins :rolleyes:
 
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If a cat switches to Levemir, it can take up to a couple months to see then flatten out, even up to three months. Two weeks won't tell you much. You could try it, but you can't reach a conclusion in that amount of time. Plus, there is the time to get the new insulin, so maybe not starting until next week, leaving one week to go.

Toujeo - just say no. It's a U-300 insulin, you can't make smaller than 1 unit changes. I've seen it used successfully in a couple very high dose cats. Dimi is on too small a dose, by far, for Toujeo to be effective. Prozinc, also the wrong direction.
Bobbi Kraham said:
However, after the three month period ends, they'll start charging to review his data and make changes.
Click to expand...
We cost nothing and can help you with those decisions, and to learn to make them yourself, if you follow one of our dosing methods.
 
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