8/18 Buddha -- debating switch from Lantus to Levemir

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Judging from the comments in your Lantus ISG thread and from the colorful look of Buddha's spreadsheet, I'd say stick with Lantus unless it's a cost issue for you or you want to improve your ability to give later, less 12/12 adherent shots.

Switching to Levemir and using it in the same dosing manner is going to yield pretty much the same results, because it's not the insulin that's the problem, it's the dosing. Switching to Lev and not making dose reductions when needed will result in the same frustrations. I agree with the comments that some cats need a higher threshold for dose reductions.

Has anyone recommended dropping back to .5U and essentially trying a reset? The idea is to allow them to level out and stop bouncing, then you gradually raise the dose until you see lower but steadier blood glucose values. Anytime you're getting greens at preshots with resulting 300s and even 400s the next preshot means the dose is too high.

With that said and you're really interested in the split dosing abilities of Levemir to extend duration, I can help with that. To extend duration you need to be able to give 2 half dose shots approximately 2 hours apart. So say you dose normally at 7AM. You give 1/2 dose at 7AM, then the other half dose at 9AM. That extends the duration to 9PM and further shots can be given at 9AM/9PM. When you need to get back to 7AM/7PM shot schedule you reduce the dose by 15% and give that reduced dose beginning the cycle before you have to make the shot at 7 instead of 9. You also give the reduced dose again at +10.

I cannot say how well split dosing works with Lantus. I believe it is worth a try. My concern in Buddha's case for using split dosing with either Lantus or Lev is that he gets on a more reliable dose. At present there is too much swing going on and split dosing techniques can exacerbate that effect.
 
I am intrigued by the notion of split dosing. This is not a technique that I've heard about.

As to .5u dosing with Lantus -- not something I would readily consider. Buddha has DKA in his past and I often feel as if I am too conservative in his dosing, not too aggressive.
 
I have to agree with Vicky that Buddha's numbers won't change on lev versus lantus unless the dose also changes. Lev would be a good insulin if, also as Vicky mentioned, you want to save money or shoot not strictly 12/12. Although, I bet you can actually do that with lantus, it just has never been "allowed" in the lantus protocol.

I also think that he is getting too much insulin. I think people take the mantra "shoot low to stay low" too literally. When we all switched from the faster insulins, like vetsulin, seeing PS's in the 100s, or even low 200s, was hard to get used to. I do not like to see full doses shot on 60s and then seeing that the cat has to be fed HC and/or the next cycle is high and flat, to me, just reinforces that it isn't productive.

Donna, if you don't want to start over at .5u, how about slowly stepping down to it? Go to 1u, then .9u, then .8u and so on, letting each reduction settle for up to 7 days. Swings from 40 to 400s is a clear indicator of rebound. What were the circumstances when he had DKA? Was that when he was first dx? If his health is good overall (no infections brewing), teeth are good, he is eating well, then ketones are less of a risk. Plus you can test his urine for ketones every day if you are concerned. Right now he is hitting 300s regularly and 400s on occasion. I think you will see better numbers on a lower dose - fewer 300s, no 400s and slightly higher nadirs (80-90 instead of 40-60). That alone will make him feel better.

Because insulin is a powerful hormone and the responses to it are complex, especially when it is overdosed (even slightly), more is not always the answer. And I don't think it is the answer here.
 
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