? 8/8 Levemir starting dose- Beenie

[Beenie (GA)]

I picked up our script today for Levemir. Will pick up from pharmacy tomorrow but I won't start it until the following morning (8/10/17) so I can monitor more closely during the day. Chatted with my vet a bit and he said to start at 1 U. That seems absurd when we're at 13.5 U now on ProZinc. I didn't press the issue and the fact that I disagree because I have you all . Where should we start? Will be at 14 U on ProZinc for tomorrow evenings dose.

Before I left his office I asked if he had any other high dose kitties. He said he does not but that's because I'm the only one who home tests so there really is no way of knowing with his other patients. Made me sad.

On a side note he is reaching out to MSU on the mailers he ordered since they haven't come in yet. Its been almost two weeks. I told him I'm very anxious to get that testing going...I need to know.

PS I saw this on FD Facebook group and though it was adorable so I had to share

 

[Tuxedo Mom]

1 unit is definitely RIDICULOUS!!!

Tagging @Wendy&Neko to get some advice for dosing with changing insulin types.

 

[Jill & Alex (GA)]

I picked up our script today for Levemir. Will pick up from pharmacy tomorrow but I won't start it until the following morning (8/10/17) so I can monitor more closely during the day. Chatted with my vet a bit and he said to start at 1 U. That seems absurd when we're at 13.5 U now on ProZinc.

Yikes! I agree with you. Starting over at 1u is crazy!
Double check with @Wendy&Neko . I think she'll suggest a starting dose much closer to what you're giving now. Probably around 13u BID.

 

[Beenie (GA)]

1 unit is definitely RIDICULOUS!!!

Tagging @Wendy&Neko to get some advice for dosing with changing insulin types.

Thanks! I kind of figured. I've scoured the big gulpers SS's and didn't see anyone drop dose that much when switching insulin.

 

[Beenie (GA)]

Yikes! I agree with you. Starting over at 1u is crazy!
Double check with @Wendy&Neko . I think she'll suggest a starting dose much closer to what you're giving now. Probably around 13u BID.

I was thinking 13 U but I'll wait for the big gulp crew to chime in. Thanks!!!

 

[Doodles & Karen]

Yes, I would hold off until Wendy responds. When switching from Prozinc to Lantus it's the same dose. However not sure about Prozinc to Levemir. When we swtitch from Lantus to Levemir the dose is reduced around 20%-30% depending on what the SS looks like. After looking at Beenie's SS and the fact that he's not anywhere near a "good" dose I'm thinking the 13u is ok to start with. Some kitties have a marked response to an insulin change so what ever dose is decided be sure you can monitor closely for the first 18-24 hours. Looks like you do that daily but wanted to mention it.

 

[Wendy&Neko]

Hi Michelle,

I will be back later with some thoughts on dose. I am currently in a ferry lineup. Knowing if Beenie is IAA or not would have been useful cause IAA kitties can have strong initial cycles after the switch. Check out Jack, @saltycat SS if you can. I will try to find a link when I got home if you don't have it then. Jack did the Prozinc to Lev switch and saw his first greens right away.

BBL.

 

[Beenie (GA)]

Hi Michelle,

I will be back later with some thoughts on dose. I am currently in a ferry lineup. Knowing if Beenie is IAA or not would have been useful cause IAA kitties can have strong initial cycles after the switch. Check out Jack, @saltycat SS if you can. I will try to find a link when I got home if you don't have it then. Jack did the Prozinc to Lev switch and saw his first greens right away.

BBL.

Thanks Wendy. Take your time. I posted now so that I/we have time to make a decision. I still have a few days worth of ProZinc left. If in the end if we take a more conservative approach I'm ok with that. I know with TR you can increase, if necessary, every 6 cycles. I've been increasing every 3 cycles to try and break the resistance. I'm going to check out @saltycat SS now.

 

[Beenie (GA)]

WOW I saw @saltycat SS. Switched on 5/28/16 and I can't believe the impact! Beenie has never seen any greens......can count on one hand the blues. Well this just proves I have no idea what I'm doing. I would have thought for sure start at 13U but now seeing the impact of salty cats SS makes me question it.
I plan on being home to monitor so I've got that covered, I literally have a Hypo tool box, its labeled and everything
I'm really only sharing this so you have a idea of the person I am. I'm super organized and want nothing but to give my little sweetie the best care. This may or may not impact your dosing advise but I think it will help
Thanks again!!!!!

 

[saltycat]

Jack was dx'ed with Acro and IAA. I think the big reaction when switching was due to the IAA. It had built up antibodies for the Prozinc, but had no idea how to attack the Levemir. After a few days the antibodies figured out the switcharoo and the dose started climbing again. It was definitely a shock for me since Jack had been stuck in high numbers and saw his first greens right after the switch. His reaction was more pronounced then most when switching but shows what can happen. Being home to monitor is a great idea since you have not had the acro/iaa tests done yet and Beenie might have a few surprises for you. I was glad I had gotten a hypo kit ready and the members here were very helpful since I was not accustomed to numbers like that and the reassurance helped keep me from panicking.... too much

I'm very glad I switched over to Levemir and hope Beenie gives you some good numbers after switching(in a nice controlled fashion). Let us know when you are switching over and I'm sure you'll have some extra eyes on his condo to help with some moral support and guidance if needed.

 

[Wendy&Neko]

I think that your starting dose will really depend on your ability to monitor. Most kitties making the switch don't have that strong a reaction as Jack. Chuck switched from Prozinc to Lantus April 3rd at the same dose and little drama. Here is his SS. I don't think the Lantus vs. Lev made the difference. He hasn't been tested yet, so we don't know if IAA is in the picture. Colin switched from Prozinc to Lev 9/25/2015, with little fanfare - Colin's SS. Sharon started him on a bit smaller dose. Colin is acro, don't know about IAA cause the vet didn't ask MSU for that test in spite of being asked to.

I do hope you have an extra package of test strips in that hypo kit - and chocolate for you!

 

[Beenie (GA)]

Thank you all for your comments. I'm a little worried now. I can monitor but I can't test as much as I'm seeing on some of these SS's (Jacks, Chuck,Colins...). When do you guys sleep?
I've become so used to flat numbers I'm nervous about all the dips and drops I see
I'm thinking of starting at 12 U and will monitor and see how Beenie reacts. See you all tomorrow morning

Thanks again

 

[Djamila]

Hi Michelle! I'm so excited that Beenie is starting on Levemir tomorrow, and hope it leads to some better progress. I don't know anything about Levemir, and have only been on Lantus for a little while, so I'm wondering what some more expert folks around here think about dropping 2 full units for your starting dose? I totally understand the concern if he over-responds, but you can't change doses as quickly as you could on Prozinc, so I'm a little worried about him going a couple of weeks with a dose that might not be enough. Hopefully by commenting here, it will bump your post to the top and get some folks who can chime in to either say that 12u is the best idea, or some other alternative.

 

[StephG]

Thank you all for your comments. I'm a little worried now. I can monitor but I can't test as much as I'm seeing on some of these SS's (Jacks, Chuck,Colins...). When do you guys sleep?
I've become so used to flat numbers I'm nervous about all the dips and drops I see
I'm thinking of starting at 12 U and will monitor and see how Beenie reacts. See you all tomorrow morning

Thanks again

I'm lucky to have DH who works a late second shift so he takes over a couple hours after I go to bed. We wouldn't get half as many tests if we both had first shift duties.
I think 12 units is a good start. My first thought was 13 but if you can't monitor too close then 12 is a good compromise.
Good luck with the switch! Safe surfing vines sent your way!!

 

[StephG]

but you can't change doses as quickly as you could on Prozinc, so I'm a little worried about him going a couple of weeks with a dose that might not be enough.

I'm not sure about levemir but with lantus once you get over ten, protocol says to increase by whole units. So it shouldn't be too long at the lower dose if it needs to increase.
With lantus TR protocol it's 5 days at the starting dose then increase, 3 days at new dose (unless you see greens you hold longer), then increase.
Are you following TR or SLGS? I must have missed that part.

 

[Jill & Alex (GA)]

I totally understand the concern if he over-responds, but you can't change doses as quickly as you could on Prozinc, so I'm a littlet worried about him going a couple of weeks with a dose that might not be enough.

With lantus TR protocol it's 5 days at the starting dose then increase, 3 days at new dose (unless you see greens you home longer), then increase.

One thing to remember that we often tend to forget...
There are always exceptions to every "rule". In a case like this, if it appears the Levemir starting dose was set too low, there's not a problem with taking the dose up sooner rather than later. Why allow kitty to hang out in higher numbers any longer than you have to if you can see the starting dose was off? For example, when Alex fell out of remission in 2009 I started her on 0.5u Levemir. It was a new insulin to her and I wasn't sure how she'd react. Within 4 cycles it was obvious the starting dose was too low so I increased to 1u bid after only 4 cycles at 0.5 unit. It was a good decision based on data and my experience level.

If Michelle feels more comfortable starting with 12u BID it's not a problem. Those with Lev and/or high dose experience can keep an eye on how Beenie is doing and help with dosing if it looks like the starting dose was set too low.

The main thing here is for Michelle to feel comfortable with what she's doing...

 

[StephG]

The main thing here is for Michelle to feel comfortable with what she's doing...

100% agree.

 

[Jill & Alex (GA)]

I'm not sure about levemir but with lantus once you get over ten, protocol says to increase by whole units.

Actually, that's not quite right. Over the years, increasing by whole units once kitty has reached 10 units BID is based on anecdotal evidence seen on on this forum. The TR Protocol suggests 0.5u increases for kitties receiving higher doses.


Edited to add: Unless it's changed in the last couple years, the German Board (where the TR Protocol originated), doesn't get overly concerned about high dose conditions until kitty hits around 10u BID. We've seen numerous benefits with suggesting acro/IAA testing earlier on the FDMB.

 

[StephG]

Actually, that's not quite right. Over the years, increasing by whole units once kitty has reached 10 units BID is based on anecdotal evidence seen on on this forum. The TR Protocol suggests 0.5u increases for kitties receiving higher doses.

I learn something new every day! I swear some vet's should be reading this forum every day too!

 

[Beenie (GA)]

Thank you so much for the feedback. Kind of threw me when the vet said to start back at 1 U. I'm going to start with 12 U tomorrow. I'll be posting tomorrow for sure. Wish us luck

 

[Jill & Alex (GA)]

Wishing you and Beenie the best!