Boo Radley changed to Levemir

Status
Not open for further replies.

Jessica & Boo Radley

Member Since 2011
We've had quite the journey with diabetes over the past 8 months. Boo Radley was diagnosed in Aug of 2011 in DKA. We started out on Lantus at 0.5 U and climbed as high as 4.0 U, and tumbled back down to 0.5 U using the Tilly protocol. My spreadsheet doesn't include 2011 #'s because we were one of the unfortunate ones using the Freestyle Meter....at the end of 2011, we ended back up in DKA because we thought the numbers we were seeing were reliable, only to find out the beautiful blues and greens at 0.5 were really pinks and reds. At the hospital in our second DKA, my freestyle meter said 150....the vet's number said 480. (I'd be happy to send anyone that data for reference, but there's just no telling what's true and what's not). We've since switched to the Relion Meter and have found to be within 30 points of the vet numbers.

In January, coming out of that 2nd DKA, my vet convinced me to give Prozinc with Regular bolus doses a try. After a couple of weeks I knew it wasn't the right decision, so back to Lantus we went. I kept using 0.25 bolus doses of Regular if we were above 350 (the brown R on my sheets represents a 0.25 dose). We started at 1.0 in Lantus and worked back up to 2.25 U before we started seeing some better numbers, tumbled back down and then back up (again following the protocol).

I began to read and watch the Levemir board and some things resignated and peaked my interest. Boo has the big swings on other insulins that people were talking about over here. Once thing I've learned with him over the past 8 months is that he is very, very sensitive to low numbers and is spectacular (if you want to call it that), at protecting himself from hypo's by throwing out tons of glucagon. Bounce, bounce, bounce....... the downside of not having to worry about lows.....2 DKA's later....is the highs.

I started on 1.0 U of Levemir in my heart thinking and worrying that it wasn't enough insulin (so after just a few short days and a few bolus doses of R....I upped him to 1.5 and cut out R all together). We're in our 6th full cycle at 1.5 and I'm just not sure what to do....is it too much insulin, is it too little? I'd love to hear anyone's thoughts....

Here's just a bit more info:

Feed Fancy Feast Classic
Shoot almost religiously on a 12/12 cycle (once in a blue moon we have to alter)
Relion meter, home test
Boo is 4y/o, weighs 11 lbs, HIV positive but not sick
 
Welcome to lev!

Is the whole top part of the SS actually lantus and not PZI? Or did you start on PZ this year and then switch (there's no note in the SS when you went back to lantus).

Anyway, I think that you will find that you don't need R with lev because it won't cause the spikes on lantus. But you may be looking at getting to a higher dose. It seems like you started seeing some blues and greens after you got to 2u - 2.5u of lantus.

Normally, I advocate for lower doses when there are swings to help flatten the curve and stop the swings, then the dose can be slowly raise, but with his DKA history I don't think that is a good idea. I am sure you feel that way also. Some cats take longer to settle on a dose - the sensitive ones seem to fall into that category - and allowing 5 days to settle on a dose and slowly increase by about 20-25% helps to keep the swings from starting up again. I'm not sure how you feel about that with his DKA history. I'd just hate to see him start swinging again on lev. Maybe go to 1.75u next, settle, then 2u, settle, then you can go to .5u increases.
 
Thanks for the welcome and advice!

The whole spreadsheet you are looking at is Lantus beginning 1/18/2012, with a change to Levemir on 4/5 in the p.m. cycle. (I do have Lantus data from 8/1/2011 through 1/3/2012 and Prozinc data from 1/3/2012 through 1/18/2012, but have it separate to try to keep things less confusing).

I'm definitely cautious about going down vs. up because of his history with DKA's (and also his HIV status,....making him more prone to UTI's).... but knowing I'm cautious, leads to me to want to get some opinions to ensure I'm not just being overly cautious and jumping to my "safety" of wanting to go up.

From looking at others sheets, it seems sometimes the higher numbers are a reaction to too much insulin and I am intrigued about that with Levemir, the high numbers often respond to a reduction vs. an increase - (this obviously didn't happen for us with Lantus). For Boo, in my Lantus history, he gets better numbers on higher doses, but can also tend to bounce and swing more once he gets a good number.

Your thoughts sit well with me (increase and settle, increase and settle).....and it's good knowing your experienced eyes aren't seeing a "too much Levemir insulin" reaction. ;-) ;-)
 
Yes, we do see a lot of cats with higher numbers that are getting too much insulin. I look for periodic drops to fairly low numbers followed by high flat numbers, or deep swings. Or flat numbers higher than about 350. These can all indicate rebound with a cat on a low carb diet and no other significant health issues.

If you slowly raise the dose until he responds, but then he drops low, that warrants a decrease. If the numbers then flatten out again, I might suggest another small decrease to see if that can induce better numbers. I had a point where Beau was dropping low on .5u, but flat on .4u. I ended up going back and forth on those two doses a few times until I realized he was rebounding on both doses and dropped him to .3u. That did the trick and his numbers started to fall. Sometimes they need to "break-through" on a higher dose before being slowing reduced. Seems like you saw that on lantus with Boo Radley.
 
High there you two.

I'm so new my levemir title squeaks when I turn around so I'll just stick to WELCOME!
 
Status
Not open for further replies.
Back
Top