On Thursday I wrote this in your thread on Health which asked if some cats don't respond to Levemir:
Most likely Buddy's is doing better because the 1U was not enough. 3U could very well be doing a good job at getting him down off the ledge and helping him feel better, but if it's too much Buddy could get in to trouble and experience a low.
I see he certainly does respond to Levemir, but what you are seeing with going from 500 to 111 is an example of exactly what I meant in that thread. Although he did not "get in to trouble" with a hypoglycemic low, he experienced a dramatic drop in BG which usually leads to what is called rebound, which is not bad, just very frustrating to deal with. Please read about that here:
http://petdiabetes.wikia.com/wiki/Somogyi_rebound
In our experience, the most experienced users of Levemir are on FDMB and the German Diabetes Katzen forum (although that is in German). Yes, that's right - here. Very few vets in the US even know about its use in cats. And even fewer know how to manage it. Levemir cannot be dosed like fast acting insulins, such as Humulin N or even Prozinc. Unfortunately my assumption is that your vet thinks it can be. That is not to diss your vet, he/she may simply not have access to the best information available on using Levemir.
Buddy is probably a good candidate for the Tilly Protocol. It was created by members of the German forum and has been medically published. Please read through it here:
http://www.tillydiabetes.net/en_6_protocol2.htm
The Tilly protocol is probably the best instruction for you and your vet to learn how to dose Levemir to achieve the best results. And as Lori said, testing before each and every shot is mandatory, as are mid cycle tests as often as you can at this stage. As Melissa said, I would move the time of your mid cycle checks to +8 or after. +5 is too early, although it is sometimes helpful to get tests even at +1, +2 or +3 so you can learn when Levemir starts to work.
500s are usually red flags and may indicate a rebound has taken place perhaps the cycle before. Rebound may be caused by sudden drops in blood glucose and not necessarily to low numbers.
I cannot stress enough that in a cat without other health complications, such as acromegaly, going from 1U to 3U on Levemir is, frankly, dangerous. And to do so without regular BG tests is even more dangerous. The 111 12 hours after the previous shot is a good indication he is getting too much insulin on 3U.
I'm not sure how you feel about staying with the 1.5U, but that is my advise at this point. Although it's higher than I normally recommend, he did not seem to have much movement on 1U and you said he seems to have done better at the 3U dose. However the 111 is an indication that the shed Melissa mentioned is full and spilled over, meaning 3U is too much.
We have to start at a lower dose to work up as the Tilly protocol mentions. Starting lower fills the shed gradually rather than suddenly. And yes it may take a while to get to the spill over point, which is why you did not see the 111 a week or more ago. He did not have the 111 simply because you increased that evening's dose "a tad," as you described. It was a few days in the making.
To reassure you about the numbers you are seeing - although hyperglycemia is not ideal over time, in the short term it is not as harmful to cats as it is to humans. Gandalf has had way more 300s in his diabetic lifetime than most humans could tolerate, but he is doing OK for a cat who's been diabetic for 6 years and will be 18 this spring. I don't like to see them, as I know they are harmful to other organs in the long term, but they are not as life threatening as hypoglycemia can be. High numbers are going to happen, especially in the beginning. You are doing the best you can for him and the hometesting part is very important, so the most help you can be to him now is to get on a regular schedule with testing. Then we can help you even more! As the numbers are sporadic now it's very difficult to tell how he's doing. I am just glad that you tested when you got the 111! Hopefully you are seeing how important it is.
Please do some reading and get back to us with more questions. Sorry this section was quiet today. I was at work all day and others probably had plans as well. Thank you Melissa and Lori for helping out and to Sue for alerting my via PM to your post here!
