Changing from NPH to levimir

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Linda and Scooter & Jack

Linda and Scooter & Jack

Member Since 2012
Hi Folks:

I ordered Scooter Levemir yesterday and I expect it will be here today or tomorrow. He has been bouncing around all over the place on NPH and the vet thinks this will be best for him. Her suggestion is to start at .5 for 5 days with triple testing for each shot. +2 +6 +9. So I am hoping to get advice from you all and make sure we are doing the best for my little old man.

Linda
 
I think that is a good plan, but be prepared to drop his dose to .25u if you get a huge response to the first few doses of lev or a very low number. It is easier to slowly work the dose up than figure out if rebound has set in and try to deal with it by reducing.

The reason I say that is because a) lev can have a dramatic effect on kitties coming from the fast acting insulins - like humulin and vetsulin, and b) his SS looks to me like he may be rebounding from a dose that has been raised too fast and in too big increments.

Please read the sticky notes at the top of this forum about lev.

It is important to remember that you do not make dose changes to lev based on preshot BG numbers. Dose adjustments are made based on the nadir number, so those spot checks the vet is asking for are very important.

Also, lev doses should be increased/decreased based on percentage of current dose, not set amounts like a half pr full unit. For instance going from .5u to 1u is a 100% increase and that can cause all kinds of confusing responses. We recommend no more than 20%, rounded to the nearest .25 (or less if you can manage to draw the dose - some increments take practice).

Make sure you are using u100 syringes with lev.
 
Oh, one more thing: you may want to vary your spot checks by maybe doing +2, 6, 8, 10 one day and +3, 6, 9 the next. Lev tends to nadir later - anywhere from +6 to +12, but +7 to 9 is common). I just think that one check between +6 and +12 isn't going to tell you the whole story.
 
Thanks Shelia!

I checked with my Vet based on what you are saying and she agreed to start at .25. She also thought that we can go up easier than come down. Scooter is a little kitty as well and reacts to things quickly so I loved your idea.

I did read all of the sticky notes about lev and my plan is to keep close to you all in the hopes that we can get him stable. Do you know where the spreadsheet for lev is found? My current one is 3 times a day of course.

Thanks you for your help.

Linda
 
I think the spreadsheets are all based on one. You can find the template in the Tech forum. Or you could just created a new header row across right below his NPH numbers and number it 1 through 12 (X2) instead of 1 to 8 (X3). I would insert a row above, merge all the cells, fill it with a color and write something like: START LEVEMIR in it. (see Beau's SS, click on the tab at the upper left that is called "Numbers", and look about a month down for where I started lev).

Otherwise, your plan sounds good. Do hold the dose for the full 5 days before considering a raise, and make sure you have located his nadir so you know how low he goes each shot.

Good luck! I think you will like lev over NPH, but it is a whole new animal and takes getting used to. You have to really forget almost everything you know about fast-acting insulin. That was probably the hardest thing for me to do after 2+ years with Beau on vetsulin.
 
Okay so Scooter just got his first .25 shot of levemir.
I am praying this works for him since 2 other insulins have not stabilized him.

What are the best brand needles for lev? I am using the relion 8mm 31 gauge and I viewed the 101 but was unsure if my dose was exact.

thanks,
Linda
 
Are the needles you got the U-100 3/10cc ones with the 1/2 unit markings on the barrel? Those are great when you are giving the tiny doses like you are for Scooter. I used the Relion ones, the 3/10 cc, short needle, 31 gauge. It's not so much what is best for the Lev insulin. It's what makes it easier for you to measure those 0.25U and 0.5U dose increments.

Good luck with the Lev! Hope Scooter regulates better on this insulin for you. It's a whole new ball game as Sheila said.

ETA: you might want to update your signature and indicate that you are now using Lev instead of Humulin and the date you switched. You can cross out the NPH (s edit command box about the posting text box) and add the Levimir.
 
If you have the 3/10cc with .5 unit markings, I think you have the best syringe type. The .5 unit markings are critical. You will never be 100% accurate in .25 u increments, but being consistent is more important.

Have you checked out the "drop method" photos linked in the Lev 101 sticky? There are photos that help explain the way to get those smaller doses. When I draw 1/4 u, I draw so there is just a hair line space between the bottom of the zero line and the top edge of the stopper flange (needle facing up) - because I know my syringe marking lines are just about .2u wide (they are actually .18u wide). What that gives me is maybe .22u or .26u or somewhere in between, but as long as I am consistent it doesn't matter what I call that, I just know the dose works (or not). Make sense?

I use Good Neighbor Pharmacy syringes that I order online. They work very well. I hate BD syringes as they draw bubbles and are impossible to "un-bubble". I have never used Relion ones, so can't comment on them.

Paws crossed for success with lev!
 
You know I feel like a fool I have no idea if I am using the needles you ladies mentioned.
I am however going to the city today so I will stop in to the pharmacy and get needles with the .5 since I am not using those. I have two kinds of needles. Relion and BD.

The relion box is marked 1/2 ml capacity 31 gauge 5/16" length Insulin syringes. It is marked in units. That is the one I used.
The bd is marked 1 ml 27G1/2 tuberculin latex free. It has many lines 10 tiny lines to .1 then more to .2 ect. It appears to be more precise. It is marked in ml not units.

I updated my SS and my signature but ran out of space so removed the NPH strike thru.

Thank you SO much!

Linda
 
Remember, the lev takes longer to onset, and the nadir is later in the cycle. No need to panic. Try to be calm. You're doing great.
 
Aw thanks Deb.

Yes it is coming down +3 is 454. He also grabbed the kittens mouse toy and was running around with it talking. I have not seen this in a very long time. :-D

Linda
 
So I am concerned that Scooter has been in the high 400's all day.
I know it's his first day but I could use advise. Should I just go ahead and give his 2nd lev shot at +12. I am assuming I should leave the dose at .25.

Linda
 
It's going to take a few days to build up that insulin depot with the Levimir. Usually it takes 3-5 days before you start seeing results.

Yes, I'd recommend going ahead and giving Scooter his next shot, the 0.25U at +12 (aka PMPS).
 
If the Levimir/Detimir forum is too quite, you could always post your question over on the Lantus TR forum. That forum is usually busier, later in the evening with all those west coast people posting.
 
Linda, I don't think you want to use the tuberculin syringes. They are for u500 insulin and the .05 line = 5u of lev and the .1 line = 10u of lev. It is NOT more precise in measuring u100 insulin. So, ditch those so you don't give an over dose.

I also agree to hold the .25u dose, at 12 hr increments for a few days - maybe 4 cycles. Has Scooter ever had an issue with ketones? Do you test for them? It might be a good idea to do so while he is settling out. Ask the vet about raising the dose after four cycles if you don't see a noticeable drop in numbers.
 
Hi Ladies:

well day two and we start off at 394 so I am excited about that. Hopefully he will be even better today.

I did ditch those needles and hopefully the weather will let me get to the city today to get the u100. I live in rural Minnesota and the roads have been ice.

I imagine just introducing myself at the lantus forum would be okay?

Once again thank you so very much!

Linda
 
I took your advice and I am getting amazing advice in the TR Lantus forum.
I raised his dose today to .5 after reading the TR Protocol.
So I will post his numbers over there. :razz:

THANKYOU!

Linda
 
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