Welcome to the FDMB!! Great job getting Jerry’s SS up and running and home testing. You’ve been doing a great job at testing during the day lately!
I’d just like to clarify a few things to best help you.
If you would like to change to levemir, it’s an awesome insulin and there’s no need to use lantus if you and your vet have determined levemir is the one you want to use. They are both long duration insulins. They differ in the method in which the insulin is actually released to the body but they have the same potential to deliver nice, long flat curves. I’ve used both and switched from lantus to levemir just because lantus wasn’t working as well
for Gracie but every cat is different (ECID). The other differences are in terms of onset and nadirs. Some report that levemir can also give longer durations but, again, ECID. Lantus, in general (again..remember ECID so this can vary), onsets about +2 and a “typical” nadir would be around +6. Levemir onsets, generally, around +4 and can nadir anywhere between +8 and +12. (The plus numbers are the hours since insulin was last given). Lantus may sting some cats but for others, even 2 or 3us may not bother them. Unlike the shorter or medium duration insulins, lantus and levemir are dosed primarily on the nadir with some consideration given to preshot BG instead of being dosed just on the preshot BG.
Levemir is a long lasting insulin and as you know, works differently than the Humulin NHP you've been using, so my thinking would be that you'd want to start off as if starting from scratch. The usual starting dose for Lantus and Levemir is calculated as 0.5u/kg of weight twice daily. You'd calculate Jerry's weight in kg by dividing his weight in lbs. by 2.2. Then take his weight in kg. and multiply that by 0.5 to get his starting dose.
Unfortunately, this is not correct advice. Those starting doses are used when cats have not been on a previous insulin. If a cat is on another insulin that is not one of the L insulins (lantus or levemir), we take the current dose and patterns into consideration. Also, the starting dose quoted above, if the cat is new to insulin, is for those who plan to use the tight regulation protocol with lantus or levemir. If a caregiver plans to use the SLGS approach and is new to any insulin, the starting dose is not calculated as shown by Linda.
Edited to add: I neglected to mention that the formula for starting dose for Lantus/levemir for the TR protocol for cats new to any insulin is not 0.5u/kg. It is 0.25u/kg of
ideal body weight. If kitty is underweight, one would use kitty's current weight.
Just also want to clarify here that SLGS is not a protocol. I want to be sure you have the correct information. The Tight Regulation Protocol is based on scientific research. SLGS is an “approach” or “methodology” based more on anecdotal information, not scientific research, and is, therefore, not a protocol. Both have the ability to get cats well regulated and into remission although the TR protocol is more aggressive and has a fairly decent track record of remission. I like to suggest that new members focus foremost on getting kitty regulated and so the important decision for you is whether the TR protocol or the SLGS approach is best for your ability and availability to monitor Jerry. We do have a lot of members who work and do the TR protocol but it’s best that you read about both and determine which is best for the two of you.
Sorry to go on all about that before getting to the dose questions but it’s important you receive correct info as well as others who might be reading but not asking questions.
When I’m looking at Jerry’s SS, he has seen response to insulin even at 2.25u (and by response, I mean normal numbers on the AT). In fact, he’s seen some normal numbers at 2us on the AT. The reason I think you are seeing so much black is that Jerry is dropping on you, particularly at night when you have no data. Many cats tend to go lower at night. When the BG drops fast, drops lower than the cat is used to, or drops low (as in below 68 on the AT), it causes the liver to release counterregulatory hormones which drive the BG back up to keep kitty safe (we call this “bouncing”). Bounces can take up to 72 hours to clear but Jerry looks to me like he’s clearing them faster on some days. I would encourage you, no matter which insulin you switch to, to try, at night, and get at least a before bed test on Jerry. The more data you are able to build, the more you will be able to help Jerry flatten out and minimize his bouncing.
Because Jerry has seen some response into lower numbers at 2u, I would suggest that’s where you start with the levemir. The more spot checks you can get on him, the better you will be able to tell how he’s responding and I’d encourage you to monitor him closely over the next few days when you switch. While lantus and levemir both have depots that typically need to build, we have, on occasion, seen a fast response. You can shoot the NPH one cycle and the levemir the next. From experience, I’d recommend you start the new insulin during the day
There are just a lot more eyes around to assist you.
You might also want to post in the Lantus and Levemir Insulin Support Group on this forum. That’s where the majority of L/L users are and there are a lot of very experienced eyes there to assist you. There is also a plethora of information (in the form of “Stickys”) in that ISG that can help you determine whether you want to do the TR protocol or SLGS approach. There is also information regarding the difference between lantus and levemir, how to properly store and handle it, etc. The wealth of information is astounding and should help you as you move forward.
Please let us know how we can help.
