Considering switch, need info

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Dragonfly229

Dragonfly229

Member Since 2012
Due to the shortage of ProZinc, and the fact that Linus has never had great numbers on it, I'm thinking it's an opportune time to change insulin and try something new. We are a busy family, and we do our very best with shot timing, but it's not always the perfect 12/12. Can we do this with Levemir? We can be up to an hour early and sometimes up to 2 hours late depending on everyone's activities. I do try to compensate when possible and split the time difference with the next dose.

Linus has been on ProZinc since January, his numbers are stable but not normal, 300-375 at pre shot, nadirs in the high 200's at best. I have tried to increase the dose, and he goes to high flat 300's each time. I am holding in the 1u to 1.4u range, shooting a little bit of a sliding scale. My spreadsheet is not up to date, we have been busy and out of town off and on, but I always test before shots, and in the middle when I'm around. You can get an idea of the kind of schedule we keep, though.

Any input appreciated. I would like to try something other than ProZinc, he hasn't done that well on it, and the only option left is to go for dramatically higher doses in hopes that that would force his numbers down instead of up. I need to call the vet for a prescription, and would like to have my ducks in a row when I do. Thanks!
 
Well, hello there Dragonfly! I remember you two from over in PZI land :lol: :-D .

Levemir, while it is best to dose on a 12/12 schedule we know we can't take our kitties EVERYWHERE with us and changes have to be accommodated.

It is a longer acting insulin so that might be what Linus needs and if you know your schedule changes in advance you could figure out the early/late dose needed to keep him as steady as possible.

Just remember to go for the pens instead of the vial as they will last longer even though they have a higher price tag you are looking at more than a half a years worth of insulin verses 2 months at best- big distinction to use all to the last drop or throw out half of what you bought b/c it went bad. Only us beans with acro cats and IAA (and cats named Missy) buy vials b/c they use them up fast :roll:

Has Linus any history with ketones? I ask because it does take a few days, for most kitties, to fill up the elusive 'shed' to where the insulin is at full force. not that he won't get any those first few days but really only about half of the dose instead of all of the dose.

Heather
 
Heather, thanks!
So let me see if I understand this . . . first doses of insulin (or late doses) go to fill the "shed", which is like a building full of insulin to draw from when there isn't any forthcoming. So it would seem to me that late shots are less of an issue than with ProZinc, because there is the shed to draw from? But the first of the next dose goes toward refilling the shed so it isn't available for use?

I'm sure my vet has never written a prescription for Levemir, what does it need to say? Does she need to specify the pens? Is Wal-Mart as good a place as any to get it?

Knock on wood, Linus hasn't had any issues with ketones, so hopefully this switch will go smoothly. I have the strips, he's an indoor/outdoor cat so sometimes hard to test but I'll try to catch him, and I'll watch him like a hawk for any symptoms.
 
Dragonfly229 said:
Heather, thanks!
So let me see if I understand this . . . first doses of insulin (or late doses) go to fill the "shed", which is like a building full of insulin to draw from when there isn't any forthcoming. So it would seem to me that late shots are less of an issue than with ProZinc, because there is the shed to draw from? But the first of the next dose goes toward refilling the shed so it isn't available for use?
Click to expand...

pretty much. If you shoot early that is like a dose reduction (as it is further than the next dose) and shooting late is like a dose increase for the next one (as it is closer to the next dose) so you increase or decrease the dose amount by how much you will be off- and, no, i don't know the formula for that one- I usually do 10-15% less/greater per hour I would be off :lol: .

I'm sure my vet has never written a prescription for Levemir, what does it need to say? Does she need to specify the pens? Is Wal-Mart as good a place as any to get it?
Click to expand...

Neither did mine- and this was the first time he saw Sneakers. I just printed off Tilly's protocol and some of the other stuff on Lev and said this is what i want. Then made sure to mention I wanted to pens like the articles suggested.

Knock on wood, Linus hasn't had any issues with ketones, so hopefully this switch will go smoothly. I have the strips, he's an indoor/outdoor cat so sometimes hard to test but I'll try to catch him, and I'll watch him like a hawk for any symptoms.
Click to expand...

Sneakers threw ketones- light ones mostly- back when we first switched to PZI from humulin. Mainly b/c she wasn't getting the insulin she needed being a high dose cat (acro cat so her dose currently is 22u BID) and then dropped her eating for the first round before getting into dry food and spiking up again.
 
Hi Sue & Linus.

(gotta correct something here: shooting early with lev = a dose increase and shooting late = a dose decrease. Heather, I'm not sure how you have that backwards...?)

I (me, personally and no one else) would suggest that you forget about the shed concept. What is really happening is dose overlap. The idea of the "shed" being a storage locker for insulin that is not correct. Lev and lantus work by being long acting and not entirely out of the system in 12 hours like ProZinc or other faster insulins. They have an onset, peak and fade out like any insulin, but it just happens (generally) more slowly. Also generally, a larger dose has a faster onset and longer duration and a smaller dose has a slower onset and shorter duration. Finding the right dose is a matter of finding the dose where onset overlaps fade out and produces a steady level of circulating insulin. Like this:

(this is a human lev curve. Cats don't really get 24 hr duration).

So, what does that mean for an "odd" schedule? You need to do some planing to accommodate changes. The more you can spread the change over multiple cycles, the better. For a "sudden" two hour delay you can split doses the shot before. Let's say you shoot at 8am and 8pm, but need to shoot at 10 pm one night. The dose is 1u. That morning you shoot .5u at 8a and .5u at 10 am. Then that night you shoot the 1u at 10 pm. Now you need to slowly back the time up to get back to 8a/8p. If you can't do it slowly, then you would need to reduce the morning shot by some factor. To shoot early, you can reduce the shot before the early one as well as the early one - so it gets complicated when you shoot late one night and then early the next morning (which you would be doing going back to the old schedule at the very next shot).

As you can see it isn't a matter of sliding scales, but it can be done. You need to gather data and find what works for your cat, but we can explain the basics. I never have to do a 14 hr cycle followed by a 10 hour one so I tend to slowly move things later and then slowly move them earlier.

Lev is a great insulin - very gentle. It seems to be more flexible (schedule-wise) than lantus. A box of five pens will last you a very long time. At 1u bid, they would last two years or something as each pen has 300 units in it. Many of us have used a pen to the last drop in 6-8 months with no problems.

You may need to raise him until he breaks through insulin resistance and/or glucose toxicity - based on the numbers you have been getting he seems to be sort of stuck. If you can keep his SS up to dat from now on, then when you get ready to switch it will be easier for us to make suggestions on doses, both starting and raising him. Gotta have the data to make the decisions....
 
Sorry Sheila- I always get things like that confused :oops: .

Plus you have a very good reason to not call it a shed and an explanation that I could actually understand :-D

I'm book marking this!
 
Thanks Sheila, I love the graphic, it makes sense. I have updated the spreadsheed, the most recent information is the second link in my signature, the first one with the older data isn't working. I have tweaked the spreadsheet a little so it makes more sense to me, and I can see where the shot times line up day to day. AMPS and PMPS are in colored letters, any other mid cycle tests have colored backgrounds. I haven't been around much to get mid cycle numbers lately, hope to do some tests this weekend.

No callback from the vet today regarding insulin, I'll try again to reach her next week, it's hard from work and I can't always take a callback. I'm running out of ProZinc, and given the numbers Linus has, I'm not sure how effective it still is.
 
Hi Sue -

Just saw you over here... I'm not around like I used to be. Hope Linus is doing well, and if you've transitioned to Lev, hope that's going well for you both. I think most of use that have switched are pleased with the results.

Grayson seems to be trending downward from his monster doses... and his numbers are looking much better than before. Not sure if it's just the Lev, the right dose, the SRT, the shape of the moon... but things are looking up for us! Hopefully the same w/ Linus soon!!!

Lu-Ann
 
OK, picking up rx this afternoon, and will get it filled so we can start this weekend. I've been using u100 syringes with ProZinc, the usual dose has been 1.2u, which is 3u on the u100's. My vet is suggesting 1u of Levemir in the am and .5 in the pm as a starting dose. How do those numbers sound? Should I start out even lower?
 
Levemir needs the same dose each time. And it may take a few days to notice improvement because of the way it is delivered,

If his dose is 1.2 on ProZinc and it is suggested to start at 50%-75% of the original dose I would maybe start at .5u for right now and give it 3-5 days to settle in as the first 3 days may be a wash as the... delivery system builds up. If he doesn't start into better numbers after 10 cycles then it is too low and you can go up.

If I recall there have been no ketone issues so if you have the ketosticks maybe just check once or twice to keep an eye on them.

Heather
 
I would suggest starting at .5u bid as well. If, after 3-5 days, the numbers are not improving then increase to .75u bid. My Cami was at 360, untreated, and while the vet suggested a 1u starting dose, I choose .5u instead because I know the second or third shot can produce a dramatic response. In Cami's case she hit 100 on her second cycle.

Just so we are on the same page: lev is u100 and so the doses are "straight" doses - no conversion or anything. Do you have the u100s that are 3/10 cc with half unit markings? They make dosing so much easier.

And, yes, same dose am & pm.

Good luck
 
Still on ProZinc, Linus threw me a bit of a curve yesterday, +7 was 87! He has never been that low. Back up to 147 in 2 hours, and back over 300 at PM shot time. I gave his shot in the morning after getting off a night shift, I guess I could have screwed up the amount, but I really don't think I did. I told husband to give 1u last night instead of our usual 1.2u, and I hope he doesn't bounce too high.

I was wondering if I should not give insulin at all today (Thursday) to give the ProZinc time to clear his system and then start Friday morning with Levemir?
 
I do believe ProZinc is considered out of the system by 12 hours as it is a short term insulin. So there is no need to wait.

Plus, since we don't know how much of the Lev Linus will get in the first few cycles that isn't necessary, either.
 
Nope, no need to "clear" the prozinc. It will be gone by the time you shoot the first lev.

That 87 is a great nadir. His response to it, rebound, just means he is not used to a low like that. Another reason for starting at .5u on the lev. If you start Friday am, be sure to get some spot checks in after the pm shot if you can. He may drop lower over night on the second dose - or he may do it on the third shot during the day Sat. After that, things tend to even out a bit better.
 
Hi Sue -

By now, you've probably gotten your Lev and started. I was gonna tell you that I found Walgreens to have a better price than WalMart. There's also a coupon on the Lev site that's worth taking with next time.

Hope you like the switch Linus! NO MORE PANCAKES!!! :o ;-)
 
Linus update 11/12

Yup, got it at my local pharmacy - I was using pricing the Levemir to check out this pharmacy as I needed to switch my personal stuff anyway. I probably paid too much by a bunch, but they were very helpful and got the rest of my business, too. Oh well, if it lasts longer than 6 months it's as cheap or cheaper than ProZinc anyway.

Linus numbers have been kind of high and flat until last night when they started dropping. I've been trying to graph this to get my head around how this is working, his nadir numbers have been the same or higher than his shot numbers, which has been weird. Hopefully things will start to slide down from here. It's been 3 1/2 days at this point.

I've had to slide backward a half hour at a time, need to give shots the rest of this week at 8:15am. I hope that's ok, he certainly hasn't had any numbers suddenly in the danger zone.

Spreadsheet is updated, it's SS#2 in signature.
 
Hi Sue,

Questions for the group...
It's been 5 days since Linus saw the pretty green on Prozinc. Since switching, pinks and high yellows. Has the bounce cleared from that low 5 days back? Is it time to consider an increase yet?

Carl
 
I wouldn't worry too much about the slightly higher numbers at nadir- he is really just basically flat, as you pointed out. The encouraging number is the 243 at 1730 this afternoon.

That one number alone says to me he may still be settling on this dose, but if you wanted to increase him, its probably ok - I would just go to .75u. Some of us have found it best to think of dose changes in percentages - so going to .75 is a 50% increase - which is a big percentage increase, but the next easiest to do (as compared to .6u, say).
 
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