Day 1

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Today is Buddy's first day on Lev, my first day of home testing, first day on the board, rather unfamiliar with terminology and feeling a bit overwhelmed. Buddy was diagnosed 11/19/10 with BG of 454. Vet prescribed 3 units of Humulin 2X/day. Buddy's 12/13/10 vet visit revealed BG reading of 127. His 1/10/11 visit revealed BG 264. Increased Humulin to 4 units. His BG on 1/14/11 revealed 335. We started on one (1) unit of Lev today (on 7am/7pm schedule). Unsuccessfully attempted to test him in morning. Successfully tested at noon and his BG was 376; tested again at 9:30pm and BG was 390.
We're heading in the wrong direction but guess it should be expected this early in the switch in insulin, right? Buddy is 8 years old. His food of choice all of his life has been Fancy Feast and just this week eliminated dry food. How long does it usually take for the lower numbers to kick in before increasing dosage?
Thanks in advance to anyone out there willing to offer advice.
 
First I would like to welcome you to this site. You are off to a good start on several things: Levemir is a good insulin for cats, you started on a lower dose and you are home testing. You get four paws up for that! In general, you should hold a dosage for at least three or four days before increasing it. When you do increase the dose it should be done in small increments of a half unit or a quarter unit at a time. It is generally better to have the numbers too high then risking your cat going hypo (too low). I would also encourage you to test your cat for ketones if you aren't already. When the blood glucose levels are high some cats can develop a condition called DKA when the ph of the blood becomes too acidic. This can be life threatening and very expensive to treat.

Since my cat is on Lantus and I do not use the TR model, I will try to get some people from the Levemir support group to give you some additional feedback. Good luck to you and your kitty!
 
Fantastic job getting started and welcome to the Vampire Club!

One more thing. A spreadsheet will help you see trends and patterns as it is color coded. And when you want advice, it will help members see what your history is with bg levels and doses. Here are the instructions: Setting up a spreadsheet If you need help, just ask.
 
Welcome Bel & Buddy!

I know those high blood glucose (BG) numbers seem like he isn't responding, but it is important to not raise the dose right now for a variety of reasons.

1) levemir takes several days to settle after you start and after every dose change. In the beginning you should allow at least 3 days, and 5 to 7 would be better.

2) Dose changes should be made based on what is called the nadir - the lowest BG of the 12 hours cycle - usually around 6 to 9 hours after the shot with this insulin, but it could be earlier or later, especially when the dose is not quite right (too high or too low).

3) I am pretty sure he was in what is called rebound on that high dose of humulin. From what you have posted, he was started at too high a dose and raised from there. The starting dose should have been 1u twice a day (bid).

Rebound causes them to release stored glucose and the stress hormone cortisol in order to fight off a hypo situation. The body senses the BG dropping too far or too fast and reacts with a flood of glucose and hormones. This will cause the BG to soar very high. Each dose increase after that will make it worse until the body can't fight it anymore and has a serious hypo.

So, for now, keep the 1u, get your testing process down be testing before every shot and in the middle of the cycle at random times. Write those numbers down and post them here like this:

amPS - 350, shot 1u
+3 - 275
pmPS - 325, shot 1u

amPS = morning preshot number, +3 = 3 hours after that am shot, pmPS = evening preshot.

There is a possibility that even 1u is too much for him, as there are a lot of cats on Lev at less than 1u bid, and you have just eliminated the dry food that really contrubutes to higher BGs, but let the 1u settle and we can see how he is doing on it.

Ask questions. Here is a link to some basic info on using levemir: http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=682
 
Sue and Oliver said:
Fantastic job getting started and welcome to the Vampire Club!

One more thing. A spreadsheet will help you see trends and patterns as it is color coded. And when you want advice, it will help members see what your history is with bg levels and doses. Here are the instructions: Setting up a spreadsheet If you need help, just ask.
Click to expand...
Thank you for advise .... I need all I can get. Once I'm able to get on some kind of pattern I will do so. The blood testing attempts are not going well. He totally hates me now. I've attempted twice so far today with no luck. I'll keep trying.
 
Do you give him a treat afterword? I use pieces of boiled chicken (zero carbs).

Also, are you using a rice sock to heat up his ear beforehand? It makes getting the blood drop much easier. Fill a thin cotton sock with raw rice, knot off the top (or sew closed), heat in the micro until very warm, but not too hot (I do 35 seconds in my micro, which is an older model). Hold it over his ear edge for about 10 seconds (more or less depending on how tolerant he is and how warm the sock is). That will dilate the blood vessels. Be sure to aim for the tiny strip between the main vein and the edge. I do two quick pokes right next to each other and I have the strip in the meter ready to sip. If he wiggles too much, you can transfer the drop of blood to something like the edge of a used strip to test when you let him go. Press a bit of tissue over the edge of the ear with gentle pressure for a few seconds and let him go. Test the drop and give him a treat, tell him he is the best kitty ever.

I use only one kind of lancet and I hold it in my fingers (freehand) for better control over the lancet pens. The only lancets I like are BD Ultra Fine II ones. I have tried a bunch of different, cheaper brands, but the don't work well. It's like they aren't sharp and don't glide right in like the BD ones do. Plus, the cats act like they hurt, even yelping a bit. To me they make all the difference in the world in getting the cat to tolerate testing. Beau was always very patient with me. I learned on him! Now that I don't test him very often (he is in remission), he is less patient with me. Jeddie, on the other hand bit and fought and scratched. I got a bad bite from him early on (but he had just been rehomed so was not in a great mood anyway). I had to wrap him in a fleece blanket with only his head showing, and hold it snug under his chin with one hand and test with the other. But now he sits quietly and sometimes purrs. Its the treat afterward, I am sure of it.
 
Hometesting can be scary even for us old timers. I can test Tucker in the dark (okay - not really), but my newly adopted FD Kiki, well testing her has been so hard and so frustrating that I feel like a failure at times. I'm giving treats with each and every test and slowly she's coming around, so please don't be hard on yourself, I've been testing cats for a long time and I can promise you, it does get better.

Now that you've removed the dry food, the BG should start to come down a bit naturally so I would hold the dose for a bit.

Is there any particular terms you find confusing, you mentioned the terminology in your first post? Did you see the glossary that we have? I'll link it here just in case:
viewtopic.php?f=14&t=1124

Please feel free to ask lots of questions, anything at all, we're happy to help. Looking forward to hearing more about you and Buddy.
 
Sheila & Beau & Jeddie said:
Do you give him a treat afterword? I use pieces of boiled chicken (zero carbs).

Also, are you using a rice sock to heat up his ear beforehand? It makes getting the blood drop much easier. Fill a thin cotton sock with raw rice, knot off the top (or sew closed), heat in the micro until very warm, but not too hot (I do 35 seconds in my micro, which is an older model). Hold it over his ear edge for about 10 seconds (more or less depending on how tolerant he is and how warm the sock is). That will dilate the blood vessels. Be sure to aim for the tiny strip between the main vein and the edge. I do two quick pokes right next to each other and I have the strip in the meter ready to sip. If he wiggles too much, you can transfer the drop of blood to something like the edge of a used strip to test when you let him go. Press a bit of tissue over the edge of the ear with gentle pressure for a few seconds and let him go. Test the drop and give him a treat, tell him he is the best kitty ever.

I use only one kind of lancet and I hold it in my fingers (freehand) for better control over the lancet pens. The only lancets I like are BD Ultra Fine II ones. I have tried a bunch of different, cheaper brands, but the don't work well. It's like they aren't sharp and don't glide right in like the BD ones do. Plus, the cats act like they hurt, even yelping a bit. To me they make all the difference in the world in getting the cat to tolerate testing. Beau was always very patient with me. I learned on him! Now that I don't test him very often (he is in remission), he is less patient with me. Jeddie, on the other hand bit and fought and scratched. I got a bad bite from him early on (but he had just been rehomed so was not in a great mood anyway). I had to wrap him in a fleece blanket with only his head showing, and hold it snug under his chin with one hand and test with the other. But now he sits quietly and sometimes purrs. Its the treat afterward, I am sure of it.
Click to expand...
Hi, thanks for advice. Yes, I am microwaving rice-filled sock, treats afterward, the whole bit ... it's just that he is squirming so much, fighting the procedure, have tried different positions and if I do get the needle in many times it's not deep enough to produce any blood. I'm using the free hand poke because he did not like the sound of the "click" with the "cocked" tester. It's just going to take a lot of practice; right now it's just very, very frustrating for us both. But I'm not giving up.
 
Some people use the clothespin trick to keep their kitties still until they get used to testing: Clothespin trick It mimics the way a mother cat holds her kittens by the nape of the neck. You usually don't have to use it very long - just until you both figure out the way it will work best for you.
 
Welcome Bel,

Sheila did an excellent job of outlining how to approach dose changes on Levemir.
At this point, I hope you will continue asking questions, both about home testing and the insulin you are using, which is one of the best there is for cats, IMO.

There is no need to get to the spreadsheet right away. Posting numbers as Sheila described is fine. The main plus to a spreadsheet is it makes it easier to identify patterns in the BG changes.

Let us know what we can help with.
 
(It looks like my earlier post didn't make it.)

Welcome, Bel and Buddy, to the best place you never wanted to be. You've gotten alot of great advice. You are doing well, and hopefully Buddy will soon cooperate with the testing.

You also could slide the blood drop onto your fingernail and test it from there.
 
tuckers mom said:
I would suggest the One Touch Delica lancet device. It costs about $20 but it's worth it. Very delicate and comfortable strike.
Click to expand...

Bel, that lancet device takes a special lancet, not the "universal" ones that you have. If you get it, be sure also to get the Delica lancets.
 
Hi Bel!
I had similar troubles when I first started testing... squirmy cat and a nervous me made for some tense and upsetting attempts at getting blood. I think my first post I mentioned that the only blood I got was from my own fingers.

I just couldn't poke the ear freehand. (I still can't!) I wasn't as quick jabbing as the lancet device and BigMac clearly didn't like it. So I started clicking the device next to his ear without actually poking him. Click - click - click to get him used to the sound as I rubbed his ears. I was trying to condition him. Then someone told me to try really hard to be confident and tell myself "I can DO this." So my cat wouldn't sense my tension. I told myself and my cat... "I am going to do this because it will save your life, BigMac. YES, I am the boss here!"

I am not sure if it helped BigMac, but it sure helped me, hahaha! I still struggled a bit, but it did become easier. Another thing that many people do is to pick one location in your house to always do the tests. Then the kitty becomes used to it and knows he will get a treat when he is at his testing location. I put my cat up on the kitchen island because of the good light and I don't have to bend down. Up on the counter I can get a good grip on him without too much difficulty. These days, BigMac hops up there on his own as soon as I pull out the bar stool. He knows it is time for a treat... and he accepts that he will get a poke.

And one last thing, Bel. I use Neosporin ointment with pain reliever on the ear just before I warm it with the rice sock. I put a dab on and gently wipe most of it off leaving a thin film. Sometimes there is too much goop and I use the rice sock to wipe it away more as I warm up his ear. Maybe that helps numb the area a little and the ointment film helps the blood drop bead up just a bit instead of disappearing into the fur.

Sometimes I tested by using the inside of the ear because I had trouble seeing the blood drop with BigMac's dark furry ears.

Oh, I forgot to say... Welcome to FDMB! It's great to see you here! :RAHCAT
 
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