A note on consistency (x-posted from Lantus ISG)
Unfortunately, consistency doesn't mean a whole lot when the dose is too high to begin with.
More and more we are seeing cats coming from another insulin to Levemir who begin at too high of dose because it was based on their previous insulin's dose or because they read the Tilly protocol and see 1U or the weight recommendation. I spouted the begin-with-1U mantra for years myself.
It wasn't until Sheila came to the Lev ISG with Beau, that I learned that Levemir is the Gentle Giant. After 2 years on Vetsulin Beau was OTJ on Levemir within 3 months because Sheila identified he was rebounding on even .5U. Even such a tiny amount can wallop diabetes!
500s and 600s are not "normal" BGs for Levemir. Forget that "Levemir can't handle those numbers," we are seeing that with Tom it evidently can.
Think about that for a minute. 1U of an insulin notorious for not being able to handle extreme rebound numbers (500+ is almost always a rebound number) is dropping Tom by over 300 points. Why do you think that might be?
Because the 1U dose is too high.
Levemir likes consistency, yes, consistency in time, consistency in dose and consistency in blood glucose. You must allow Levemir to level out the blood glucose before you can begin to say you're close to an optimum dose. The way to do that is the start low and go slow approach. And the thinking needs to become very low dose, like .5U.
Yes, we bang that drum pretty loudly in Lev ISG. That's because it works. I don't mean to belittle any of the advice that's been given so far, but telling Lori to maintain a too high dose is going to continue to cause her upset and confusion because that's what doses that are too high do!! They create irrational patterns and the caregiver is left bewildered.
Lori, the .6U did not "work" because it needs time to work. You will rarely see a reliable trend with Levemir after 1 use of a particular dose. Please consider the possibility that Levemir will make you rethink everything you thought you knew about Tom's diabetes. You may have instinct about Tom, but not about Levemir. You cannot force it to work the way you think it should or will or the way PZI worked for Tom.
I know you are seeing 2 camps of approach right now - the 1U camp and the lesser dose camp. So ask yourself, is the 1U dose working? No, it does not seem to be. And very unlike PZI or Prozinc, you cannot throw more Levemir at higher BGs. That only compounds the problem of a dose which is already too high.
If you are ketone testing regularly (you are, right?), please consider going to .5U and maintaining as close to 12/12 schedule as you can (no more than 30 minutes either way if you can absolutely help it) through the weekend at the very least, then re-evaluate his progress on Monday. I am willing to bet you'll see a difference. That's what it's going to take to get these numbers to calm down. You have to work within the strength of Levemir, which is to maintain a steady level of blood glucose. Not the curves you see with faster acting insulins. Even a tiny dose is capable of that and when several of us very experienced Levemir users see 500s, the too high dose bell goes off.
BTW, Tom chasing butterflies reminds me of Gandalf after 2 weeks on Levemir outside catching a mouse! He had come off 2 1/2 years of swinging numbers on PZI and felt fabulous. So take heart and watch Tom playing - he doesn't know his momma is having trouble helping him. He knows he feels darn good and despite the difficulties, you have Levemir to thank for that, so I hope you'll keep an open mind and keep learning what others know about Levemir instead of trying to shout everyone down.
