Lev starting dose

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Charliemeow

Charliemeow

Member Since 2010
I've gotten the ok to start levemir now. Charlie is on 7.5u bid of prozinc. Vet wants to start lev at 4u bid. I'm inclined to agree with this beginning dose. Any opinions? I'm going to shop prices tomorrow and probably start it on Saturday.

Thanks!
 
Without a diagnosis of acromegaly which requires larger doses of insulin to regulate, I cannot agree with a starting dose of Levemir any higher than 1U.

Charlie has not had a great response to prozinc from the looks of his spreadsheet, so at this point he probably has some insulin resistance going on. And starting at 4U of Levemir could just continue that trend.

Have you inquired on the high dose/acromegaly ISG about indicators of acro?
 
I would want you to get as many thoughts on this as possible - more of what worked for others on high doses.

IMO, 4u is a HUGE starting dose. It is less that the 70% of previous insulin recommended in the stickies. However, we see so many cats here on much less insulin than that and for most cats the starting dose should be .5u - no more than 1u.

You should post your question on both the High Dose ISG (for acro/cushings/IAA) and the Lantus ISG - make your subject line "Lev starting dose for higher dose kitty" so you can get some of those with specific experience to chime in.

ETA: Just looked over his SS again. He really had the same numbers on 2.2u as he has since then no matter what the dose. It is possible that PZI just doesn't work for him, but changing to another insulin may give dramatic results. An overdose hypo on lev is a much different thing that on the faster acting insulins. So, given that, I would not start at higher than 1u. You can raise in .5u amounts every 3-5 days if his numbers are showing NO changes. I just don't think 4u is safe.
 
Vicky- I know there's the possibility of acro/iaa but the tests are on the back burner for now. I just don't want him back in the 600s again, and I pretty much know that's where we'll be if we start over at 1u.

Sheila-I just posted on the acro group, I'll copy it over to lantus. Thanks for the tip!

Thanks a lot!
 
Glad you received the ok to start Charlie on Lev. I think you are going to love it! I will say that so far, Lev has been a totally different animal than prozinc. I agree with Shelia that you should start Charlie on 1u. I know that's hard given that Charlie is up to 7.5u, but it's a different insulin and you just don't know how he will react to Lev. I can't wait for you to start. :smile:
 
LOL! While I was off hunting Marcy and Klinger's SS to post as an example of why it is good to start at 1u, she was actually here posting the same thing! LOL!

Anyway, I was going to post to take a look at Mars72 SS as a prime example of why starting Lev at 1u is a good idea.... here is her SS link or you could go through her sig in response above mine: https://spreadsheets.google.com/pub?key ... 0S2c&hl=en

If you look back at her "NUMBERS" heading, that will show you she was up to 7u on Lantius, then her PZI was in the 4U to start I think- or thereabouts and it was really never very successful...when she started over at the 1u on Lev, no the numbers were not good, but in short order she is starting to see that the optimal dose is in the neighborhood of 2.75 to 3.0....if she had started at the 4u or more, she would have bounced all over, continuing those high reds until she finally decided to start over at 1u and then still had the climb at .5u intervals to find the 2.75ish that may work for her and Kilinger (knockwood,antijinx)

I can't access your SS for some reason, so I am taking a stab in the dark to assume the PZI isn't working for you guys, regardless of the dose....

It would be my suggestion also to start at the 1u, hold each dose for a MINIMUM of 6 cycles ( I prefer to hold 10-12 cycles) and then step up by .5u if you are in reds- be sure to check ketones along the way, of course....if you are getting some response, you may want to consider stepping up by .25u, but we can deal with that when the times comes.

Of course, we don't want your cat in the reds either, but no matter which way you look at it, there will be some settle time...You will likely have higher numbers anyway, and assuming you are having high numbers on PZI and that is the reason for your switch, what would it hurt to just start over at the begining and seek the optimal dose faster- from the bottom up, rather than top up, then down, then up again.

Unless the acro beans indicate otherwise, I agree with the 1u vote.
 
Thanks, Melissa, for pointing out Klinger's progress and writing up such a good example as to way starting at a low, safe dose is preferable to starting so high.

It did not take Marcy long to get to a better dose for Klinger and starting at a lower dose did not put him in danger. You have the correct tools such as ketone strips and know how to use them to keep Charlie safe. The BG should not get any worse than it already has been even if 1U is not enough. Please test for ketones maybe a little more frequently than you have been, especially as long as he is under treatment for an infection.

I see you had trouble with the Clavamox, that is not unusual. Gandalf pukes it up too.
 
Charliemeow said:
I've gotten the ok to start levemir now. Charlie is on 7.5u bid of prozinc. Vet wants to start lev at 4u bid. I'm inclined to agree with this beginning dose. Any opinions? I'm going to shop prices tomorrow and probably start it on Saturday.

Thanks!
Click to expand...

I am wondering if it is wise to start a new insulin (any insulin) if Charlie is still on antibiotics. You said his toe is better (in another thread) but that you might have to go another round with the ab's?

I just think it complicates things a bit as you are trying to find your right dose with the Lev.

Also, just as an aside, you mentioned if the Clindamycin didn't work your vet was thinking about giving an ab in shot form. If you go that route for this second round (doesn't sound like he is having any problems with the Clindamycin though) please make sure it isn't Convenia. Dr. Lisa has posted about the dangers of using this AB and many vets are still using it. Just making sure.

http://www.felinediabetes.com/phorum5/r ... sg-1905168

P.S. I am also in the camp of starting over with one unit, but with an infection present that would be risky too. Glad to see you are getting lots of other opinions in the other forums. :)
 
I may be able to stretch my prozinc to last thru the ab's, but I'm not sure. We don't have a lot left and I really don't want to buy another vial of it. I see your point though. His toe is looking better, not as red...more pinkish, but still a bit puffy. So I'm really hoping we don't need a 2nd round. The injectable ab's were only going to be an option if he had a bad reaction to the clindamycin. Thankfully he is doing just fine with them. He loves that he gets a little treat when he eats them. So, no injections for this booboo. Thanks for that info on the clovenia though.

Based on the advice of the high-dose moms I think I will follow the vets instructions and start at 4u bid. Maybe 3u, but we'll see how brave I'm feeling.

thanks to EVERYONE for their tips and advice and support!
 
What would be the problem with switching to Lev while on a/b? Keep in mind that the current insulin is not working well, you don't have all that much of the old insulin left, and the vet said something about maybe needing to give 2 rounds of the a/b. Starting lev should be no problem at all as the dose is about half that of the current insulin.

Should the dose be a bit high once Charlie gets done with the a/b, then the dose can be lowered.

As it is, you will have the shed to build up, so see if you can get some testing done to monitor the switch and how well Charlie is reacting during the first week on lev.
 
So you don't see any merit in clearing up the infection before switching? that's good, since like I said, we're almost out of pz. I'll make sure I can test regularly when I do the switch for the first few days. I'm excited but nervous!
 
if charlie's number were always likely due to infection of some sort i would say wait until finishing ab's as you don't want 2 variable's at the same time..but charlie was like this long before he 'stubbed his toe'
and welcome to the wonderful world of lev. take a look at my ss. i seperated the pzi page and the lev page but you'll see an immediate and interesting difference. i was a bit dissapointed at first with lev being such a slow turning ocean linear but to always stalls and holds a mid cycle # for hours and hours.
claudia this insulin is NOTHING like pz...find a good person to help you. you will likely need it.
 
Well, it seems like everyone has taken an interest in coming up with an opinion about what to do with your Charlie.

So whatever you decide to do, please do check for ketones. I know you know this, but I can't help but mention it here in light of the infection.

I know I said...."I am wondering if it is wise to start a new insulin (any insulin) if Charlie is still on antibiotics."

Actually that is true, but I should have said in particular when switching to Levemir (and Lantus too), in that these insulin's don't react as quickly to bring down numbers in a cycle when an infection is present as do the shorter acting insulin's like PZI or even Humulin N (or dare I say it, even Regular) when an infection is present.

So again, whatever you decide, please do the ketone check. I hope that Levemir proves to be the insulin for your Charlie. :)
 
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