Levemir dose increase. Very underweight cat. Please advice

[Vintry]

Dear forum members,

I would like to ask you for advice. I am not new here, my cat Barsa has been diagnosed with diabetes in Nov 2013. With your help I was able to set up a spreadsheet and successfully regulate her diabetes, she was in the range of desired numbers most of the time, on 3 units of Caninsulin. About 3 months ago, while I was away on holiday, my mum tested and noticed Barsa's BG was a lot higher than usual, she decided to up the dose to 3.5. Then up to 4 units. I think she increased it prematurely and too soon. Cat's pre-shot BG went from the usual 15-17 to over 20, while nadirs sometimes went too low and sometimes remained very high. We realised she's experiencing Somogii effect. Went back to 3 units, remained on that dose for 3 days. Pre-shot BGs came down back to 15-17 BUT she's developed resistance to Caninsulin, it no longer lowers glucose like before. While all that was happening Barsa lost A LOT of weight, from 4kg to now 3.1kg. At some point she didn't want to eat anything but it is better now.

The question I have is about insulin dose. I just started her on Levemir. My vet instructed I administer 2 units. I was afraid it might be too high after reading some information on how to determine the correct dose (0.25 x cat's weight). So I started her on 1 unit and I suspect that is not the right dose, it is too low, taking into account that she was on 3units of Caninsulin, 1 unit if Levemir might be not enough.. Now the problem is that Barsa is at a critical weight and I'm just happy that she's eating but if I don;t regulate her sugar soon enough..I just don't know how long she can put up with constantly high sugar. It's not in the 20s anymore, on 1 unit of Levemir she's 17 pre-shot and nadir is 12-14 after 4 cycles but that is still high. I know that I can increase the dose only after 3days.

Question - Levemir dose increase should be done in 0.25 increments after 3-5 days. Can go from 1 to 2 units? If not, can I increase to 1.5 instead of the recommended 1.25? I can up the dose on 7th cycle (after 3 days), which means this Sat evening. Hopefully you can help me decide what to do.

P.S. The spreadsheet is not updated. I relaxed and stopped updating it when Barsa became well-regulated on Caninsulin.

Thank you

 

[Larry and Kitties]

Without any BG numbers, including ones between shots, with the Lantus I can't make any suggestions.
I myself have made dose increases in more than 1/4 unit increments but it depends upon the BGs on the lower does and how long that lower does was used.
What are you feeding?
What is Barsa's current and prior weight?

 

[Vintry]

I've updated the spreadsheet now. I'm feeding her low-carb wet canned food, also boiled chicken breast sometimes. She's not gaining weight because of high sugar I think, her appetite is much better now and she wants to go outside in the garden but I'm trying to keep her inside because she's so painfully thin and very weak, don;t want her to lose more weight. I think if I can get BG down, she will gain weight. Just worried she will lose appetite and stop eating if I don't lower it soon enough. And it's very dangerous at her 3.1kg

 

[Larry and Kitties]

I would have not problem increasing to 1 1/2.
When yo get around it you should have your SS link open to the World mmol_L sheet

 

[Vintry]

She's at 19.6 before food/shot tonight weighs 3.2kg

What will happen if on Sat evening I up the dose to 2 units, not 1.5?

 

[Larry and Kitties]

My gut feeling is that going to 2 would be OK but I myself would try 1 1/2 for a few days.

 

[Vintry]

Thank you

 

[BJM]

It takes 3-5 days for the dose effects to stabilize with Lantus and Levemir. Pop into that forum to read over the stickies on optimizing how you use and store it.