Levemir dosing in blues

Howiesmom

Howiesmom

Member Since 2020
Howie hit his first blue (that I’m aware of) this AM (AMPS 181). YEAH! I was able to get help in trying to figure out a proper dose since I had to go to work. Here is the thread: https://www.felinediabetes.com/FDMB/threads/11-3-howie-amps-181-dosing-question.238032/

I am following TR and am wondering if the SLGS recommendations for AMPS/PMPS under 200 (or above 200 but low for the kittie) are the same (no shot, token shot, stall). I just find no info for what to do on TR unless it is assumed it is always the same.

Also, when it is recommended to do a lower dose if they are below 200, how do you figure out how much lower? I lucked out and had someone gave me dosing advice but am concerned if /when I run into future issues and no one is available. He always has 3 mini meals in each cycle but I work outside the home most days of the week.
 
With Levemir, there are a couple of things to keep in mind. Wendy gave you some great thoughts here...might be worth re-reading.

https://www.felinediabetes.com/FDMB...vemir-feedback-requested.237171/#post-2661856

one of which is that sometimes with Levemir, kitties may hit their nadir (lowest point in the cycle) close to the time you need to give insulin, and so far, while the preshots are a little lower than you are used to, you may need to get used to giving the full dose.

With TR, there isn't a specific recommendation about stalling/no shot/reduced shot, most people get gradually lower and lower as they get comfortable, and will give insulin as long as the kitty is above 50. What you have mentioned regarding shooting under 200 is only really important for newer members just starting out with giving insulin and testing. Once the caregiver has a good sense of how their own kitty responds to insulin and carbs from their food, even people following SLGS will shoot as long as the preshot is above 90.

One thing that I would also suggest, it looked like last night he came down at +3, so I might have set an alarm and gotten a test later in the cycle. Even sometimes doing a spot check at +11 now and again can be good info. It will tell you if he is trending up by preshot which might make you more comfortable in giving the full dose next time. Remember, you are shooting the number he is going to be in 4-5 hours, not the number he is now.

Since he has access to food, the other thing you might consider is having some higher low carb food to prop him up around onset. Whenever I get a lower preshot and am not sure where the cycle will go, I will leave some 6%, but that's us, and it depends on how carb sensitive Howie is. Maverick goes higher even just by smelling MC food :)
 
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Remember, with Lev kitties, and often with IAA kitties, the nadirs are later. And also the onsets. Neko often nadired at or around preshot time of the following cycle, and once as late as 3 hours after that. What does that mean? It means you have to get used to shooting lower. On the up side, you've got hours until onset and the next shot starts taking effect. Looking at Howie's spreadsheet, it looks like onset isn't until somewhere between 4 and 5 hours after his shot. So even if you shoot lower, he's going to keep going up for 4-5 hours after food before the next shot takes place.

Levemir, like Lantus, works better with the dosing methods here if you give the same dose each cycle - unless then earn a reduction or need an increase. Yesterday suggestion on a slightly reduced dose was not a suggestion I would have given. Due to the depot effect, the cycle following a barely reduced dose will look almost like you shot the full dose.

On this forum, for people following TR, we suggest that under 150 you do not feed, and post for help. Over 150, just SHOOOOOT! Eventually as you gather more data for Howie on Levemir, you should be able to shoot well into the green. The suggestion for 200 as preshot is for people new on the Feline Health forum. I printed out the following Sticky Note, just in case of emergencies. I did need it during one power outage:
Tight Regulation: Becoming Data Ready to Shoot / Handle Lower Pre-shot Numbers
 
This is all so helpful...thanks so much to both of you! Do you suggest I move up to 9 units tomorrow as scheduled? He just finished up his 6th cycle on 8.5 units. I’m just not comfortable yet making these decisions as he moves colors!
 
Since you shot a reduced dose a couple cycles, you haven't yet had the full six cycles of 8.5 units in a row. Every reduced dose depletes the depot. The cycle count starts over tonight at cycle 1. So you have to wait yet for the increase.
Counting Cycles
 
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