Levemir initial dosing

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dosgatos

dosgatos

Member Since 2010
Hi all,

I hope some of you remember me. I posted about diluted levemir a while ago. Thank you so much for your input back then! Subject: Diluted Levemir? need advice

Shortly after that, our vet somehow managed to import another few bottles of BCP PZI for Akane so I'm still using it. It is working all right at the moment but as the current 3 times a day dosing might not be possible for me in the future and also seeing sometimes pretty sharp ups and downs with PZI, I'm beginning to feel that maybe gentler acting insulin could be better for him.

So I'm trying to inform myself and came back here.
I'd be happy if you could teach me know how to decide the initial dosing.
If the preshot BG is 300, how much should I dose Levemir initially? I'm using a sliding scale now with PZI and here is the current one:

150-170mg/dL 1.2 unit marking
171-200 1.5 unit marking (=0.6U)
201-250 2 skinny
251-300 2 (=0.8U)
301-350 2 fat
351-400 2.25
401-450 2.5 skinny (=1U skinny)

I understand that Lantus or Levemir dosing depends on nadir numbers but how would you decide the very initial dosage?

Thank you again for your assistance.

Mami
 
Hi Mami

I remember you! You're in Japan right?

Welcome back to the Lantus forum! How is Akane doing?

I've sent out a note for feedback on your questions about starting dose for Lev. So do check back here for replies.

In the meantime, would you be able to set up a spreadsheet and profile for Akane?
A spreadsheet will help us very much in seeing how Akane is doing on insulin, plus with a profile, we won't be asking you over and over about her health, diet etc.

Here are instructions for that:

How to Make A Profile

Spreadsheet Set Up

Hope to see you posting often!
 
I use the flex pens....is that what you have?
Welcome too! :mrgreen: Hope you see some fine activity with Levemir! Looking forward to watching your progress!
 
You are correct that Levemir dosing is based mainly on nadirs. Generally speaking a newly diagnosed cat would be started on approximately 0.25U of insulin per kilogram of ideal body weight. Since the average house cat has an ideal weight between 3-6 kilograms (4kg being the average) that means 4kgx 0.25U= 1 unit which is where most people begin. When switching from one insulin to another generally the dose should remain about the same (although they have different working profiles and duration of action most insulins have a simular potency) in other words Lantus/Levemir are not "stronger" or "weaker" than PZI or Lente insulins in terms of thier ability to lower BG but they do have a more prolonged affect. It's like regular headache medicine and retard preparations they have the same amount of "drug" in them but one has another molecule which makes it last longer.

Since your using a sliding scale it's difficult to say what your "best dose" is but it looks like you are dosing between a half and 1 unit on the PZI (and that 3x a day) Levemir will need to be given just 2x per day so if a good day on the PZI meant 2 doses at 0.8U and one of 0.6U you would have given 2.2U in 24 hours so it would seem reasonable that 2U of Levemir should give you good results (1U every 12 hours) which also would be a good starting dose for alomst any insulin. Therefore I would pretend as if you were starting from scratch with levemir and begin with between one half to 1U every 12 hours (you will have to decide based upon your test results from the last few cycles on PZI before making the switch and consider your preshot value when your ready to give your first dose of the levemir) A dose of 1U as long as you are hometesting and are able to monitor closely for the first 2-3 days should be a very safe dose to start with.
 
Hi all,
Thank you very much for your replies!

Hi Ronnie, Hi Pat,
Thanks for your welcome and assistance.
Akane is doing fairly well concerning blood glucose but he seems exhausted from heat and humidity :oops:
About Levemir, it wasn't a pen type when I tried it last year for a very short time.

Monique, thank you so much for your explanation.
I understand the idea and how to figure it out so well now!
Akane is 3.7kg so from that perspective, 1U or 1U skinny 2x per day seems just right, too.

Thank you again. I'll talk with the vet and hope to come back to report his update. :smile:

Mami
 
Hi
I've got another question. confused_cat
I've seen some of your spreadsheets and noticed that there are members who are managing very fine dosing such as 0.1U.
I'm surprised! :o

I've learnt how to fine dose with "Fine Dose Pictorial Guide" and "Fine Dose Gradations" in the sticky.
But as the report in "Syringe Accuracy Assessment", I also find many discrepancies in 1 package I buy from our vet (it's BD's).
I'm trying to use only good ones but sometimes there is like only 1 or 2 out of 7 syringes and I'm often get unsure
about the borderline between "good" and "not good".
And I'm struggling to measure tiny amount with those "unstable" products.

As a tiny bit of insulin makes a huge difference with bg numbers for my cat, I'm really struggling.
I wonder how you are doing.
Isn't it difficult? How are you managing with syringe discrepancies?

Mami
 
I use one type of syringe only...so I do not concern myself with discrepancies between brands...know what I mean? We usually start out a 1.0u of insulin per shot and then sometimes work our way down to the smaller dose when the numbers warrant a reduction. The stickies at the top of the page talk about the protocol.
We need magnifying glasses (I bought strong prescription reading glasses and use that to see the syringe) If you pull more insulin into the syringe and then turn the plunger to the right, the insulin is expelled and then you can get down to the smaller doses. Some people have practiced time and time again and when you are working your way down to the smaller doses, it gets easier.

Instead of the vials we buy the flex pens of Levemir and use the syringe to pull out the insulin from the membrane at the end of the pen.
I usually push the plunger in as far as I can to expel the air and while holding the plunger down, I insert the needle into the flex pen or vial, release the plunger slowly and then draw out the insulin. If there is an air bubble, it is easily flick to the top of the barrel. I then express that and refill the syringe to the right amount of insulin. (It helps if you push the plunger back and forth about 5 or 6 times first to spread the little lubricant around inside the syringe...that helps to cut down on air bubbles. Do that before anything else)
I buy my syringes at Walmart....Reli_On 3/10ml cc 29 Gauge 12.7mm (1/2") and use them all the time.
You can also buy syringes from Hocks (there is a box at the top of the page-click on that and order from there)
 
So you do not have any problems with Reli_On syringes in accuracy? That's great.
I only use one type of syringe, too. Sorry for my English. I meant discrepancies not between brands but within one brand.
I use Becton and Dickinson 3/10ml 29G and 30G and I often find problem. Sigh.
I think I will post this question to the main board as well. Maybe I could talk to someone with the same problem.
Thank you!

Btw, congratulations for Raja's OTJ! How nice!
 
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