Levemir vs Lantus Absorption and other questions

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nepenthe

nepenthe

Member Since 2010
Have any of you noticed better, more consistent absorption with Levemir?

The manufacturer seems to suggest there are studies that make the case that Levemir has more consistent absorption.

I keep getting some weirdness with inverted nadirs and am wondering if the cause might be variability in shot absorption with Lantus. (I know other causes of inverted curves could also be too much or too little insulin, which makes it more confusing)

When you started out switching from Lantus to Levemir, how much did you have to adjust the shot by? And did your cat end up eventually on a dose of Levemir that was the same as with Lantus?
 
Not sure the answer to your questions, but I'm interested in this as well, so I want to follow along with this post. :-D
 
I just switched Xuxu to Levimir yesterday and it was a wild ride. He was on 2.25 Lantus, so I used the same thing for Levemir. From what I'd read, you actually need a bit higher dose of Levimir. But not so with Xuxu, he crashed big time. I dropped it to 1.5 2nd dose yesterday but it was only when I gave him an extra 100 cc of subq fluid this morning (he gets 100 cc subq at night) before he actually started physically recovering. So from this experience, I'd definitely reduce from the Lantus dose when switching.

I waited 5 hrs before giving his dose of Levimir 1.5 this morning to make sure the high dose was out of his system. Today is proving to be a much smoother curve, with a low of 191 and just starting at 7 hrs to go up (311). 191 @1.5 Levir is a much lower curve than he ever got on 2.25 of Lantus. I can also say he is a much happier cat. He was very grouchy yesterday, everything p'od him, but he's back to being my sweet boy today.
 
The rule of thumb for dosing is that lev would be 70% of the lantus dose.

These two insulins have significantly different properties that make them long-acting, or extended release. They both have "usable" and "unusable" states that prevent them from binding to an insulin receptor. Lantus forms a precipitate (clumps) and slowly breaks down the clumps until the insulin molecules are "singles" that can bind to the receptor. Levemir binds to albumin in the subQ space and in the bloodstream, but the molecules bind and unbind repeatedly. Only in the unbound state can they then bind with an insulin receptor at the cellular level.

I have not used lantus, but the action of lev seems to be very gentle and consistent. There have been several people here that have noted a more even curve on lev when they switched their cat from lantus as well as some that noted a happier cat. Probably there are some cats that do better on one insulin than the other, but I would always choose lev over lantus because I think it is more flexible schedule-wise, if you need that (and who doesn't sometimes), it is ph neutral so won't sting on injection, and because I have lots of experience with it (on my 3rd FD now).
 
It would be nice if the 70% rule was in the 101 sticky. It just says start with 1 u, and with Xuxu's high levels, I did think that couldn't possibly be enough. It wasn't, but his Lantus dose was obviously too much.
 
Sheila & Beau & Jeddie (GA) said:
The rule of thumb for dosing is that lev would be 70% of the lantus dose.

These two insulins have significantly different properties that make them long-acting, or extended release. They both have "usable" and "unusable" states that prevent them from binding to an insulin receptor. Lantus forms a precipitate (clumps) and slowly breaks down the clumps until the insulin molecules are "singles" that can bind to the receptor. Levemir binds to albumin in the subQ space and in the bloodstream, but the molecules bind and unbind repeatedly. Only in the unbound state can they then bind with an insulin receptor at the cellular level.

I have not used lantus, but the action of lev seems to be very gentle and consistent. There have been several people here that have noted a more even curve on lev when they switched their cat from lantus as well as some that noted a happier cat. Probably there are some cats that do better on one insulin than the other, but I would always choose lev over lantus because I think it is more flexible schedule-wise, if you need that (and who doesn't sometimes), it is ph neutral so won't sting on injection, and because I have lots of experience with it (on my 3rd FD now).
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When we see an "inverted nadir", does that usually mean that the dose isn't strong enough?
 
DebH said:
I just switched Xuxu to Levimir yesterday and it was a wild ride. He was on 2.25 Lantus, so I used the same thing for Levemir. From what I'd read, you actually need a bit higher dose of Levimir. But not so with Xuxu, he crashed big time. I dropped it to 1.5 2nd dose yesterday but it was only when I gave him an extra 100 cc of subq fluid this morning (he gets 100 cc subq at night) before he actually started physically recovering. So from this experience, I'd definitely reduce from the Lantus dose when switching.

I waited 5 hrs before giving his dose of Levimir 1.5 this morning to make sure the high dose was out of his system. Today is proving to be a much smoother curve, with a low of 191 and just starting at 7 hrs to go up (311). 191 @1.5 Levir is a much lower curve than he ever got on 2.25 of Lantus. I can also say he is a much happier cat. He was very grouchy yesterday, everything p'od him, but he's back to being my sweet boy today.
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Is Xuxu still getting over pancreatitis? Are you saying that he seemed in a better mood after getting Levemir?
 
It's hard to know if he's over the pancreatitis, the 2nd ultrasound showed no real inflammation, but some scarring where it had been inflamed a month before.

I don't know if he felt better because of the Levimir or just because his BG hasn't gone so low. We'll see over the next few weeks.

I just did his PMPS and it's back up to 750. That just seems to be his cycle. I read something this afternoon about giving R the same time as a long acting to have a longer time at a lower level. Has anyone on this Board tried that?
 
It's hard to know if he's over the pancreatitis, the 2nd ultrasound showed no real inflammation, but some scarring where it had been inflamed a month before.

I don't know if he felt better because of the Levimir or just because his BG hasn't gone so low. We'll see over the next few weeks.

I just did his PMPS and it's back up to 750. That just seems to be his cycle. I read something this afternoon about giving R the same time as a long acting to have a longer time at a lower level. Has anyone on this Board tried that?
 
I was looking at Xuxu's chart - there is really extreme bouncing going on. Maybe adding the R is too much and causing bouncing? Maybe he would do better with just the Levemir (assuming you can figure the right dose)?
 
Deb, you are right about the 70% thing not being in the Lev101 sticky here on the Lev ISG. I believe it is somewhere in the stickies on the Lantus TR ISG because that group is the one that determined it and also determined that lev was close enough in action to lantus to just "roll" it's use into the lantus stickies.

However, there was a core group of us here (I think I am the only one left who posts regularly) that found that many people with cats on lantus who came here looking to switch had spreadsheets that indicated a too high dose and/or big swings in numbers, so we found that starting at .5u to 1u was safer. And that it is easier to stop the big swings and then raise to the proper dose than lower to it. That is why the Lev 101 stick has 1u as a starting dose. With a cat that has had DKA that technique may be too risky, so I have accepted the 70% concept as a good compromise in those situations

What I have not ever seen is that lev is supposed to need a higher dose than lantus for equal result. Where did you read that?

Yes, there are people on this board that have used R at the same time as lev or lantus is given to bring the high numbers down quickly so that the longer-acting insulin can take over and hold the numbers down longer. I think that may be something practiced more in the lantus TR forum, but you could post a question on Health and get some suggestions there.

Nepenthe, an inverted curve could be an indication of too much insulin, but it isn't a sure fire sign of it. Lev tends to nadir later than lantus ~ about +8 on average, but I have seen some +12 nadirs. I think that if the peak numbers are a lot higher than the nadir, no matter when they are happening, that is a better sign that it is too much insulin (given no other health issues and a low carb diet).

The patterns of the numbers, for an individual cat, can be really difficult to "read". So many factors go into it, not just dose and diet. It all needs to me looked at together.
 
Oliver's curve was always like a mountain, not a valley... his nadir was +10 and as last as the next shot time; +12. He never had a normal curve like other cats..... I would expect his BG to rise till around +5 or later, then start the drop. I needed to test him at +10 or +11 so that I would know which direction his BG was going.

Most people on Lantus switch at 70 to 75% over to Levemir, but in most cases, they end up at or very near the same dose as on Lantus, only with a smoother curve and better BG numbers.

I found that Shadoe's nadir around +5 was just a shade later after switching from Lantus to Levemir, but her improvements was in her whole manner.... she was more relaxed and no longer tense, plus her erratic BG numbers calmed down and smoothed out with less of a range between the highest and lowest numbers in each cycle.

Oliver just got better numbers; his nadir did not really change as it was always late.
 
Sheila & Beau & Jeddie (GA) said:
Nepenthe, an inverted curve could be an indication of too much insulin, but it isn't a sure fire sign of it. Lev tends to nadir later than lantus ~ about +8 on average, but I have seen some +12 nadirs. I think that if the peak numbers are a lot higher than the nadir, no matter when they are happening, that is a better sign that it is too much insulin (given no other health issues and a low carb diet).

The patterns of the numbers, for an individual cat, can be really difficult to "read". So many factors go into it, not just dose and diet. It all needs to me looked at together.
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So, if I understand this, the "peak" is the point where the insulin's action is strongest, which usually is (but not necessarily) the "nadir", or lowest point of BG?

So, with an "inverted curve", if the nadir is the PS, the peak is the highpoint in-between shots?
 
The peak of the insulin (when it is the strongest) and the nadir (the lowest point in the BGs) are one and the same....Since it is when the insulin is the strongest that causes the BGs to be at its lowest.

Autumn often has very late nadirs on Levemir especially when compared to where they were when she was on Lantus. Many times her nadir will be at +7 or later, as well as her onset (when the insulin first starts bringing the BGs down) is later on Levemir.

Mel, Maxwell,Autumn & The Fur Gang
 
Sorry - I should probably not have used the word "peak" when I said "peak numbers" as I meant highest numbers because we say "peak" insulin action to also mean the lowest/nadir numbers. That was not clear... :roll:

I gotta stop trying to make sense so late at night ohmygod_smile So, let me rephrase:

"I think that if the highest numbers are a lot higher than the nadir, no matter when they are happening, that is a better sign that it is too much insulin"

Does that make sense?
 
Sheila & Beau & Jeddie (GA) said:
Sorry - I should probably not have used the word "peak" when I said "peak numbers" as I meant highest numbers because we say "peak" insulin action to also mean the lowest/nadir numbers. That was not clear... :roll:

I gotta stop trying to make sense so late at night ohmygod_smile So, let me rephrase:

"I think that if the highest numbers are a lot higher than the nadir, no matter when they are happening, that is a better sign that it is too much insulin"

Does that make sense?
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ah, tks, so if I am seeing days like I've seen the past couple of days, where the +6 is the highest point of BG and the PS is the lowest, this is telling us one thing for sure - that the nadir is the PS? (in other words too, is this what people on here call a "late nadir"?)

I wonder if this has to do with variability from shot-to-shot in these basal insulins? (like with my boy, some days he is like clockwork in getting his nadir at +6 and others, he does the inverted curve thing, with nadir at PS)
 
Can you update his spreadsheet please so we can see the same numbers you are that will go a long way in helping us figure out what is going on and we will be better able to help you figure this all out.

Usually what I see with Autumn at least when her dose is too high is I start getting really ugly reds and black numbers with a check mark look to her spreadsheet where she rises consistantly throughout the day and then dips right before her next shot, or she has an inverted curve where she goes up and up and then starts going back down around +7ish so she has lower preshots than she does midpoint. So instead of looking like a smiley face it looks more like a frown if you plot it on a line graph

Mel, Maxwell, Autumn & The Fur Gang
 
MommaOfMuse said:
Can you update his spreadsheet please so we can see the same numbers you are that will go a long way in helping us figure out what is going on and we will be better able to help you figure this all out.

Usually what I see with Autumn at least when her dose is too high is I start getting really ugly reds and black numbers with a check mark look to her spreadsheet where she rises consistantly throughout the day and then dips right before her next shot, or she has an inverted curve where she goes up and up and then starts going back down around +7ish so she has lower preshots than she does midpoint. So instead of looking like a smiley face it looks more like a frown if you plot it on a line graph

Mel, Maxwell, Autumn & The Fur Gang
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Hi, I guess to update it, I have to "publish to the web" every time I want changes to be public? (I did this now, let me know if you can see it)

if you can see it, it looks like the right dose for my cat is either 1.25 or a fat 1. His numbers and dose have come down in the past month as he came off a long term dose of prednisolone and also I got him over a recent p-titis flare.
 
Yep I can see it now..One of the first things that jumps out at me is that you are doing a lot of dose hopping and not letting any one dose settle. Both Lantus and Levemir like consistancy. So you need to pick a dose and stick with it for 3-5 days if following Tilly's Tight regulation. However, I personally I have found that some cats take longer than that you settle into a dose or at least my Autumn does. She takes almost 2 weeks before she will settle into a dose for the most part.

That said if he was mine I would go slightly below what right now looks like the ideal dose at say 1u hold that for at least a week and let him get good and settled on it before adjusting upwards if needed. It has always been easier for me to go up than down in dose when trying to find hte ideal dose. And do realize what was the perfect dose this week may change over time so never become complacent with the testing.

Good example Autumn started out on 1.5u of Lantus 7 months ago today she is at .3u of Levemir. Which has very little to do with the difference between Lantus and Levemir and has everything to do with her getting healthy and beginning to heal from the inside out so to speak, she probably would have gotten this far on Lantus as well, but for her it was the wrong insulin because it made her tense and grumpy and she already had enough tortietude to last a lifetime. :lol:

Mel, Maxwell, Autumn & The Fur Gang
 
MommaOfMuse said:
Yep I can see it now..One of the first things that jumps out at me is that you are doing a lot of dose hopping and not letting any one dose settle. Both Lantus and Levemir like consistancy. So you need to pick a dose and stick with it for 3-5 days if following Tilly's Tight regulation. However, I personally I have found that some cats take longer than that you settle into a dose or at least my Autumn does. She takes almost 2 weeks before she will settle into a dose for the most part.

That said if he was mine I would go slightly below what right now looks like the ideal dose at say 1u hold that for at least a week and let him get good and settled on it before adjusting upwards if needed. It has always been easier for me to go up than down in dose when trying to find hte ideal dose. And do realize what was the perfect dose this week may change over time so never become complacent with the testing.

Good example Autumn started out on 1.5u of Lantus 7 months ago today she is at .3u of Levemir. Which has very little to do with the difference between Lantus and Levemir and has everything to do with her getting healthy and beginning to heal from the inside out so to speak, she probably would have gotten this far on Lantus as well, but for her it was the wrong insulin because it made her tense and grumpy and she already had enough tortietude to last a lifetime. :lol:

Mel, Maxwell, Autumn & The Fur Gang
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Are you basing the recommendation to lower him to 1 Unit based on the numbers you're seeing or that this is the only way to rule out if too high a dose is causing the inverted nadir?
 
A little of both, he wasn't getting bad numbers at that fat 1u and the more you raise the worse the numbers are getting, plus he never was truly started at what most of us consider a starting dose of 1u and held there until he settled.

But the constant switching from 1u to a fat 1u to 1.25u and then back down and back up again makes it very hard to decide which way to go, so taking him to a flat 1u is 1) easy to be consistant on 2) and isn't that far off from where it looks like he was getting the best numbers on. & 3) I have always found it is easier to adjust up if it isn't enough insulin that it is to try to go down in dose, especially when trying to fine tune a dose.

One thing I have found with Lev as opposed to Lantus is that Lev produces a much flatter curve that Lantus does...Lev likes to surf for a long time at a particular level where with Lantus you get a steeper more smiley face curve. Ideal you want to see a flat curve even if it is slightly higher and then slowly go up in dose to lower the overall curve.

Mel, Maxwell, Autumn & The Fur Gang
 
I agree about picking a dose and sticking with it for a good stretch of time (barring a very low number, of course). If you notice when you dropped Chingis to 1.25u from the 1.5u/1.75u doses it took 8 days to see that nice surf of 76-70-85 on the 5th. So it looks like he needs a lot of settle time.

As for a dose to stick with right now I could see either 1u or 1.25u, but I do think that he should have been started at 1u and not 2u and he isn't too far from really good numbers on the fat 1u, so 1u is a logical dose to try and see what happens.

Remember that these insulins should not have the dose changed based on a preshot number, particularly a slightly higher one. I will sometimes back off on a PS that is suddenly lower than normal especially if I don't have the data to show me how the cat will react and/or I won't be home (or awake) to monitor, but I know I may loose some ground doing that. I just feel it is safer than shooting a full dose on a sudden 90 or something. Dose changes are made looking at the nadir, but taking the whole curve into consideration as well.

Also, know that a number as low as 35 is safe - although not a number to aim for. So a 70 is a great nadir. I would not have reduced the dose after that 70 myself. I would have waited to see if he started dropping even lower. I like to aim for a nadir in the 80s, would be fine with the 70s, but below that I might shave a little off for some cushion. Others are fine with aiming for 60s or even 50s. I'm just not comfortable with it.

He looks like he is doing really well now. And his numbers are looking good.
 
MommaOfMuse said:
A little of both, he wasn't getting bad numbers at that fat 1u and the more you raise the worse the numbers are getting, plus he never was truly started at what most of us consider a starting dose of 1u and held there until he settled.

But the constant switching from 1u to a fat 1u to 1.25u and then back down and back up again makes it very hard to decide which way to go, so taking him to a flat 1u is 1) easy to be consistant on 2) and isn't that far off from where it looks like he was getting the best numbers on. & 3) I have always found it is easier to adjust up if it isn't enough insulin that it is to try to go down in dose, especially when trying to fine tune a dose.

One thing I have found with Lev as opposed to Lantus is that Lev produces a much flatter curve that Lantus does...Lev likes to surf for a long time at a particular level where with Lantus you get a steeper more smiley face curve. Ideal you want to see a flat curve even if it is slightly higher and then slowly go up in dose to lower the overall curve.

Mel, Maxwell, Autumn & The Fur Gang
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Thanks for this, but one thing I forgot to add is that he was on Lantus since june 2010, and then came down with p-titis for the first time in Jan 2011, where he was hospitalized. Before then, he was getting 1u and when he came home from overnight at the vets with p-titis, he was much higher in bg, so I put him from 1u to 2, which is too high a jump (I know that now).

So, looking at this journal I was keeping of him over the past 2 years, he was getting 2u and bouncing from approx 125-380 on avg, plus, the vet had him on long-term low dose (5mg prednisolone eod). So, when he had a recent p-titis flare, I took him off the pred and aggressively treated the p-titis and since then - this past Dec - he has been coming down. (good thing is that I got him an ultrasound 4 weeks ago which showed a good liver, no ibd, and a fairly ok looking pancreas with just slight inflammation there. But, the bad then was that the 2 yrs of higher/roller coaster bg's caused some early stage renal, like "stage one" with normal blood values) So, now its real critical to me to get him in line with the protocol.

So, he actually is at 1-1.25u, coming down from 2u for 2 yrs before that. Some of these numbers are actually maybe better than they look b/c of the AlphaTrak meter I've been using since November 2012.
 
Sheila & Beau & Jeddie (GA) said:
I agree about picking a dose and sticking with it for a good stretch of time (barring a very low number, of course). If you notice when you dropped Chingis to 1.25u from the 1.5u/1.75u doses it took 8 days to see that nice surf of 76-70-85 on the 5th. So it looks like he needs a lot of settle time.

As for a dose to stick with right now I could see either 1u or 1.25u, but I do think that he should have been started at 1u and not 2u and he isn't too far from really good numbers on the fat 1u, so 1u is a logical dose to try and see what happens.

Remember that these insulins should not have the dose changed based on a preshot number, particularly a slightly higher one. I will sometimes back off on a PS that is suddenly lower than normal especially if I don't have the data to show me how the cat will react and/or I won't be home (or awake) to monitor, but I know I may loose some ground doing that. I just feel it is safer than shooting a full dose on a sudden 90 or something. Dose changes are made looking at the nadir, but taking the whole curve into consideration as well.

Also, know that a number as low as 35 is safe - although not a number to aim for. So a 70 is a great nadir. I would not have reduced the dose after that 70 myself. I would have waited to see if he started dropping even lower. I like to aim for a nadir in the 80s, would be fine with the 70s, but below that I might shave a little off for some cushion. Others are fine with aiming for 60s or even 50s. I'm just not comfortable with it.

He looks like he is doing really well now. And his numbers are looking good.
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tks, its a really hard call with him, b/c he has been at 2u for the past two yrs and that dose was way too high.(there were other things going on, see the above post for background - the poor cat was on prednisolone needlessly for 2 yrs). Where he is at now is down from 2u.

Weird thing is that when I give him 1.25, he seems perfect (like when he had nadir at a 70), but then a few days later starts with these inverted curve days, as if either the shot isn't absorbing, or that its too much/too little. His diet and other metrics are always consistent- same low carb food, water intake etc.
 
nepenthe said:
Weird thing is that when I give him 1.25, he seems perfect (like when he had nadir at a 70), but then a few days later starts with these inverted curve days, as if either the shot isn't absorbing, or that its too much/too little. His diet and other metrics are always consistent- same low carb food, water intake etc.
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That run of perfect number "scared" his body and he "pushed back" against them. I think he would have come back down if the dose had been held. Didn't you reduce him to a fat 1u after that run? that Could have been the "unbalancer".

Maybe going to and staying with, 1.25u is the thing to do now - based on his previous history.

Beau was on oral pred, same dose, for 3-4 years! I am sure that, the ptitis itself and the dry food all contributed to his diabetes. He was on insulin for 2-1/2 years before going OTJ - a miracle! So, keep the faith!
 
Sheila & Beau & Jeddie (GA) said:
nepenthe said:
Weird thing is that when I give him 1.25, he seems perfect (like when he had nadir at a 70), but then a few days later starts with these inverted curve days, as if either the shot isn't absorbing, or that its too much/too little. His diet and other metrics are always consistent- same low carb food, water intake etc.
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That run of perfect number "scared" his body and he "pushed back" against them. I think he would have come back down if the dose had been held. Didn't you reduce him to a fat 1u after that run? that Could have been the "unbalancer".

Maybe going to and staying with, 1.25u is the thing to do now - based on his previous history.

Beau was on oral pred, same dose, for 3-4 years! I am sure that, the ptitis itself and the dry food all contributed to his diabetes. He was on insulin for 2-1/2 years before going OTJ - a miracle! So, keep the faith!
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Think this is what I am going to do, hold this dose for a week and if I see this inverted nadir thing then I could assume that the dose could go down to 1u.

With Chingis, the ultrasound from last month showed he has the early stage of kidney disease, even though his blood numbers are normal. Bet this was caused by the prolonged time on prednisolone, which caused a lot of swings into high numbers too often for too long. At least I know now that I have to watch his kidneys. (my other cat was dx/d with CRF in 09 and was told he was in "stage 2" then and given 2-4 yrs. I put him on a daily antioxidant - n-actylcycteine - and as of last month, almost 5 yrs later, his numbers are still the same. That compound is a wonder for CRF cats)
 
I learned to not "bank" on health prognosis for my cats because I have experienced both the joy and devastation of those prognoses not being right. Beau was given 2-5 years with his HCM in 2002, but next month it will be 11 years. Jeddie was given 3-6 months and did not make it to 6 weeks. Statistical prognosis is fine for scientific journals and studies, but not for applying to individuals.

I would go with those blood test results as your guide to how his kidneys are dealing with the diabetes and aging. You have a lot of tools you know how to use to give him the best life for as long as possible. That's a pretty good deal.
 
Big thing I'm noticing is kind of conflicting. I see the "perfect" dose for now seems to be either a fat 1u(1.1?) or 1.25. Not a whole lot of difference, really, maybe 10-15% difference between those two.

It could be the higher one is causing some bouncing that I'm not seeing in the middle of the night. Or a variability in shot absorption. Or the dose is too low.

If I were to switch from Lantus to Levemir (which I'm thinking of doing b/c my vial was bought this past October) - what dose should I start him on? Say, .5u Levemir?

(reasoning: that way, switching insulins, I can see two things, test the supposedly better consistency of Levemir and see how he responds to a lower dose as he starts the Lev)
 
I think starting lev at .5u is a good idea. You might want to make the first shot on Sat morning so you can spot check that day and the next. If he is going to be one of those that responds strongly to lev, he will drop low in one of the first 3 cycles. This is assuming you are home on the weekends.

FYI - I think those small dose differences DO make a difference. I have dosed two cats now on .05u and gotten a response to that ultra micro dose.
 
Sheila & Beau & Jeddie (GA) said:
I think starting lev at .5u is a good idea. You might want to make the first shot on Sat morning so you can spot check that day and the next. If he is going to be one of those that responds strongly to lev, he will drop low in one of the first 3 cycles. This is assuming you are home on the weekends.

FYI - I think those small dose differences DO make a difference. I have doses two cats now on .05u and gotten a response to that ultra micro dose.
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I see that shaving the dose could be what helped Beaumont into remission. Maybe a lot of the bouncing he was getting before was from dose too high?

I am going to switch him over today. Plus, my Lantus Im using has already been around since last October. I think that with Beaumont, another thing could be the prolonged effect of Levemir creates such an overlap, essentially 2 shots working at once, there is such an even effect. Its hard to say if he would have ever hit remission with Lantus.
 
nepenthe said:
I see that shaving the dose could be what helped Beaumont into remission. Maybe a lot of the bouncing he was getting before was from dose too high?
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Shaving the dose is definitely what helped him to remission and the bouncing was also, definitely, caused by too much insulin. It just took me a long time to figure it out (or it felt like a long time - 6 weeks). He was not following the protocol at all and what everyone here kept saying was, "raise the dose", or "shoot low to stay low", neither of which worked for him.

It was finally something on petdiabetieswiki that made sense to me, that chronic rebound on the long acting insulins causes high flat numbers, punctuated by sudden lows and a return to high, flat numbers, but the lows don't always happen. That fit Beau's numbers to a Tee.
 
Do they make insulin needles with smaller increments than U100's? I've looked at the pictures of smaller doses on the site, but I don't think my eyesight or hand dexterity could be very consistent on those doses.
 
Depends on which U100 syringes you are using Deb...the U100 is the consentration of the insulin not the syringe persay...it means that there are 100 units in a cc. There are both syringes that have markings for full units only and there are syringes that have half unit markings. Now how far those lines are apart depends on how much insulin the syringe holds. For a cat most of us use what is considered a child's syringe.

What I personally use is a 3/10cc (30 units max) 31 gauge (very thin needle), 5/16" (short) needle. I perfer the short needles even though all mine have been long hairs, however, I do know that many with longer haired cats like the 1/2" needle, I just feel like that is a harpoon.

My eyesight is pretty much trash too but if you happen like me to be near-sighted it comes in handy, just take the glasses off or the contacts out. You can also get magnifiers that clip on to the syringe that help with the tiny doses. Or even those lighted craft magnifiers work great.

Mel, Maxwell, Autumn & The Fur Gang
 
The U100 I was given are what you describe. I was told specific syringes go with specific insulins. My vet has a whole bunch of boxes of syringes that all go with specific insulin (I don't know why, I didn't think she had that many diabetic patients). But surely there are smaller bore syringes out there, insulin isn't the only drug that comes in small gradations. I too have to take my glasses off all the time anymore, but my eyesight still isn't good enough to distinguish a .2U as Sheila was was describing.
 
Some folks use calipers to set a measurement reliably.

And magnifiers, or a pair of over the counter reading glasses with or without regular glasses underneath, really helps.
 
To get to the .2u that Sheila was talking about it takes practice...basically what many of us do is use an old syringe and colored water then practice twisting the plunger until we get a bead of insulin about the size of the head of a pin on the needle, flick that off twist up another bead, flick it off. The goal is to get to where you can consistantly get 4-5 beads of insulin out of a .5u. Then each drop is fairly close to .1u so .2u would be two of those drops left in the syringe.

Sheila has some dynamite pictures around here somewhere of how to microdose. If I can find them tomorrow I will post a link if she doesn't beat me too it. Right now I have a spliting headache and I'm about to drag my hiney to bed.

Mel, Maxwell, Autumn & The Fur Gang
 
BJM said:
Some folks use calipers to set a measurement reliably.

And magnifiers, or a pair of over the counter reading glasses with or without regular glasses underneath, really helps.
Click to expand...
The digital calipers are the only way to go for anyone serious about drop by drop accuracy.

The Terumo syringes help as well. They don't have the variable hub, in fact they essentially have no hub. What you see is what you shoot. They also have more linear real estate per dose for greater precision.

The Terumos/calipers combo also helps with microdosing, since you always have a set reference for squeezing off beads.
 
Dale, what do you mean by no hub?

Here is a link to the photos and, below them, the instructions for getting .1u and .05u: http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982

I have done this with reading glasses over progressive lens glasses and without any glasses. Someone else used one of those magnifier lights where you look through a large magnifying lens and the light encircles that opening. It does take good lighting.
 
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