Levemir_first day_low number at +4

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vgriguil

Member Since 2013
we've just switched our cat to Levemir. +4 pm measurement came in at 51. Should we do anything beforehand? we gave her Nature's Choice canned food, one teaspoon.
thank you
 
How is she doing right now? Can you test her again and let us know? 51 isn't too low, but at +4 with Levemir, it's a lot lower than we like.

At any time, If she at all appears disoriented, has seizures, or does not respond, rub Karo syrup or honey in her gums and take her to the vet immediately. In case you haven't seen it, give a read-through of how to treat hypos since it might come in handy.
 
Could you get another test and post it, please? Levemir has a later nadir and the glucose may continue decreasing for a few more hours.
 
Thank you for all responses.
at +5 BG was 71. She went to sleep in her favorite place. Nothing unusual.
BJM:
we leave in OH as well.
 
If it were me in your shoes, I think I would change the dose to 1/2 unit BID and see how that goes.
Good job last night :mrgreen:
 
SS updated. this morning AMPS was at 456. injected ~between o.5-0.75u (it is very hard to measure on those syringes!!!)
 
Over in the Levimir ISG, last night, Sheila had advised you to drop the dose to 0.25 this morning. You said that you would do that reduction but I guess you forgot about that.

Please monitor closely today. Even though you had a high BG at pre-shot this morning, the Lev is taking your kitty to very low numbers on a small dose and your are still building up the insulin depot. You may get some more low numbers with that increased dose you gave.

The high 456 you got this morning, is very likely a bounce from the lows of last night. A cat's body will compensate for those unexpected lows by pumping out sugars and counter regulatory hormones to protect the brain and other organs from damage. Yes, I iknow it's scary to get that high number but "Better high for a day than low for a minute".

Unlike the NPH you were using, Lev is not dosed based on the pre-shot tests. Lev is dosed based on the nadirs.

I think the 0.75 or even the 0.5 dose of Levimir is too much insulin for JJ right now.

Please, do not give more than 0.25 for the evening shot. I can provide a picture of a syringe with 0.25 dose in it. The last of the three pictures shows 0.25U.

someinsulin-1.jpg

01unit-1.jpg

025unit-1.jpg



Would you please update your signature to strikethrough the NPH and type in Levimir right after that. To strikeout a word, highlight it and select the S (to the left of the youtube box) in the codes just above the text free form text box where you type in your message.
 
took 10 minutes to play with syringes with so miniature doses. Pulled 1.25 unit, tried to get rid of bubble, end up throwing 1st syringe and the dose away. Pulled insulin second time w/new syringe. Same thing, air bubble. I think we’ve injected somewhat in between 0.5 and 0.75 in am. There could be little precision with such tight marking. We wish there would be a syringe for 10 or less units!
 
Do you give the barrel of the syringe a good "flick" with a couple of fingers to force the air bubbles to the top of the syringe?

Hold the syringe in your dominant hand, needle pointed up. With your empty hand, take you index and middle fingers and put them against your thumb pad. Flick those two fingers straight out quickly to tap the syringe barrel. You may need to do this a couple of times to force a large air bubble towards the needle end.

Now slowly move the plunger up to squeeze out the air bubble and any excess insulin. Sometimes twisting the end of the syringe is easier to move out just a little bit of insulin, without forcing out too much and having to redraw.

Some more tips:
1. Draw slow to minimize air bubbles.
2. Practice with a used syringe to get that plunger twisting motion down.
3. Be sure to move the plunger in the syringe up and down a couple of times to spread that silicone lubricant on the inside of the barrel before you draw. Makes it easier to move the plunger. The Relion syringes I used tending to stick too much if I forgot to do this.

ETA: What brand of insulin syringes are you using. People may have suggestions on others that work better, more smoothly for example.
 
Levimir tends to have that later nadir, around +8 to +10. Would you be willing to do another test at +10 and then one at PMPS?

We are trying to pin down the nadir a bit more by having you do that +10 test.

You might want to consider a +9 test since that 74 is pretty low.
 
A +10 would be good - never assume when they are dropping that they will go back up when you think. every cat is different!

If you are under 200 at preshot please do not feed, do not shoot and come here and post. Then test again in 30minutes to see where JJ is (or what is your kittys name?). We want to see what she is doing naturally and without the influence of food.

If you dont think you can get 0.75IU on the syringe, aim for very slightly more than 0.5IU.

Wendy
 
we missed +10. will measure at +12. If JJ at the number 150+ as yesterday, we are not going to inject more than .25 u
 
+11:50, BG=129
It took us 1 min to draw the blood. she was nervous for some reason. Even so, BG is as it is. should we wait some more?
 
Give her 30minutes to see what she is doing and retest. When did you last feed? we want to see if she is rising naturally without the impact of food..

Also do you have extra strips, high carb gravy food and syrup?
 
She ate about 3-4 hrs ago, 1/4 of 3 oz can. She's hungry now and looks serious siting under the fridge. We have honey, maple syrup and strips but really do no want to go there. Rather not to shot now and monitor how BG will behave. By all means, the largest does suggested was 0.25u for tonight
 
Ok thats fine. It will be good data to see how she gets on.

Tomorrow morning, assuming she is over 200, maybe go with 0.5 or 0.25?
Wendy
 
Problem is That food will spike Her numbers for an hour or two and then she could come down fast when the food wears off. So if you want to shoot tonite, don't feed to see what she is doing naturally.
 
were you suggesting no shot tonight at all and just do one in the morning? She ate 1/4 3oz can of FF beef ~40 min ago. Will do another test to see where she's at
 
yes i thought thats what you meant about not shooting now and monitoring?

Anyway since she ate its probably a good idea to skip anyway unless you want to be up all night testing?

Normally we tell new members, if you see a number under 200, dont shoot, dont feed and retest in 30 minutes to see what the cat us doing naturally and post here for advice. Over time we train them how and when to shoot at low numbers.

Since you fed we dont know what she is doing naturally and you would need to wait a couple of hours to find that out. That will put you off schedule. So you might be best skipping the shot and shooting tomorrow instead at your usual time at the new lower dose. But I would still get a test in tonite before bed to give you more data on what she does ..

Wendy
 
ok cool - remember tomorrow though you need to shoot at 12hours from tonites shot. But you can gradually move the shot back by 15minutes each time to get back on schedule

the 203 reading should really go in the PMPS column since that was the shot number and put the 129 in the previous + 11 column with a "stall" note in there or something.

Since you shot close to 200, I would get a +2 if you can. to avoid surprises.

Wendy
 
Looks like a long bounce off yesterdays green . She will come back down though at some point today or tonite so a midcycle test today would tell you if thats happening.

Not sure what you are doing with the dose? Back to 0.5 consistently tonite? (unless she drops under 50)
 
Have readings at +12 (8-00pm). BG=143. Sorry, could do any prior ones, but BG is on the rise. JJ ate around 7-20 om
 
That's not ideal because we don't know if this latest raise is to do with food. Can u wait 30mins and test again and see if JJ is still going up?
Wendy
 
We will test at +13. JJ has all her ears pricked a lot and verysore. The trand is up. She ate just a hair of very low carb food (2%) and it alone could not double the BG. It most likely because levemir is wearing off.
 
Probably but we want to be 100% sure. If you shoot 0.5, Will you be able to get tests in tonite, she is likely to drop down again.
 
Here's the thing, levemir is a depot insulin.. So there is a good chance that 39 you got today was a result of the previous 0.5 dose which had built up in her system, and not the new 0.75! So although you were right to reduce the dose, you might want to try 0.25 for a few days to see how that works...
 
Sheila has been giving you some wonderful advice and information and explanations over in the Insulin Support Group for Levimir/Detimir.

She is wonderful with her advice.
 
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