Looking for some dosing input

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AndreaM

AndreaM

Member Since 2010
Hi Everyone,

on your advice, I read up on Levemir and made the switch for Schroeder about 3 weeks ago. I took him from 5U Caninsulin all the way back to 1U Lev. I read that Levemir potency is less than than Caninsulin, and so I was afraid to keep him at low doses for too long. His readings were consistently in the black and had been for the last month. I got some feedback from a board member to supplement with some Humulin R. I did this for a couple of weeks, but then I couldn't tell how the Levemir was behaving. So last week I made the switch to just Levemir. We are at 4 Units. I would like it if someone could look at the numbers and let me know if you suspect Somoygie. I backed off a .25 unit this morning. I have a curve planned for tomorrow, but my weekly schedule is such that it's very difficult to try to get a nadir reading, though I do do random spot checks.

I've notice a consistent trend over the last few days. AMPS is high, and PMPS is terrific (blue zone). Dosing protocol calls for full dose to be administered as long as BG isn't under 100, which is very different from my Caninsulin days... Anyway, Schroeder is showing no signs of hypo, other than possibly eating a little more than usual. Drank a lot of water by about +4, but then i went to bed. He slept soundly at my side all night until he gulped a bunch of water down when he got up with me!

You'll notice my chart looks a little different b/c I keep track of mg D/L and mmol/L, and the times I shoot, so I can tell when there has been inconsistancy. Thanks in advance for your attention to this. Getting concerned that I might not be able to get Schroeder back into remission like I did the first time, and I'm beginning to panic that the window is closing...

Andrea.
 
Welcome, Andrea & Schroeder,

I don't have any experience with Caninsulin or R, but Klinger got up to 7.5 units when he was on Lantus and again when he was on Prozinc. When we switched to Levemir and followed the protocol, he had a break through at 3 units after about a month and started to see some great numbers. I guess I just wanted you to see that for Klinger, Levemir worked a little differently.

Hopefully others with experience with R or Caninsulin will be on to weigh in on Schroeder's numbers.
Hang in there.
Marcy & Klinger
 
Hi Andrea,

Congratulations on making the switch to Levemir! You won't regret it.

The past few days are not too bad! Yes, the 400 could be what we call a bounce, but it sometimes happens when they finally get lower numbers or the BG drops too fast, not necessarily because it went too low. Schroeder has had a lot of high BGs so his liver & pancreas are not used to lower BGS! I would recommend staying with the 4U unless you catch low which dictates a dose DEcrease, such as 40 mg/dl. (Thanks, Sheila!!)

You were correct that R can confuse the action of Levemir. Although some people successfully use it for acromegaly cats, in a cat not diagnosed as acro it is not advised by those of us who monitor the Lev ISG. I also used R a long time ago on advice from the board and a University of IL vet explained to me that although R will bring down blood glucose rapidly, the basal insulin (in this case Levemir) has to work from a "false start," so to speak and for the caregiver the results become confusing, as you saw, and it becomes even more difficult to determine the correct basal insulin dose. R should be used in emergencies only - such as by a vet in a DKA situation.

If there is truly a need for R, meaning the BG will not come down any other way and the basal insulin dose is greater than 5U BID, then the cat should be tested for IAA and acromegaly.

So I'm sorry you've had that hiccup with Levemir. A couple other observations from his spreadsheet: I see a few times where shot times are not consistently 12/12. They need to be as close to 12/12 as possible at this stage. If your schedule requires odd shot times, there are ways to manage Levemir in those instances, which I can help with. Otherwise, anything other than 12/12 shot cycles is going to give an unreliable curve upon which to base dose changes.

Also, you don't need to be nervous about 100s on Levemir! It takes time to get comfortable giving shots with BGs in the 100s, but they are the ideal we are looking for with Levemir and are necessary to maintain if there is hope for remission.

And about remission. It may be helpful to put that "goal" aside for the time being and simply work on getting him on a good dose that leads to regulation. A happy, healthy diabetic kitty should be the goal first, then remission may be possible. Caregivers get frustrated and make incorrect dosing decisions when they are overly concerned with remission or even "got to get the BG down." Yes, 300s and 400s are not ideal, but they are going to happen until you get a handle on Schroeder's optimum dose.

Does Schroeder eat overnight? Or is he very active during the day? Those are a couple possible reasons why you are seeing higher BGs at AM than PM.

Overall I say you've done pretty well. The rapid dose increasing seems to have worked for him. I would really like to see those 500s vanish, that's for sure! I am sure you would too. Good job!
 
Vicky & Gandalf (GA) said:
I would recommend staying with the 4U unless you catch low which dictates a dose increase, such as 40 mg/dl.!
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She meant a dose DEcrease - not increase and I think she meant to add any time during the cycle.

One thing lev likes is consistency - unlike caninsulin which allows you to change the dose based on the PS number. So try to not change the dose in response to changing PS numbers unless you get a much lower number than you have a been getting. And especially if you can't be home to spot check him and don't know how he will react to a full dose on that PS number.

What are you feeding him? Is it still low carb wet food?

I think there have been so many factors in his dosing that it will be very hard to tell if he is getting too little or not enough insulin. I would have liked to see a systematic approach to dosing with lev - starting on 1u and raising by .5u every 5 days after enough nadir checks have shown that he did not drop low enough. Usually numbers in the 400s and 500s (red and black) are from rebound or high carb food, or I suppose other factors like infection, but not from too little insulin. In my experience reading SSs, and with my two cats, a cat on a low carb diet the highest numbers are mid 300s.

What you could do now is hold the 4u and raise it by .5u after 5 days and a curve if he isn't getting to ~100. If he is getting too much insulin, that raise will probably induce some very low numbers. Also, he could have built up some insulin resistance because of all the different insulins and changes and just needs to be systematically raised until he "breaks though" the resistance.

I would not focus on getting him back into remission - it will either happen or it won't and there isn't a rush. My Beau went into remission after over 2-1/2 years on insulin, so you never know. Jeddie was in remission for 3 months after I got him, but then he slipped out and I have not been able to get him back into remission. He is regulated and not drinking water or peeing excessively so I am happy with that.
 
Excellent feedback. Totally appreciate it. Will hold at 4U for now and do curve tomorrow.

Schroeder still eats low carb wet food (no gravies) and Evo dry food (very low carb/high calories) because he lost a lot of weight with the diabetes last time. He is holding at a healthy weight this time around. I feed him the wet food twice a day right after I get his preshot values and give him his insulin. The dry food is out all the time and he free feeds from that. He is generally quite inactive, other than chasing his brother around, he's an indoor cat that tends to sleep a lot, or stare longingly out the window... lol.

So, why the very high BG? Don't know. When I first had him rediagnosed with the diabetes, I put him on antibiotics for just over 2 weeks to quell any low lying infection (he has bad teeth, that I suspect are to blame for his first diabetes go-round). The high numbers continued despite the antibiotics, and nothing came up on any of the panels the vet did.

I do regret not having followed protocol with the Levemir, but I just panicked with Schroeder in the black so much of the time. I was in a big hurry to get him into any other colour... However, we are where we are now, and continue to be appreciative of your collective experience and guidance. I will try my best to be consistent with the times.
 
AndreaM said:
Excellent feedback. Totally appreciate it. Will hold at 4U for now and do curve tomorrow.

Schroeder still eats low carb wet food (no gravies) and Evo dry food (very low carb/high calories) because he lost a lot of weight with the diabetes last time. He is holding at a healthy weight this time around. I feed him the wet food twice a day right after I get his preshot values and give him his insulin. The dry food is out all the time and he free feeds from that. He is generally quite inactive, other than chasing his brother around, he's an indoor cat that tends to sleep a lot, or stare longingly out the window... lol.

So, why the very high BG? Don't know. When I first had him rediagnosed with the diabetes, I put him on antibiotics for just over 2 weeks to quell any low lying infection (he has bad teeth, that I suspect are to blame for his first diabetes go-round). The high numbers continued despite the antibiotics, and nothing came up on any of the panels the vet did.

I do regret not having followed protocol with the Levemir, but I just panicked with Schroeder in the black so much of the time. I was in a big hurry to get him into any other colour... However, we are where we are now, and continue to be appreciative of your collective experience and guidance. I will try my best to be consistent with the times.
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I wanted to ask why the dry food is still available? It could well be he is very carb sensitive and by removing the dry, you could bring down his numbers a great deal. If my Shadoe gets even as little as 3 pieces of dry food, her numbers will be in the upper 400s. Have you already tried to remove all the dry foods?

For sure any bad teeth could be contributing to the high numbers as well. My Shadoe's dose dropped from around 14u BID down to 2.5u BID after her dental.
 
I have to agree with Gayle about the dry food. I can see giving a few as "treats," maybe after BG testing, but leaving it out all the time is defeating the action of the insulin. I know given the values for the EVO it seems a "safe" diabetic food, but in my experience with Gandalf no amount of "safe" dry food was good for him. It raised his BG every time. I tried them all - Core, EVO and a vet brand available online only. He LOVED dry food and I tried to keep him happy, but it just wasn't worth it. I really don't understand why that is, given the kcal from carb values, but maybe it's something in either the food processing or the body's processing of the food, such as the dry aspect causes it to stay in the gut longer.

I'm not sure the values given in the food chart for Innova EVO cat & Kitten dry food are correct. It says 8% kcal from carbs, yet the calories are over 600! Much higher than any other food on the list except 1. Those calories have to be coming from somewhere. The other dry food which is almost that high in calories is Purina DM which is considered a "diabetic dry food." DM has 50% kcal from protein, higher than the EVO, yet its carb load is 5% higher. So if the protein was that high, you would think the carbs would be lower, but the fat is lower instead. I just didn't think "meat" added that many calories.

Those calories have to be coming from somewhere with the EVO & the DM and I don't know that I buy the 8% kcal from carbs because of the amount of calories, maybe 13% for the DM, but still. Maybe someone could help me out with that, but if you're feeding the EVO thinking it's a "safe" diabetic dry food, well, there is no "safe" dry food for any cat quite frankly.

I'm also concerned about how high the phosphorus is with EVO. That is hard on the kidneys. Coupled with it being dry food, I just can't see that it's worth continuing to feed the dry food. Even increasing the amount of canned food would be better if you need to maintain his weight. A timed feeder would allow you to feed him canned food as meals when you're gone, for example. having food available all the time, whether it's dry or not, will also contribute to higher BGs.

There is nothing wrong with needing to give more insulin - you give what's needed to bring the BG down. But you will have a better chance getting him in to remission again without the dry food. It may in fact be the reason why he's become diabetic again, not the bad teeth. But Gayle is also right about them - they need to be addressed as well. Why the food causes high BGs when supposedly the food is low carb, I don't know, but enough of us have experienced the dry food effect on BGs to know there is something about it that causes need for higher insulin doses.

I hope I haven't frustrated you too much. The unfortunate fact is that there's more to diabetes treatment than just giving insulin. And it's often a puzzle which each owner has to work at to figure out for their cat.
 
Oh wow. Sad to hear about the Evo! Thought I'd found a good comprimise there. I will take it up.

Schroeder got a 92 this morning, which is great on one hand, but puts me in a quandry on the other. I had to decide what I would do if this were a Monday morning and I had to turn around and go straight to work. So, as per the dosing protocol, I chose to back off the dose by .5U and feed him as usual. I will be doing checks every 1-2 hours today. That was a pretty large BG drop from 440 last night. I need to get both my cat's teeth done. It'll be a couple months until I can afford to do that. Costs a fortune. But then again, so does insulin, strips and syringes!
 
You might consider just using the EVO kibble for treats. I think Sheila does that as test treats for Jeddie. That way he's not going cold turkey. :lol:

He might need a dose reduction after all, yes. He probably will especially if you take up the dry food, so it's very good that you're on top of his BG!

Yes, dentals can be horribly expensive.

BTW, I love his picture in your icon. He looks like a sweetie!
 
AndreaM said:
Oh wow. Sad to hear about the Evo! Thought I'd found a good comprimise there. I will take it up.

Schroeder got a 92 this morning, which is great on one hand, but puts me in a quandry on the other. I had to decide what I would do if this were a Monday morning and I had to turn around and go straight to work. So, as per the dosing protocol, I chose to back off the dose by .5U and feed him as usual. I will be doing checks every 1-2 hours today. That was a pretty large BG drop from 440 last night. I need to get both my cat's teeth done. It'll be a couple months until I can afford to do that. Costs a fortune. But then again, so does insulin, strips and syringes!
Click to expand...

I should mention that there have been a couple cats who would not eat wet food, and the EVO dry was about the best to feed them. Unfortunately, with the carbs being maybe 18% or higher, you could be just causing high numbers and the need for the insulin!

While both cats may need their teeth sprucing up, the diabetic one would be best to do first because you could find that taking away the dry food and fixing the teeth may be just enough to result in no insulin needed at all!
I think that may be incentive enough to look into getting the teeth checked out. Maybe by fixing Shroeder's teeth, you will save money on insulin and supplies and it can be spent on the 2nd kitty's teeth.

Hopefully with the diet change and some polished teeth, things will be much better for you and Shroeder.
 
Nadir hit around hour 5-6. +5=59 +6=68. Was getting nervous we were headed for hypo territory.

QUESTION for PM shot dose. If it falls under100 again, should i hold at 3.5U or should I further reduce the dose? And if the dose really heads north, 300's or 400's, would you also back off the dose? Was way easier to interpret what was happening with Caninsulin because there's not overlap. You always knew where you were in the cycle, and I found I could adjust doses accurately based on that.

Happy for green zone, but it's way more nerve racking! I've never been through a hypo with him. I'm prepared, but terrified he's just going to start seizing and die! I assume it doesn't happen that fast. More concerning with these healthy numbers is that he could hypo while im at work. Theres noone else who can check on him. It's partly why I would like to keep the Evo down for him, so he can treat himself for impending hypo if need be!
 
I think you will see higher numbers at preshot tonight. Staying at 3.5U is probably a good idea. Otherwise his shed could drain too fast. Are you familiar with what that means?

I understand the desire to leave food down for him and canned food would be fine. But if you intend to take up the dry food, only do so when you can be there for the next few days to test him, as I'm pretty sure you'll see decreases. It's not a good idea to try to prop up BGs with dry food either. We don't recommend using it to treat low numbers either. First it's not necessary and second, it takes too long to be digested and effect BGs plus fills them up so they won't eat when you may need them to during a low spell.

Unless there is an actual overdose, the possibility of hypo with unconsciousness and seizures is less on Levemir than faster acting insulins, that is even stated about its use in humans. While I don't mean to downplay the risk that hypos pose, their likelihood when the owner is home-testing and at a reasonable dose given recent blood glucose values (not seeing 30s or 40s) in our experiences here is less with Levemir than say N or Vetsulin/Caninsulin.
 
Hi Andrea, just wanted to welcome you to the Lev forum. I am sorry Schroeder came out of remission, but at least you found your way to a great insulin with Levemir. Maybe he will get there again. :)

You received great advice from everyone. I just wanted to add that if you can, try to get a before bedtime BG test in. I see you do it sometimes, but especially when you shoot those blues like you did on the 24th, and also because you aren't able to get much data during the day when you are at work.

You guys are doing great. BTW how old is Schroeder?
 
pamela and tigger said:
Hi Andrea, just wanted to welcome you to the Lev forum. I am sorry Schroeder came out of remission, but at least you found your way to a great insulin with Levemir. Maybe he will get there again. :)

You received great advice from everyone. I just wanted to add that if you can, try to get a before bedtime BG test in. I see you do it sometimes, but especially when you shoot those blues like you did on the 24th, and also because you aren't able to get much data during the day when you are at work.

You guys are doing great. BTW how old is Schroeder?
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Thanks Pamela!! Appreciate the encouragement. Schroeder is approximately 10 years old. I would love to get more numbers post PM shot. Just wish I could stay awake longer... ;-) I do wonder where the nadir hits on the PM shot. It seems to act differently (i.e. slower) than through the day.
 
If you are able to, you could set an alarm to wake you up at +6 at night to test. I did it a few times. It's REALLY hard! At least for me. But sometimes you need the data, or you have a feeling he might head low and just need to do it.

It's funny reading about how you are having a hard time relearning how an insulin works because of using caninsuil before - funny because when I switched Beau from vetsulin/caninsulin to lev I thought I'd NEVER be able to "erase" what I learned and be comfortable working with lev. I was very frustrated too. But now, I can barely remember how vetsulin worked. It actually is easier to use lev because you hold a dose, for the most part, even with some fluctuations in the PS values. You will get to the point where it is second nature - unless he goes OTJ before that happens.

I do use kibble as treats in the morning, but the rest of the time my cats all get wet food and I leave it down up to 12 hours - usually the bowls are empty before 12 hrs. I like to have food down for a cat on insulin although Jeddie has almost never gone low. With Beau I left huge bowls of dry food (crappy, awful, horrible Iams Wt Mangement junk) because my vet told me I didn't have to worry about his diet until he was regulated (huh? What? That's just crazy). However, it probably did save his life because he got up to 7u of insulin thanks to my vets' advice and the fact that I wasn't testing him. I shudder to think about it even now that he has been off insulin for over 2 years. I just would not do it now - leave dry food down - for any cat for any reason (well, I suppose if I had a cat that refused to eat wet food, I would have to, but I don't, so I am spared making that decision). As said, ween him slowly from it and don't go cold turkey with it when you are not there to monitor and test. Leave some wet food down during the day when you are gone. It will be fine.
 
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