Need advice, new on Levemir.....numbers strange

Status
Not open for further replies.
KSAkitties

KSAkitties

Member Since 2011
Hello FDMB members,

We started on Levemir on 28 Aug. My sweet boy Major's numbers were reasonably good for a week but in the last few days (starting on 4 Sep) his curves have been quite flat, his BG values at nadir were either not much lower than the pre-shots values or occured much later than +6. I really don't know what's going on? Is this rebound or something else? Why is the curve so flat?

4 Sep: AMPS: 91, nadir @ +6: 78; PMPS 87, nadir @+11: 73
5 Sep: AMPS: 95, nadir @ +7: 91; PMPS: 109; nadir @+9: 69
6 Sep: AMPS: 135, nadir: 67 (taken at +7). I fell asleep and missed the +6 test.

Today, I upped his dose by 0.25u, giving him 0.75 instead of 0.5 becasue his pre-shot value was the highest we have seen since we started Levemir, and I wanted to see if we can achieve a better BG at nadir. His BG at nadir was 67 after the 0.75u shot this morning.

I don't know if this (increasing his dose) is the right thing to do. Can someone please take a look at Major's SS and give me some dosing advice? Thank you.
 
He really likes the Lev! I personally would not have increased the dose, but since it's been done, you should stick with the higher dose but monitor closely. With numbers like you are seeing, the +10 and +11 will tell you how much duration he's getting. If he's staying flat (a good thing IMHO), you'll also want to get +2 and/or +3. If he's getting more than 14 hours of duration from the dose, I wouldn't raise again. It's hard to see where his peak is on a flat profile so get the occasional +8 and watch for outward signs of going low.
 
Flat is what you want. Flat is what you're getting. Don't mess with success! 135 is perfectly acceptable for a preshot. I don't know how much lower you would want it.

Yes, please monitor, because that 67 nadir is probably going to be a 40 nadir tomorrow. Try to get a +6 or +7 tonight even. Not sure what time it is where you are.
 
Terri and Lucy said:
He really likes the Lev! I personally would not have increased the dose, but since it's been done, you should stick with the higher dose but monitor closely. With numbers like you are seeing, the +10 and +11 will tell you how much duration he's getting. If he's staying flat (a good thing IMHO), you'll also want to get +2 and/or +3. If he's getting more than 14 hours of duration from the dose, I wouldn't raise again. It's hard to see where his peak is on a flat profile so get the occasional +8 and watch for outward signs of going low.
Click to expand...

Many thanks, Terri.

I will do more +2 and +3 tests (I am already doing +3 test on most days). I will also add more +10 and +11 tests.

So for now, I will hold Major's dose at 0,75u. Is this correct?
 
Vicky & Gandalf said:
Flat is what you want. Flat is what you're getting. Don't mess with success! 135 is perfectly acceptable for a preshot. I don't know how much lower you would want it.

Yes, please monitor, because that 67 nadir is probably going to be a 40 nadir tomorrow. Try to get a +6 or +7 tonight even. Not sure what time it is where you are.
Click to expand...

Thanks Vicky. I am not concerned with the 135 pre-shot (even though this is the highest pre-shot number since we started Lev on 28 Aug). I was concerned with his nadirs being not much lower than his pre-shot values AND occuring much later than +6 on on 4 and 5 September.

I get very worried whenever I see somthing out of norm. This is the first time I have seen a flat curve for Major AND the nadirs were higher than normal; therefore, I was concerned. Major has never given me a flat curve before even when he was on PZI and eventually went OTJ three years ago.
 
Unlike PZI, Levemir often has a flat curve. Lucy's BGs rarely fluctuated by more than 10-20 mg/dl except when she was sick. And when they did drop, it was never at +6--always at +10 or 11. Put PZI out of your mind and concentrate on how Major is using the Lev--it's a very different insulin. You're doing fine. And yes, stick with the .75 unless he goes too low.
 
Terri and Lucy said:
Unlike PZI, Levemir often has a flat curve. Lucy's BGs rarely fluctuated by more than 10-20 mg/dl except when she was sick. And when they did drop, it was never at +6--always at +10 or 11. Put PZI out of your mind and concentrate on how Major is using the Lev--it's a very different insulin. You're doing fine. And yes, stick with the .75 unless he goes too low.
Click to expand...

Thanks, Terri.

If a flat curve is what I should expect with Levemir and is considered good then Major is not doing as well as I thought because on most days he still has a hyperbolic curve with a much lower nadir than his pre-shot values. I am wondering whether I am not getting the duration I should be getting for Major because his +10, +11 and +12 values usually shoot up quickly. I am hoping to give him a bit more overlap to avoid the rapid increase in his BG at +10, +11 and +12. Major can't be feeling well when the numbers go up so quickly when the insulin is wearing off fast.

I am trying hard to get out of my PZI mentality. Will hold Major's dose at 0.75u.
 
The goal with diabetic cats is to keep their BG within the normal range all the time. Normal is around 40 to 160. You have accomplished that in no time at all. So, there is no need to tinker with perfection. Many of us would die to have Major's spreadsheet. His pancreas is very likely already well on the way to repairing itself and he will be OTJ in less than 3 months. The key to that will be to go slow and reduce his dose little by little -- again, the key is to go slow so his pancreas can start doing its job again.

Lana
 
Lana,

Thank you very much. I am a nervous mum and have a tendency to worry too much. I seem to watch for the slightest change in Major with a magnifying glass. LOL. Thank you for the reassurance.
 
Status
Not open for further replies.
Back
Top