Need dosing advise.....

[Jane & Boo (GA)]

Silverado's test results for Acro/IAA won't be available until next week. And I have still not changed to the Levemir. In the meantime... Silverado has finally decided to react to the ProZinc. At 9.6 Units, there was no magic, so I bumped him up to 10.0 Units and after 7 days at that dose, I'm getting blue numbers that I don't know what to do with. When he went into the blue on Dec 2, I made a wild guess as to how to handle it. Now that he's done it again, I think I need some sound advise. I know not to shoot under 200, but what do I do at say +16 with a 205. How does that effect the next dose at the regular dosing time?

Please take a look at Silverado's SS and let me know what I should do. I'm thinking that a reduction is in order but by how much? 9.6 wasn't getting results. If I drop him back to 9.8, is it possible that .2 units can make that much difference at this high of a dose?

Also, considering that we may have a break through here, do you think that a switch to Levemir would be a benefit? or will that depend the results of the Acro/IAA tests.

Thanks all.

Jane & Silverado

 

[Blue]

Re: Still pondering the switch from ProZinc to Levemir....

I can`t comment on ProZinc as I have never used it but it`s said that Levemir is quite gentle so better for higher doses. Also, Lev is longer lasting so you will have a smoother more even curve with a bit of overlap.
When you skip a shot, you still have that big shed with Lev, but I don't know what you have with Prozinc.
Numbers are usually higher on that skipped shot cycle I have experienced, but part of the Lev shed is being used/drained.
When I give the next shot, the shed needs to be filled first.

If you want to step back a bit, with a small decrease, you could try it, if you think you are getting numbers too low. If no good, you can always go back up.

 

[Jane & Boo (GA)]

Thanks for responding Gayle.

I changed the subject line because I think what I originally had was preventing others from realizing that I need dosing advise as well as advise on the Lev vs ProZinc issue. I'm still flying by the seat of my pants and have decided to go the conservative route for now and drop back to 9.0 units from the 10.0. I only have enough ProZinc to get me through tomorrow's AM dose and then I have an appointment with the vet, at which time I will need to make the decision about which insulin to take home with me.

If I stick with the ProZinc, I still need dosing advise. If I change to Lev tomorrow, dosing advise for ProZinc is not needed. Oooohhhh, I'm so confused. :?

Actually, I am leaning more toward the Lev, but need to know a couple of things:
1) Should I continue to let Silverado graze all day? or do I need to put him on an every 12 hour feeding schedule? Lately his voracious appetite has calmed considerably and I could probably put him on a 12-hour feeding schedule. As of now there is always Low Carb wet available for him and the civies.
2) I understand that injection routine is especially important with Lev. For the most part, Silverado gets dosed at 6:30 am and again at 6:30 pm, but sometimes it's as late as 7:30 am and 7:30 pm. That 1 hour window never seemed to matter with ProZinc. Will it matter with Lev?

If I do go with the Lev, I will probably do as Nancy did with Cody and start at half the amount of what I have been doing with the ProZinc and then work up from there.

I think that's all I really need to know for right now.

Many thanks.
Jane & Silverado

 

[OptOut]

Hi Jane,

I don't know ProZinc - I think Nancy and Carolyn are your best resources for that. Most of the acrocats are on Lev, so dosing advice is much easier to come by.

I'll try to answer some of the other questions.

You can definitely let him graze all day. Since Lev is a slow-acting insulin, you have hours to get food into him. It's also safer to allow them access to food all day so that he can eat if he feels his glucose dropping.

While it's important to try to be consistent on 12/12 dosing, 15 - 30 minutes early/late at times is no problem. The few times I had to shoot an hour late weren't really a problem either, although if possible, I would work in 30 minute intervals to get her back on schedule...and if that wouldn't work, I would just shoot at the scheduled time (especially if she was at a higher number).

I can't remember, but I think Nancy said that starting Lev at 1/2 the ProZinc dose was not quite enough. But again, I would defer to her on that.

 

[Blue]

OK, foods I can talk - here goes.

In the beginning, for both of mine, they ate like cows after dx and first on insulin and unregulated. Shadoe was eating close to 24oz a day, and when I got Ollie he would upwards of 30oz a day. I let them eat because it's known that their bodies were not capable of extracting what was needed to function from the foods, so they were always hungry and needing more.
Now, if Shadoe eats maybe 6oz, that's decent. If she goes too low with BG she may eat more but that's expected.
Now, if Ollie eats 15oz, that's his usual. I need to start cutting back for him to get down to his better weight because 26lb is too much for him.

If you were to speak with a human diabetic, I think that you would learn that spreading foods out evenly through the day is better for their blood sugars. that's your goal: smooth and steady. We know that when they eat, their BG can spike, so that's why the guideline suggestion of no food 2hrs prior to your shots - you want to see a number that is not influenced by the foods.

Many people use an autofeeder for the time when they are away. During the week, I am pretty much gone for the 12hrs between am and pm shots, so foods need to be available evenly. Ollie seems to like 3 meals, but Shadoe has always been a nibbler and I use the feeder for her just in case Ollie decides to eat his and then hers too.
Here's what I use:
Petsafe 5-meal Auto Feeder

Now for the shot times.
I do believe that the times are best if 12/12, but I am sure there are others who may have some schedules that cannot stick to the '12/12'. There is the overlap with Lantus/Lev; you have the shed from which to draw, and then you would just be needing to have it refilled after a late shot. I honestly don't know how much it would affect matters - how often would there be an issue may help determine if you could go with Lev and just modify the routine to fit.
I can't comment on PZI/prozinc at all, but I had thought that it was not as long lasting as Lantus/Lev, so I am not sure how it would not have an effect, even if just a slight one. I wonder if adjusting the dose is an option when you have hours differences - i am the wrong one to comment on this aspect.

I know some would say you can stay with prozinc and should because of the shot flexibility you need, but I am not sure how much support is around for this insulin and when it comes to high dose, the majority of high dose cats are on Lev, or on Lantus and may switch to Lev.
I have only one link on differences, but nothing on prozinc and the Ls:
Lantus & Levemir: What’s the Difference?

It's up to you which way you go, but with high dose, I think you may be better with the Lev as many others will be able to help you, and sometimes you need answers quickly.
I can't say what is the best transfer in dose, but I think it may be closer to 2/3. If your dose were 9u, you could start Lev at 6u. I for sure don't know so ask others for a starting dose.
It is always better to err on the side of caution because you can always give more insulin but you can't take back too much.

 

[Carolyn and Spot]

Hiya... I'd put him at 9.8.. I think dropping back further would repeat the numbers he got the last time he was at that dose.. great to see response huh!!

Levemir? We are not very humble. We are all on levemir because it's so gentle for the kitties. We find that's the thing we all want most for our cats, a slow gentle cycle. Naturally, we are all so thrilled that we beat people over the heads with it. We don't mean to, and we apologize, but we will always say OMG YES GO TO LEVEMIR! hehehe It's a "you'll understand when you get there" kinda thing, very hard to explain, but what sent us all to levemir was the lure of the calm cycles.

As an aside, I can't remember if we've discussed Lev with you or not, but you are on a low enough dose that you should not buy vials, you should buy cartridges or flexpens. They will last longer and cost the same or less than the per unit price of a vial, with less waste. Also, if you are in the US, you should buy them from Canada because Canadian drug suppliers tend to be far less expensive.. there is a thread on supply closet about which sites most people buy from. The most common one is probably globaldrugsdirect.com