Need dosing help -Switching to Levemir

[Lisa and little]

Hi all,
Hope everyone and their fur babies are well amidst all the chaos. I Finally received my LEVEMIR and plan on making a switch tomorrow. Question is what should my starting dose be? My thought was to reduce to 1.5 to see how she does. Is that too much of a reduction? I'm always a nervous Nelly when making these changes. She is currently on 2.5 of Lantus but i've had 2 NS evenings in the last few weeks. Any advice/ guidance on this switch is greatly appreciated.
SIDE NOTE: anyone ordering from Marks marine in Canada, shipping took extraordinarily long, not due to them but the mail service in general so if you need to order, order early and take the extra packaging option to keep it cold.

 

[Jacque- Tiger & Jazz Man]

@Wendy&Neko and @Chris & China (GA) I'm tagging you Guys because you have helped my Tiger so much when we made the switch from Prozinc to Levimir.

 

[Sue and Luci]

I switched last July from Lantus to Lev. You're welcome to look at my SS to see how Luci responded.

There were some older threads where there was quite a discussion about switching from Lantus to Lev...you might try searching for them. I found them interesting and helpful.

 

[Wendy&Neko]

Here is the link to your previous thread here. http://www.felinediabetes.com/FDMB/threads/dose-increase.228915/ We include those for continuity to make it easier for people helping out.

The formula for starting dose when switching from L to L is 70% of your current dose. So, for a 2.5 unit Lantus dose, that would work out to 1.75 units Levemir. It's not that the switch to Levemir means you'll necessarily need a smaller dose, but some cats react strongly to the switch, so it gives you a margin of safety.

i've had 2 NS evenings in the last few weeks.

Can I ask why the NS? Were you unable to monitor? With Levemir, nadirs can be quite a bit later, perhaps even as later as the following preshot. You will have to get used to shooting lower numbers.

 

[Lisa and little]

Here is the link to your previous thread here. http://www.felinediabetes.com/FDMB/threads/dose-increase.228915/ We include those for continuity to make it easier for people helping out.

The formula for starting dose when switching from L to L is 70% of your current dose. So, for a 2.5 unit Lantus dose, that would work out to 1.75 units Levemir. It's not that the switch to Levemir means you'll necessarily need a smaller dose, but some cats react strongly to the switch, so it gives you a margin of safety.

Can I ask why the NS? Were you unable to monitor? With Levemir, nadirs can be quite a bit later, perhaps even as later as the following preshot. You will have to get used to shooting lower numbers.

The NS was on Lantus and pre shot was lowgreen and still dropping after a stall Tuesday night PS was 71 and 60 after 1 hr stall. Are saying I should have shot on a 60 which was technically at +13? I wanted to as I knew what was going to happen but was afraid something would happen at 3 am and I might have slept through it even with alarm.

 

[Wendy&Neko]

Are saying I should have shot on a 60 which was technically at +13?

No, I would have shot the 71, fed him to bring him up some and monitor. He might have dropped going to +1 because of the lack of food. That's what can happen if you stall too long.

Good luck with the Levemir tomorrow. The first couple cycles need to be monitored closely, just in case he's a kitty that responds to the switch.

 

[Lisa and little]

No, I would have shot the 71, fed him to bring him up some and monitor. He might have dropped going to +1 because of the lack of food. That's what can happen if you stall too long.

Good luck with the Levemir tomorrow. The first couple cycles need to be monitored closely, just in case he's a kitty that responds to the switch.

Thank you so much for the advice and all the help you have provided throughout my journey. . I am nervous and think I’m going to start today with 1.5 instead of 1.75 as she seems to be hyper sensitive to changes. Do you think that’s a mistake ? I’ll bring her up according to TR as necessary I’m just very nervous. Also. Can you just confirm what you would consider a NS number? I assume You would have shot the same 71 on Lev being the onset and Nadir are even later ?

 

[Marje and Gracie]

Thank you so much for the advice and all the help you have provided throughout my journey. . I am nervous and think I’m going to start today with 1.5 instead of 1.75 as she seems to be hyper sensitive to changes. Do you think that’s a mistake ? I’ll bring her up according to TR as necessary I’m just very nervous. Also. Can you just confirm what you would consider a NS number? I assume You would have shot the same 71 on Lev being the onset and Nadir are even later ?

Lisa...if the 1.5u doesn’t do something quickly, we can fast track up. I increased Gracie’s Lev dose after 2 cycles of no action and then again after 4 cycles. So don’t feel like you need to wait six cycles if nothing is happening. Just tag one of us.

If you are doing TR as stated in the signature block, you should be able to safely shoot everything above 50 as long as you have the supplies and are able and available to test. Even with Lantus, that should have been the case. With Lev, you will have to learn to shoot those numbers. Onset is not generally until +4 in most Lev cats so that should help you. I have observed in some cats, including Gracie, that Levemir can give a little better duration. There were frequent times that she didn’t nadir until +15. But that means I was able to take advantage of carryover and overlap for nice cycles.

You’ll get there. It will feel a little odd at first. And also remember that sometimes it takes a little time when you switch for cycles to look good even at the same dose as Lantus. I had to go higher and it was about 2-3 months before I could tell that Levemir was so much better for Gracie. Back to patience pants!

 

[Wendy&Neko]

You would have shot the same 71 on Lev being the onset and Nadir are even later ?

In a heartbeat. Never shot as low as 50, didn’t get the chance, but did shoot 51. At that point I had done enough data gathering to know how much of a bump Neko got from her meal, about 30 points, and her onset wasn’t until around +5. I had hours to get her up before the next dose kicked in. That was really helpful if she was off her food.

Like Marje said, you are back to learning mode, it it’ll come much quicker this time as you know what to look for.

 

[Lisa and little]

@Wendy&Neko @Marje and Gracie thank you both so much. I have a feeling I will be increasing as soon as tomorrow morning. I was just a bit of a chicken to start higher. I’ve shot some pretty low numbers on Lantus. The issue for me is when it’s at PMPS I’m scared I’ll sleep through or inadvertently turn off my alarm. My patience pants are on and ready to roll I just have to make sure the big girl pants are ready so I can take advantage of any lows that would give me an overlap which is pretty much what we want to happen correct? Again thank you both so very much.

 

[Marje and Gracie]

@Wendy&Neko @Marje and Gracie thank you both so much. I have a feeling I will be increasing as soon as tomorrow morning. I was just a bit of a chicken to start higher. I’ve shot some pretty low numbers on Lantus. The issue for me is when it’s at PMPS I’m scared I’ll sleep through or inadvertently turn off my alarm. My patience pants are on and ready to roll I just have to make sure the big girl pants are ready so I can take advantage of any lows that would give me an overlap which is pretty much what we want to happen correct? Again thank you both so very much.

You’re welcome, Lisa. It’s ok.....I also dropped Gracie back a bit more than normal because she was the same way.....sensitive to changes.

Certainly, you want to be able to take advantage of longer duration that gives you carryover and overlap. It’s easier to do with Levemir. But, I agree, adjusting to getting up later in the night is a challenge at first. Maybe set two alarms.....one that you have to actually get up to turn off. My DH is a sound sleeper and on the nights that it was on him to care for Gracie so I could sleep, he’d put those blasted crickets as the alarm on his iPhone yes, it woke him up but it also woke me, a light sleeper, up. I still hate those crickets

 

[Lisa and little]

You’re welcome, Lisa. It’s ok.....I also dropped Gracie back a bit more than normal because she was the same way.....sensitive to changes.

Certainly, you want to be able to take advantage of longer duration that gives you carryover and overlap. It’s easier to do with Levemir. But, I agree, adjusting to getting up later in the night is a challenge at first. Maybe set two alarms.....one that you have to actually get up to turn off. My DH is a sound sleeper and on the nights that it was on him to care for Gracie so I could sleep, he’d put those blasted crickets as the alarm on his iPhone yes, it woke him up but it also woke me, a light sleeper, up. I still hate those crickets

Ok. I’m up and from what I see- first cycle NADIR was +16?! Gonna leave her at 1.5 today and see what we get. Will also give me time to get out of the house and hit the beach this afternoon After +5. Or 6. Haven’t been out in ages and the weather has been awful I need the beach before I go completely bananas! Thanks again for helping me work through this.