Need help. Trying to find the optimal dose of Levemir...

Status
Not open for further replies.
J

Julia and Cherry

Member Since 2012
I think she may be getting too much insulin even at 1u. I say that because of the fast and far drop adn then climb back up. Going down 300 pts in 3hrs is pretty fast.

It's a little hard to tell though because of all the changes. Lev works best when the dose is held steady and allowed to settle over at least 3 days. I personally think 5-7 days is better. Unless there is a drop to a very low number, in which case you reduce on the next shot. A very low number is anything below 40-50.

If you get a low PS, like you did on that day she was 44 at shot time, you would either wait, retest and shoot after she is high enough, or reduce for just that shot. The decision here is whether you have data to show how she will respond (like how fast her BG climbs and if it, in fact, climbs), if you will be home to test and monitor, and your comfort level.

She will be safe down to 40s. I have had my cats down to the low 30s with no issues. That is a mid-cycle number though, like +6 to +8, not at PS, or a fast drop from a high PS by +2 or +3. When that happens you want to consider reducing the dose.

You have completely eliminated the dry, right? I would suggest sticking with .5u for now and let things settle out. Be consistent, don't raise the dose based on one high PS. She's going to probably "swing" a little after the fast drop and climb last night. Cutting out dry entirely probably reduced her insulin needs.

It will probably seem like .5u isn't enough because she may settle in the mid 200s. That's ok and what you want to stop the swinging BG. Then you can slowly raise in order to bring the entire cycle down - and not start swings again.

Please test for ketones with urine strips while she is in higher numbers.
 
Sheila & Beau & Jeddie (GA) said:
I think she may be getting too much insulin even at 1u. I say that because of the fast and far drop adn then climb back up. Going down 300 pts in 3hrs is pretty fast.
It will probably seem like .5u isn't enough because she may settle in the mid 200s. That's ok and what you want to stop the swinging BG. Then you can slowly raise in order to bring the entire cycle down - and not start swings again.

Please test for ketones with urine strips while she is in higher numbers.
Click to expand...

Thank you for the answer, Sheila!

Yes, we eliminated the dry food completely. Tested for ketones several times and the result was neg.
In the morning AMPS at +12 was 281, then at +3 - still 259. Looks like rebound...
Will shoot 0.5 in the evening.

Low numbers at +12 - looks like something impossible (
 
Nothing is impossible with these guys (and gals)! And you have already seen a +12 of 44, so.......

Right now you just need to sit tight and get some dosing consistency and gather data so it is easier to see what the dose is actually doing - and go from there. Yes, the flat mid-200s could be some rebound. Another couple of doses at .5u should clear any rebound hormones from her system and you will start to see how she does on .5u.

FYI, several of us have found that when making dose changes with lev it is better to think in terms of percentage and not units or fractions like .25u or .5u. Do you have syringes with half unit markings? They make this part easier. When below 1u, if you can do something that is between .5u and .75u, or between .25u and .5u - it make prevent the swings from taking hold.

There is some info and instructions linked in the Lev 101 post at the top of this forum.
 
I've just tested at +6 - 185. Not bad, flatter than yesterday...

Yes, we use the half unit syringes. Maybe the ideal dose is somewhere between )
 
Julia and Cherry said:
I've just tested at +6 - 185. Not bad, flatter than yesterday...

Yes, we use the half unit syringes. Maybe the ideal dose is somewhere between )
Click to expand...

There are some cats who are very sensitive to even the smallest of changes. My Shadoe could be touchy on changes and sometimes just a drop could make a difference in her numbers.

You can take a used syringe and practice the drop method.... fill the syringe to the 1/2 unit line and hold the syringe with the needle pointing upward. Twist the plunger until you get one drop of water on the end of the needle, then flick it off. Repeat the twist and flick until the water is all gone in the syringe.

You can get 4 or 5 drops out of that .5u of water, and it will help you to make very slight dose changes.
If you fill to the 1u line and then twist off just 1drop of insulin, that dose may be good. if you twisted 2drops of insulin from the syringe, you'd have your .25u dose or your .75u dose.

Levemir does last the full 12 to 14 hours, and when you are seeing the high numbers near the end of the cycle, it's possible that the dose was too much insulin and your cat is bouncing. Thing of ping pong or tennis; you slam the ball into the ground or table and it BOUNCES up really high, but if you just tap a ping pong ball over the net, it does not bounce as high, yes?

I hope that with the food change and a bit of insulin to help your cat's pancreas rest and heal, you may not need much or even no insulin soon. Good luck and you are doing a great job!
 
Blue said:
You can take a used syringe and practice the drop method.... fill the syringe to the 1/2 unit line and hold the syringe with the needle pointing upward. Twist the plunger until you get one drop of water on the end of the needle, then flick it off. Repeat the twist and flick until the water is all gone in the syringe.
I hope that with the food change and a bit of insulin to help your cat's pancreas rest and heal, you may not need much or even no insulin soon. Good luck and you are doing a great job!
Click to expand...

Thank you very much for the dosing advice and for the good wishes! Will try to use the drop method.
The ping pong ball metaphor is very interesting...
 
I would give the .5u some more time. Maybe 2 more days and see if she flattens out a little more. She isn't swinging that much. It would actually be a good thing to get flatter numbers even it they are upper 100s/lower 200s. Then you can slowly raise the dose to bring all the numbers down. Try going to .6u next if you can. That's a 20% dose increase.

I don't think lev is working like an intermediate acting insulin. You just haven't found the best dose yet. She has only been on insulin a few months (not yet two). It does take time to get things figured out and making other changes, like diet, are good and part of the whole process, but can add time to finding the right dose since they effect the insulin needs. We all go through this at first.

Hang in there.
 
Status
Not open for further replies.
Back
Top