Need your help again guys :)

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Charlotte & Prop

Charlotte & Prop

Member Since 2011
Hi everybody.

As some of you know I help people in Denmark with their diabetic cats. They find me through my webpage www.sukkerkatten.dk and ask for help with their cats. I few months ago you helped me with Pelle who went OTJ after a month on levemir. My own experience with levemir is only through Pelle since my own cat Prop went OTJ after 4 weeks on caninsulin.

Well this time I need help with Bølle, a 13 year old orange and white boy. He was diagnosed after christmas and started on caninsulin. Bølles mom contacted me in the end of feb. since Bølles numbers was above 600 lots of the time and the vet had raised his dose to 4 units. Bølles mom had already read my page about wet food and changed Bølle from dry to low carb wet, but Bølles numbers were still skyhigh. His numbers dropped a lot when we reduced the dose, but he still ended up being very high at amps and pmps.

On friday the family got levemir and we started him on 1 unit twice a day. I havent got an updated spreadsheet, so this is from my memory. But on that first unit he went from above 600 to around 190 . We were affraid to shoot 1 unit again since it was nighttime so he only got ½ a unit. That was to little and his numbers raised a bit, but we keept the dose to see if they would stable. Last night the numbers were up to 320 and we desided to give .8 instead since it looked like they were just slowly raising from shot to shot. During the night his number dropped and this morning he was at 180, a good number for a cat that for a long time mostly had numbers above 600. But since 180 i not to high we were affraid to give .8 so he got .6 instead. His numbers during today has been perfect until pmps.
At + 6 he was 70
At +9 he was 160
And then at pmps he was 520???????
I know the dose hasn't been stable and that is not perfect, but is this rebound? The family testet his bs twice because that is a big raise in only 3 hours. He didnt eat anything i the 3 hours, so that cant be it.

Well we only gave him .6 unit again, trying to keep the dose over a few days, but something is weird here. Any of you have an idea?

Thanks again to all of you, your were a big help to getting Pelle OTJ, I hope you can help me with this guy too.

Charlotte
 
CharlotteDenmark said:
Hi everybody.

As some of you know I help people in Denmark with their diabetic cats. They find me through my webpage www.sukkerkatten.dk and ask for help with their cats. I few months ago you helped me with Pelle who went OTJ after a month on levemir. My own experience with levemir is only through Pelle since my own cat Prop went OTJ after 4 weeks on caninsulin.

Well this time I need help with Bølle, a 13 year old orange and white boy. He was diagnosed after christmas and started on caninsulin. Bølles mom contacted me in the end of feb. since Bølles numbers was above 600 lots of the time and the vet had raised his dose to 4 units. Bølles mom had already read my page about wet food and changed Bølle from dry to low carb wet, but Bølles numbers were still skyhigh. His numbers dropped a lot when we reduced the dose, but he still ended up being very high at amps and pmps.

On friday the family got levemir and we started him on 1 unit twice a day. I havent got an updated spreadsheet, so this is from my memory. But on that first unit he went from above 600 to around 190 . We were affraid to shoot 1 unit again since it was nighttime so he only got ½ a unit. That was to little and his numbers raised a bit, but we keept the dose to see if they would stable. Last night the numbers were up to 320 and we desided to give .8 instead since it looked like they were just slowly raising from shot to shot. During the night his number dropped and this morning he was at 180, a good number for a cat that for a long time mostly had numbers above 600. But since 180 i not to high we were affraid to give .8 so he got .6 instead. His numbers during today has been perfect until pmps.
At + 6 he was 70
At +9 he was 160
And then at pmps he was 520???????
I know the dose hasn't been stable and that is not perfect, but is this rebound? The family testet his bs twice because that is a big raise in only 3 hours. He didnt eat anything i the 3 hours, so that cant be it.

Well we only gave him .6 unit again, trying to keep the dose over a few days, but something is weird here. Any of you have an idea?

Thanks again to all of you, your were a big help to getting Pelle OTJ, I hope you can help me with this guy too.

Charlotte
Click to expand...

Hi Charlotte!
Is there any chance to have the numbers put in a spreadsheet and then do a few curves? When you see how a cat is reacting, you will see the pattern... I know some cats do have extremes in numbers but I have not seen such a thing on Levemir.

So then I thought what about health? When was the last b/w done to rule out any other issues, and what about urinalysis to rule out any infection issues.
Then what about the teeth? Could there be a bad tooth?

Finally, what about the foods? I know you said there was the change to low carb wet food, but what about the brands, and flavors and quantities? If you can make notes of what food, amount and time of feeding, it could also be watched to see if it is affecting numbers at all.

Going from a +6 of 70 and up to 500+ by +12/ps, it sure looks like quite a bounce and they can take a few days to clear out.

How is he acting? At the lows and highs, what about litter box and eating routines/habits, and are there any other visual signs to mention? Sleeping more, less active, etc, anything in info could be helpful.
 
I will upload the spreadsheet later.

His bloodwork is all good, he is not using the litterbox as much and is not drinking extremly amounts anymore. He has a very good appetite and eats well. The family are waiting for an automatic feeder so that he can have smaller meals during a work day. But I am pretty sure that today since they have testet him at +6, that he had his wet food at 6 am, noon and then again at 6 pm before his shot. His food is between 3,3 %- 5% of carbs. He is happy and from what I know doing better. I am sending the link to this post to his family, maybe they have more info, but from what I know he is doing great and seem like he is feeling good.
 
On the bloodwork, are all the values good in mid ranges or are there any that are just barely making it to the OK range.
For sure something's causing the highs; what are YOU thinking about it, just to start the brainstorming?

The auto feeder may be just what's needed ... some cats can have those big drops in the early part of their cycles just by giving a mini meal once an hour after the shot, instead of just 3 meals a day.

I wonder while they are waiting for the feeder, on any day when they are home after a shot, maybe they can try to give 1tsp of food at +1, +2, +3, +4 and test those times plus at the +6 to see if food manipulation can smooth out that curve.

I could be talking through my hat but I don't recall any cats on lev with such big extremes, but I am sure the others around here may have seen some.

At least kitty is feeling better and less urine, so there are some good signs.
 
sorry the xcel sheet is taking hours to download, so i can't see it at the moment.
maybe you can export it / go to google spreadsheets and import the sheet and then it will be easier for those who want to access it.
 
OK the very first thing that jumps out at me is all the dose changes.... no way that you are going to have good results by changing the lev dose almost every shot.

Do you have the guidelines that usually followed, sort of, when using lantus and levemir?


Tight Regulation Protocol
Lantus & Levemir – Insulin Depot –AKA- Storage Shed
Lantus & Levemir – Data Ready to Shoot Low Numbers


"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

https://docs.google.com/spreadsheet/ccc ... kxLREZFc0E

I imported the ss into a google one to save time. I hope it can be seen by all.
 
Thanks Gayle. Remember he has only been on levemir for 3 days, and caninsulin before that.
Im sure the dose change has something to do with it, so if we keep him on 0,6 unit for the next 5 days, is that ok even if his numbers begin to raise?

All his bloodwork was great, no sign of infektion, great liver and kidney values.

The routine around his shots are testing the bg, eating half his food, getting his shot and then eating again. Before the family leaves for work they leave out some more food, but suspects he eats it right away. But tomorrow the automatic feeder will come and i think he then will have 4 meals during the 24 hours.
 
No problem, Charlotte, I just wanted to make sure the guidelines were followed because the spreadsheet numbers show the following dosing:
Mar2/12 - 1u am and 1u pm
Mar3/12 - 1u am and .25-.75u? pm..... not sure what that pm dose was.
Mar4/12 - .5u am and .75u pm
Mar5/12 - .6u am and .6 pm

just by looking at the numbers, i would say go to .5u and stick to it till you see all of the BG numbers level off. A minimum of 5 days / 10 shots is a good way to be sure the dose is settled and decide whether it's time to adjust. Even if the curve is all numbers in 300s (16.7-22.1) range, you want them to level off, so stick with that same dose.

The .6u dose may be OK, but if you get any low number around 50 (2.8), maybe think of the .5u dose.

Once you have that nice, flat lev curve, you can decide if it's time to change the dose.

Best of luck!
 
That sounds great. But isnt it at problem to stick with the same dose for 5 days if his numbers begin to rise up into the 400-500?
 
if you take a ping pong ball and pound it onto the table, it bounces up high like crazy, but if you just toss it lightly, you will not have the big bouncing.

It may not be the entire 5 days, but what if the dose you are giving is just right? In 5 days, you will see the numbers level off nicely and there will be no need to change it.
If you find that the .6u is giving you too low of a numbers around mid cycle, then you can drop it to the .5u and give it a few days.

The protocol says 5-7 days, but that's for a cat not already started on insulin.
Bolle already has been on Lev for a few days, so you should know before 5 days.

No matter where you are, it's best for you to hold a Lev dose for a very minimum of 2 days/ 4 shots and preferably 3 days/ 6 shots, because it takes cats awhile to adjust the shed and settle in a dose.

My Shadoe has always reacted quickly so I usually know by 3 or 4 shots, but my Oliver... well, he sure takes his time and often has taken a full 3 days/ 6 shots to notice I changed something!


Always remember that the Lev dosing is based on what's going on in the middle of the cycles, so the green number you see recently at +6 is saying 'this dose is plenty high enough'.
 
Agree with Gayle on keeping the dose steady and that .6u seems good.

What I think has happened is that he got up to too high of a dose on caninsulin and they also changed his food to low carb - probably his poor body has been pumping out rebound hormones and stored glucose to keep from having a hypo. Then you dropped the dose and his body was still pumping out those hormones and every time to perceives a drop in blood sugar it panics. Giving time to settle and calm down, I think those numbers will stop swinging. And flat numbers in the 300s are "better" than going from very high to low to very high again. Seeing a jump like that (160 to 520 in 3 hrs) is almost always rebound when the diet is low carb. That 70, which is perfectly safe, probably scared his body because it hasn't seen a normal number for so long.

He may actually end up needing less insulin very soon.

Charlotte, you are doing great for all the diabetic cats in Denmark!
 
This morning Bølle was 355 and he got .6 unit. Now at + 9 he was 140. We dont know if he will rise extremely for the last 3 hours like yesterday, but what if he dosent. Should he still have the .6 u if he is that low? It will be a bit hard to get nadirs at nighttime.
 
When in doubt, you can't go wrong with being cautious.
I know that it was mentioned the .6u dose should be OK but maybe the .5u dose may a bit safer.
See what the next ps number is and go from there.
Remember that if you go with .5u tonite, there will be a bit of the shed dumping so you may not see the true numbers till the second shot of .5u.
 
He ended on 218 this evening so no big bounce today :) Since nadirtime is at night and while the family is at work during the day we lowered the dose to .5 and will keep it there. Fridag, saturday and sunday they are off from work and it will be easier to get nadir numbers and do a curve to deside wether tho lower og rise the dose at that time.

Thank you so much.
 
That is a good plan - going with .5u and holding the dose. Over the weekend will be a good time to get a curve.

I would suggest that they get a before bed check in, that might be +4 or something, to see how he is doing. Or even set the alarm and get up to test at +6 one night. If his numbers continue to come down, he might need a dose reduction before Friday. I would make reductions of .1u (so, go to .4u after this) unless he has a really low number below 50. Then reduce to .25u.

I think you have a good understanding of how lev works and are being cautious, so I trust you to make a good decision, but I am glad you are letting us know how things are going and that you are helping another kitty.

Thanks, Charlotte.
 
Thanks Sheila.
The family always tjek bg before bed at +4, and im sure if that number is low they will tjek later.
Im surpriced how little insulin he needs and i really hope for him and his family that it means he at some point can get OTJ. Cant wait to see how he is doing within the next few days. His reation to levemir is just amazing.

Charlotte
 
His +4 this evening was 385, så once again a big bounce :( Could the .1 dose reduction mess his numbers up that much after a good day with a great +9 and pmps?
 
CharlotteDenmark said:
His +4 this evening was 385, så once again a big bounce :( Could the .1 dose reduction mess his numbers up that much after a good day with a great +9 and pmps?
Click to expand...

if the decrease was just one shot ago, it could take another shot because the shed is dumping the extra so it could.

There is not much you can do for the first few cycles at the lesser dose, and the numbers should settle.

I hope the new dose takes well and levels off soon.
 
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