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Linda and Scooter & Jack

Linda and Scooter & Jack

Member Since 2012
Hi Folks:

I am new to this forum and at the direction of Deb and Shelia they recommended I post over here since the levemir forum is kind of quiet.

Scooter has been on a journey to get here and for the first time since November I finally feel like there is hope today. I woke up to a 100 point difference in his morning numbers so I am happy. :-D

He was started on Lantus first and then NPH and now finally levemir. I do not have his lantus numbers on his chart but his NPH and lev numbers are there. He is lovingly referred to as "the little old man" around here. Since Jack brought him home years ago we don't know his real age but we have had him 9 years and the Vet guess was 7 at the time. He is a very fragile Egyptian Mau.

Anyway I thought I would introduce myself and Scooter as we have needed a lot of help on this journey.

Linda
 
hehe your sig line "Scooter is powered by Levemir" made me chuckle!

just want to say Welcome, Linda, to you and Scooter.

I'm looking at his ss - are you giving him 3 shots of Levemir, each 4units, each day? Am i reading that right? Levemir has a very long duration, so we give 2 shots a day. It looks like he's had some large dose increases - like a unit or more at each increase. I see 2 one unit shots 12 hrs apart in December, but now the 4 units 3x/day.

Can you tell us the story behind his dosing?

eta - i missed the last 2 days, sorry. now i'm seeing 0.25u BID. i'd still like to hear the story. we'll help you get him regulated - no worries.
 
Welcome to LL Linda and Scooter! You will definitely find this forum quite busy and lots of Lev users hang out over here so you will be able to find the support you need :-D
So happy to have you join us! Gonna go look at some of your posts now ;-) :-D
 
Well he was unstable on the lantus so his Vet thought to get his numbers down we would try the NPH. ( She knows about diabetes but Jack and Scooter are her only sugarcats)
As you can see that didn't work either. So here we are with the levemir. I am hopeful this morning though.
His original high reading was 631in Nov so to be in the 300's this morning is great start to me. :smile:

I am working on my signature. As I spend less time with Scooter I will get into the tech forum and shorten it. lol

Thank you for the welcome!

Linda
 
Welcome, Linda and Scooter!

You definitely are in the right place. Lots of knowledgeable folks here, that are happy to help, and lots more that provide support and encouragement. Don't be afraid to ask anything - someone here has been there! :lol:
 
Welcome to the party Linda and sweet Scooter! I hope you brought a good pair of pj's and some patience pants, too! :lol: Glad Scooter is doing better - I hope he continues to improve.
 
Welcome to the land of crazy sugarcat people Linda and Scooter!!

Just wondering why you started the Levemir at .25? We usually start at 1 unit BID (I'm a Lantus user, but Levemir is usually started at the same 1 unit dose)

Sure looks like you and Scooter have been on one heck of an interesting (and I'm sure frustrating) ride! Hope we can help you get him under some better control!
 
every cat is "unstable" on insulin when they start out. Click on any person's spreadsheet in their signature and look at the cat's beginning days. You'll see numbers all over the map.

We follow the Tight Regulation Protocol - it's the only protocol published in a professional veterinary journal on how to treat a diabetic cat - and do small incremental adjustments to get to the "right" dose. that right dose is different for every cat - but we get there!

Most vets don't have a lot of experience with diabetic cats. most are hard to get regulated, especially compared to dogs and people, and many owners put their cats down rather than treat them. Fortunately, you've found this site where there are many people who take care of diabetic cats 24/7/365 and understand how it works.

Lev is a good insulin. We see cats do very well on it - i don't know if you've gotten the explanation that it takes several days initially to get to the point where we can see what the dose is doing. In your case, having had a larger dose, there will be a few days of things equalizing out from that higher dose. What i mean is that Lev and Lantus are both depot insulins, meaning they build up in the body and slow-release, which is why they are so good for cats at evening out their blood sugar. your previously high doses - the 12u in a day for a few days - will need to work out before we can really see what the current Lev dose is doing.

When you have time, feel free to read other people's posts and see if they bring up questions for you. Ask away.
 
Hi Linda and Scooter

Welcome to Lantus Land!! We are a close family group who loves to help. We all get to know each other and, most importantly, our kitties. There's usually always someone around just about 24/7 and we love questions. :-D There are several cats here on levemir.

I read back through some of your older posts on Health and Levemir forums. Levemir is an awesome insulin (I use it, too) but so is Lantus. Your vet didn't give Lantus enough time to work for Scooter but that's water under the bridge. I only mention it because as you work with her, if she gets other diabetic cats in, she needs to give the lantus longer to work. It can take weeks or longer to see the effects on the BG depending on the cat. However, the fact that kitty is getting insulin helps him/her quickly and symptoms start to dissipate even if numbers are still high.

You will find the same thing with Levemir. I wouldn't have decreased his dose quite so much. I would have recommended a starting dose using the normal formula which is 0.25u/kg of ideal weight. If the kitty is underweight, we start at 0.25u/kg of current weight. So if Scooter weighs 10 lbs, for example, his starting dose of Lantus or Levemir would have been 10lbs/2.2 (kg/lb) = 4.5 x 0.25 = 1.13. A good starting dose for him on levemir would have been 1u. But, if you were nervous about it, starting at 0.5u would have been just fine, too. I think that at 0.25u, you will need to see him go up. NPH is not a depot insulin and so the effects of it would be out of his system by this morning at the latest. Usually where we see cats having a low cycle on the first dose of levemir is when they have been on lantus because you are overlapping depots. For that reason, we have a general guideline that we reduce the starting dose by 30% when we are switching between lantus and lev or vice-versa but not usually between one of the non-depot insulins and a depot insulin.

The other thing we often see is that the kitty might need to gradually go up in dose per our TR protocol to close to the last insulin dose. However, in the case of Scooter, I'm not convinced one way or the other that some of those high numbers could be bounces off low ones that weren't caught. He was seeing a response to 1u of NPH but then his liver was releasing counterregulatory hormones and glucagon and causing numbers to skyrocket. Your vet was probably not aware of this. Sometimes too much insulin can look like too little.

I'm not sure how much you know about levemir but it typically onsets about +4 and nadirs anywhere between +8 and +12 depending on the kitty. It is very much ECID (every cat is different). The great thing about lev is because of the late nadirs, you have a good opportunity, especially when the numbers come down, to take full advantage of it's overlap and carryover.

At this point in time, I'd leave him at 0.25u for four cycles and if he doesn't come down, I'd raise the dose to 0.5u bid. Then we'll see how he does.

It appears the formatting on your SS is not working. If you'd like help with it so it color codes the boxes, please PM me and I'll be happy to help you fix it. It really does help when you can see the waves of colors.
 
Hi Folks:

Wow what a nice welcome! :smile: So we are back in the 500's after a great start but I have not lost hope. The dosing guidance was from some experts here with the idea we can go up and both my Vet and I thought that was sound advice. As you have said ECID and since Scooter is so small it was sound thinking. He is a mere healthy 7.2 pounds. He is just built small. My other sugarcat Jack is 21 pounds but they are great friends. :smile:

I am thinking to wait at least 3 days before uping to .5 based on the help here that suggested the Humilin would be out of his system today. My sense is not to do anything without checking in here first for advice.

It is weird I wondered if my columns in my SS should be colored. lol So yes I will get that figured out.

Thank you all so much for being so kind to us both!

Linda
 
:-D

we're glad you're here, linda! it's a nice place to have to hang out! :lol:

if you're up for tinkering with your ss, one thing that helps is to grab the vertical line to the right of the AF column along the top. You'll get an <-> icon and you can grab that (click your mouse right on that and hold down) and pull it to the right maybe an inch. that'll let your remarks column spread out and it will let us see more rows of your blood sugar numbers on the screen. don't know about everyone else, but i think it's helpful to see several days at once in the same screen.

marje can give you a hand fixing those colored column issues! they help too.
 
Oh my! He is a tiny fella! :-D And yes, those spreadsheets should get their very own forum for venting! :lol: :lol:
 
Oh my! He is a tiny fella! :-D And yes, those spreadsheets should get their very own forum for venting! :lol: :lol:
 
Oh my! He is a tiny fella! :-D And yes, those spreadsheets should get their very own forum for venting! :lol: :lol:
 
I understand but please consider the following two things that are very pertinent to Scooter. At 7.2 lbs, the starting dose, as calculated, would have been 0.8u so we would have suggested 0.5u.

In this forum, most of us follow a Tight Regulation Protocol because it is the only protocol based on scientific research and published in a scientific, veterinary journal. Not all of our members here use the TR protocol and we welcome anyone using lantus or levemir following TR or the Start Low Go Slow Approach. The TR protocol provides the best chance for cats to go into remission. The original TR protocol was used by a German Forum for feline diabetics and a website was done by Kirsten Roomp (she is the Roomp from the Roomp/Rand that actually did the scientific research and wrote the protocol). This initial information is provided on Tilly's Diabetes Homepage entitled "Protocol: tight regulation with lantus and levemir for diabetic cats".

Kirsten addresses switching cats from one insulin to another and states:
Cats that have a tendency to get ketones and/or who are getting relatively high flat curves after the switch should have their dose raised earlier (after 24-48 hours).
Click to expand...

The actual Roomp/Rand Tight Regulation Protocol also addresses this; if you click on the link and look at Phase I for initial dose, it states that if the nadirs are over 300, the dose should be increased by 0.5u after 24-48 hours. I would not suggest that in Scooter but I do very highly recommend you increase his dose by 0.25u to 0.5u tomorrow morning as long as he does not come down tonight. And I doubt he will.

The longer he stays at high numbers, the greater the potential for him building up Glucose Toxicity.

eta: Just a reminder, too, what Sheila told you:
I also agree to hold the .25u dose, at 12 hr increments for a few days - maybe 4 cycles. Has Scooter ever had an issue with ketones? Do you test for them? It might be a good idea to do so while he is settling out. Ask the vet about raising the dose after four cycles if you don't see a noticeable drop in numbers.
Click to expand...

None of us are experts. :-D :-D ;-) We just have more or less experienced members. :-D :-D
 
I do think increasing tomorrow is a good idea, linda. One quarter of a unit is a dose we pretty much only see on a cat that's very well regulated and/or on their way off of insulin. It's really, really low. unless you get some BGs significantly lower overnight, i'd also increase in the morning. you don't want him sitting in these high numbers longer than absolutely necessary.

you test plenty often enough to catch any low numbers. we'll know if it's too much and be able to help you get him into safe numbers. Right now he just looks like he needs more insulin.
 
Whew how interesting. I wanted to up his dose as well. So I will do that tomorrow morning. .5 seems like a better dose to me since he is not coming down and reading the rand protocol was interesting. Thank you for that link. Also very convincing. I am going to read it more and again.

I am really interested to know if anyone had there kitty go from independent to clingy. for the last two days he is wrapped around my neck. Literally. I can barely see the screen when I type. I am hoping it's fine since his purr is loud. :smile:

Linda
 
:lol: Clingy is definitely something a lot of us have seen. You will find that with FD's nastiness, also comes an amazing bond between kitty and their bean. It's as though they realize we are helping them. It truly is a wonderful bonus.
And woo hoo!! 0.5U means you get to measure on a LINE! Also a bonus :-D
 
You're very welcome. We are here to help you and Scooter and put all our knowledge and experience towards that for you.

Glad to hear he is clingy and purring!
 
The yellow starred posts at the top of the Lantus/Lev TR forum (this one) are gold mines of information.

The New to the Group sticky has a lot of bits that will be helpful to you. Single topics like Pancreatitis, Dentals, New Dose Wonkiness (and bouncing), Should I feed kitty as much as they want, should i increase the dose, Glucose Toxicity, Acromegaly - and more are all in links at the bottom of that page. There's also a link there about the difference between Lantus and Lev and how they each work - i thought that was pretty interesting. it's helpful to understand dosing when you get how the insulin works.

The Protocol has its own post, as does how to take care of your insulin (make sure you look at that post and watch the video) and what to do when you see low numbers. The whole starred post section is great. I look back at them all the time and i've been doing this for 3 years now.

Just a little light reading for you in your spare time! ;-) :-D

and of course, you can always ask questions instead. that works too!
 
So I feel like I have taken the Masters course on FD!

Now it's implementation time. I have read everything you folks have suggested and feel pretty confident. I am glad the protocols and sticky's stay there for reference though.

This morning I doubled his dose to .5 so I am hoping he feels better and the numbers lower a little. My sense is to keep him on .5 for at least 3-5 days to see if anything is different. I am thinking I should be posting as you all do with his name and numbers and the date. It is very inspiring to see those Subject titles with stable and low numbers. :smile:

He is still on my lap today. I think he wants to say thank you to you all as well. :smile:

Linda
 
Hi again Linda and extra sweet Scooter!!

Yes, every day, we start a new post (we call them condo's) with the date, cat's name, and the AMPS number in the Subject line. As you get other tests throughout the day, you go back to that first post, and edit the subject line to add them, so if you started in the morning at 234, and 2 hours later got a 178, you're condo's subject line would look like this
1/12 Scooter AMPS 234,+2 178

In the body of the condo, you put your WCR (Whole Cat Report)..How Scooter is feeling, eating, anything you think would be helpful, as well as asking any questions you may have. If you do have a question, if you add the ? icon (directly above the Subject Line) it will show up to let us know your condo includes a question. If you have a question later in the day, you need to go back to that first post again, and add the ? icon so it shows up when we're scanning the forum.

Very happy to see you went ahead and increased to .5 today and we'll all be watching to see how it goes!

Edited to add..Forgot one thing...Always put the link to the prior days condo in your new condo. It makes it easier for people to quickly go back and see what's been said so far and read up on the history of what's been going on. Just copy the link in the address bar from the prior days condo and click on the URL tab under the Subject line. Paste the link in between the your link here[URL]
 
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