New member - Roz & Oliver

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Olliecat

Olliecat

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Oliver is 7 - I self diagnosed after reading all the great info on this subject from many of you, and the great vet Dr. Pierson. My vet seems to struggle with this so I'm greatful for all of you. He had a sister, but she disappeared many years ago while I was overseas for Iraqi Freedom. I imagine she would be a diabetic as well. For now, he is my only one - of course my 5 other cats are benefiting diet wise thanks to Ollie! :-D


ETA: This is Venita. This was buried in the poll on the design of the Health Board, so I split it apart and gave it a new heading. Welcome OllieCat.
 
Re: New member self-diagnosed FD

Welcome. How did you diagnose Oliver? Are you testing his blood glucose at home? Are you giving insulin or just doing a diet change?

It is very important to be SURE of the diagnosis before giving any insulin, but if he is diabetic he needs insulin.

There are other diseases that can show the same symptoms as FD (like hyperthyroid, kidney disease), so I really would encourage you to get him to a vet to confirm, or not, your diagnosis. I, too, "knew" Beau was diabetic, but I took him to the vet to confirm it with blood work.
 
Re: New member self-diagnosed FD

Hi Everyone -

Before anyone freaks out, yes, I have gotten an actual diagnosis from my vet. I have been doing animal (both wild and domestic) caregiving for some time and will never devalue the importance of a good vet! I self diagnosed while I was looking up information for FeLIV. One of my (6) cats has been recently diagnosed with that as well - when it rains it pours. Anyway, I noticed that he had a poor coat and was urinating in places that were not designed for him to urinate in! Along with that, it was extremely sticky, like drying varnish. Needless to say, as soon as I read about the additional symptoms of lethargy and drinking inordinate amounts of water I noticed those occuring as well and had him straight to the vet first thing the next morning. At that point his BG levels were always in the high 400's with an occasional check around the high 300's. My vet is not as well versed as many of the ones I see you fine folks quoting, so I will be relying quite heavily on internet research and an occasional consult as needed. I didn't start doing my own reading until about week 4 when he wasn't moving downward at all and I got totally frustrated - got back online to find an alternative diet (my other half refuses to let me switch to rabbit...) that is better than what I had been giving up to that point. That was March 19th. By Monday, I had all the testing equipment and two days later switched to Welness Chicken wet.

I have just recently removed all dry food because I noticed (after a wonderfully positive trend downward by adding in the Wellness wet) a huge spike upward. The dry food that was out was the remainder of the Hills Science Diet WD (yuk) in the free feeder for everyone else. Since removing the dry, there are still no solid "curves" but unfortunately, I'm administering on a TID rate as opposed to 12/12 BID. Agast now that I have found out the insulin I am using is total crud (vetsulin) and may be the root of the whacked out spikey readings. So, Monday morning it is back to the vet to have him give me a script for a different kind of insulin. Hopefully that will do the trick.

Thanks to all each of you have already been through, I'm armed with loads of info and places to do research. ;-)
 
Re: New member self-diagnosed FD

Many here like Lantus or Levimir.

Be sure the vet writes the Rx for the cartridges or pens.

5 3ml cartridges will last you AT LEAST 5 months.

Whereas a 10ml vial will only last 1-2 months, because it goes 'bad' before
you can use it all.

You will use just regular syringes to draw the insulin from the cartridges.

Be sure to visit the Insulin Support Groups here (Lantus, Levimir)....for
further info on those two insulins.
 

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Re: New member self-diagnosed FD

Excellent! Thank you. I'm checking his BG level today as often as I can (at least once an hour) - I've got to run out and buy some more test strips (dangit those things are pricey!) so I may be off a bit on one of the readings but he has had two good readings today! First ever since we began this whole oddessy... yea!
 
Have curve Q and need other info...

Ok - I'm starting my curve chart today but I'm not sure where to start my dot. Since I did not give a shot at my normal morning time because Oliver's BG was low enough not to (172) do I not start my first curve dot until when I gave him a shot? I guess the same thing goes for the spreadsheet (since I'm a tid doser it's hard to keep it straight but will manage for now because I'm hopeful that will change to bid soon with the diet change) do I not enter an AMPS until the reading I get prior to dosing? confused_cat

Ok next question. I'm not sure how I would smell acetone on Ollie's breath, but his urine does smell different than it used to - or at least different than a "normal" cat's unine. It actually smells closer to a horse's urine - if any of you know that smell. I'm worried though, since his BG was so high (>300) for so long (>4 wks) that there is a chance that he has keytones in his urine. I've seen the posts on the KETODIASTIX and others, but how do you get urine? I mean, that seems like a pretty difficult task to do without getting mixed up with my other cats and getting litter instead of urine... any info on that? Beauty is that he's not drinking 16 tons of water anymore now that I've switched his diet. Of course that leaves me without the 20 tons of water (sugar water more like) that he was getting rid of as well.
 
Re: New member self-diagnosed FD

Hi,

finding your first q in last post bit difficult to get my head round.
A curve is usually one shot to the next but I'd say with TID,just mark where the shots were given.
Vetsulin peaks around +4 (Lantus/Lev are usually +6-hence preference for them. We used cannsulin, same as vetsulin, rubbish numbers , then went to Levemir and got beautiful numbers. If within 6 months diagnosis, either insulin has a high chance of remission.If you look at the stickies in Lantus support group. you'll see the Rand study-explained in there)


Your ooking for a valley curve not a sharp drop one.
+1 as vetsulin short acting. kicks in quick.

As for testing urine, in your case it means stalking the litter box.Catch the kitty mid stream and pop the stick under-voila.
Other ones beans have done is cling film and then pop it in-needs to be pretty fresh but again with 6, you need the right one. :-D
 
lo BG need to understand...

kate and lucky said:
Vetsulin peaks around +4 (Lantus/Lev are usually +6-hence preference for them. We used cannsulin, same as vetsulin, rubbish numbers , then went to Levemir and got beautiful numbers. If within 6 months diagnosis, either insulin has a high chance of remission.If you look at the stickies in Lantus support group. you'll see the Rand study-explained in there)


Your ooking for a valley curve not a sharp drop one.
+1 as vetsulin short acting. kicks in quick.
Click to expand...

OK - I need help making sure I understand what you are saying about how it peaks - please look at my numbers and let me know if I should expect it to come back up now or drop further? It appears that with Oliver it isn't kicking in to lower until about +2. We had been checking at the vet at +1 and never seeing results hence the move from 2units bid to 3units bid to 3units tid. Obviously after this curve I'm going to talk to the vet about changing the amount given along with timing (and of course asking for Levemir instead).

Thanks - Roz
 
Hi,
sorry was off doing other things. Way past bedski here.

Anything under 50 in a newly diagnosed cat you want to high carb.
This means (if you don't know) you need wet food in your house that is above 18%, 25% is really good and also karo/honey.This will have an very quick effect on bg and get numbers up. They can rocket but in these early days (that's what looks like from chart) you haven't got the data to second guess.

From your side notes you dosed again at +3-if so that means kitty may be peaking at +3

It is an absolute must that you get kitty off vetsulin.
If you click on the isg for vetsulin you will see the sticky about the FDA warning. The company that makes it has even told vets to transition cats to other insulins. Something (I an't remember the exact detail now as been away a while) isn't stable and therefore there can be fluctuations inonset, peak and duartion of insulin. This means unreliable and no help to you that kitty is back in safe numbers.

I get another test to make sure you have a rising number and needs to be 110 in my view for you to feel comfortable (20% variance on meter readings).
No idea what time zone your in as I'm in Europe.
If you have any more emergency put the 911 icon on your first post.

If you smell acetone that is a sign of keytones.

Getting that 38 in my view means a reduction in dose when you next hoot.
If you have only just started using insulin, I'd reconsider going back to 1u and working up the dose gradually. However, get the keytone possibility checked out as this can be life threatening and requires vet intervention.

If pharmacy open where you are and you can, go get some ketodiastix.
There will be others on through the night.

Quite difficult to advise here as keytones would suggest not enough insulin but numbers are saying otherwise. When next shot is due, post for the number and ask for advice.I'd be suggesting a smaller dose but would prefer if you can check the keytone issue out.

Sorry I can't help more as it's gone 2 a.m here and work tomorrow.
Good luck.
Reemember what was said about getting the right script for Lantus/Levemir in terms of the size cartridges (works out cheaper as last longer)

Good luck
 
Questions - why the TID dosing? That is 9U of Vetsulin per 24 hours. That is a huge amount for a newly diagnosed cat. No wonder he went to 38 at +3.

And are you obtaining a different insulin tomorrow? Please let us know what your vet recommends.

Changing to wet/low carb food decreases their body's need for insulin compared to what it needed to combat the carbs in most dry foods. You probably already understand that from your reading and the fact that you have some experience caring for unique animals is excellent. However FD is a whole different ball game compared to the way most diseases are treated. More is not always better, especially when it comes to giving insulin, which is a hormone, not a drug.

If you switch to either Lantus or Levemir, only twice daily doses are necessary. Please read the stickies at the beginning of each Insulin Support Group forum, the Lantus one includes info for both Levemir & Lantus.

BTW, you did good with the 38 today. Most newbies would have freaked and rightly so. The higher numbers you see as a result are a normal reaction. Please see the article at the Pet Diabetes Wiki: http://petdiabetes.wikia.com/wiki/Somogyi_rebound
 
Thanks Vicky - I really was freaking out on the inside! Fortunately, I'd read enough about that type of drop prior to it happening to know what to do.

I think the reason that we went to tid is because the vet didn't do a proper curve. I live in a small town where most people take their animals out and shoot them when they get to be too much to take care of. I just think he hasn't had a need to become well versed on FD or any other species for that matter. We were only checking his blood one hour after dosing once a week (prior to this past week). Based on the curve I did today, it's easy to see why we didn't think he was responding. Of course at that time too, I hadn't yet changed Oliver's diet en total. He still had SD DM to nibble on at night whilst I slept subsequently raising his BG to the 400's.

We should be good to go now - once I change insulin we'll be even better.

I bought some new dry food that I can add water to - Wilderness - have you heard of it? My problem is, with an FeLIV positive cat, I don't want to leave out wet food for everyone to "free feed" because I'm imagining it would be easier for those nasty bacteria to live on wet food as opposed to dry - since they typically don't have a very long life on a counter or other similar areas, but do well in urine and saliva. Subsequently, I need to find something to let them eat on when I'm not around. This stuff looks pretty good on everything (except moisture content that is...) After I get Oliver somewhat situated, I'll put some out and see how it affects him.

Roz
 
Whoa! Roz, that is a whopping amount of insulin. The "curve" you got is a classic rebound curve from too much insulin. And, FYI, most of us have seen our kitties do this, some more than others :roll: , but I digress.....

Please reduce his dose to 1u bid (twice a day, every 12 hours) and "start over". It will take several days for the rebound hormones to exit his system, so numbers may be wonky for that time, but should begin to settle by day 2 evening. If you must shoot tid because of schedule, than try .5u each dose.

If you switch to levemir or lantus, please start at 1u bid.

Beau started out on vetsulin (Jeddie too, but I really didn't have any experience with him on it) and I was relying on vet tests - dose got very high and there was no regulation, as it seems you saw with Oliver. Beau was also still eating some dry food. I started home testing, phasing out the dry food and reducing the dose. He went from 2.5u bid to less than 1u bid and his numbers fell from 400s-500s to 200s-300s at preshot time. Every cat is different (ECID), but in general the vetsulin dose is .5u to 1.5u bid for a cat on a low carb diet.

Sooooo glad you were testing today!
 
Are you talking about the blue buffalo dry with the lynx on the bag? That is actually a pretty high carb dry food (well, low for most dries, but high for an FD). I would recommend Innova Evo that is 8% carbs - and says so on the package. And only feed small amounts. You may find that you have to meal feed everyone in order to get Oliver on a proper diet without risking infecting your other cats with FeLV.

ETA: it's not recommended to add water to dry food - it actually grows bacteria really fast when it is wet - faster than canned food.
 
Sheila & Beau & Jeddie said:
Whoa! Roz, that is a whopping amount of insulin. The "curve" you got is a classic rebound curve from too much insulin. And, FYI, most of us have seen our kitties do this, some more than others :roll: , but I digress.....

Sooooo glad you were testing today!
Click to expand...

No kidding! - The part I feel bad about is that I've been blindly giving him that much for about 2 weeks now. No telling how many close calls there have been that I *didn't* know about!

I'm going to drop the dose to 2u tonight accordingly - that will only be his second dose of the day - and tomorrow morning based on the reading I may not administer anything and just come home when I know his numbers should be rising. Once I change insulin I will start over then and get him on the straight and narrow. I picked 2u based on the calculation of how many points he drops per unit (80). Since he will be sitting around 270-290 when I dose, he should be able to drop 160 points without any ramifications. I'm just about to do that now. If it hasn't moved too much since the last reading though - I might follow your lead and only dose 1u so that he is good for another dose when I get up to go to work at 5:30am. I'm just about to check and dose now so I can go to beddybye. It has been a long and stressful day...

Roz
 
Sheila & Beau & Jeddie said:
Are you talking about the blue buffalo dry with the lynx on the bag?
Click to expand...

Yep sure is. Well - at least the other cats will have something good for a while. I may just have to keep everyone eating seperately for a while until what I bought is all gone...
:sad:

My pocketbook is taking a huge hit lately!
 
No kidding on the pocketbook hit! I'm buying canned food and/or treats every single time I leave the house lol. I don't even want to think about the total I've spent on food, supplies and treats in the past few weeks. I don't want hubby to think too hard about it either ohmygod_smile

I tried doing the "better quality" dry food for a while because my 5 were all very resistant to wet food, I thought it would be ok because it was grain free. I didn't know at the time that the drying process turns it into high carb crap anyway so I fed it for the first three+ months. Couldn't figure out why I kept having to bump Tugger's dose up to get his numbers to come down even a little bit. Then one day, they all started eating the wet food I had been offering so I just let the kibble fade away and WHAM Tugger's numbers hit the floor, compared to where he had been riding anyway. I haven't seen him go below the 40's but that may be because I had remembered that changing food could do that so I started testing him often and caught it when he went way down. Fed him a bit of high carb wet and it came back up.

It's only been two weeks and we've already been able to reduce his dose by more than HALF of what I'd been shooting. And he's acting like he wants even more reductions.

I didn't know about the Innova Evo dry at 8% but now that I do I may go grab a small bag to feed a couple of my civvies who have been having a hard time with the change. I'd rather not feed dry at all, but Bella is starting to loose weight and I don't want her to loose too much.

I hope you are able to put some of the suggestions you've gotten into practice. This place has really helped me make a big difference in Tugger's overall well being. He's healthier and more energetic, his fur is looking much better and he's interested in everything again. I'll be honest, at this point I trust the folks here on FD info and dosing and everything than I do my vet. I've got to call soon to make an appointment for a refill on Tug's Lantus and I plan to take in a bunch of info for the office. If they are willing to learn and treat Tugger according to the protocols here... he can keep getting my money, and he's gotten a LOT of it. If he's not willing to educate himself and work with me, I'll find someone else who will. From what most people around here say though, most vets are very willing to admit they can't know everything about everything and they are often happy to have clients who do educate themselves and who are proactive with their pet's care. I hope I have one of those, and I hope you do too!

There are stickies at the top of the forum, one of them is Convert a Vet. You might try printing it off and giving that to your vet. It's full of info. and it might convince him.

Let us know how the vet visit today goes!
 
Well - as for the vet - he's just going by what I'm saying and getting me the Levemir in cartridges. He wants to make sure he gets my money so he's pretty much doing what I ask for. He's a pretty good guy all around - very old, but good. Anyway, he got his supplier on the hook today and told me it shouldn't take long to get it in. He didn't know the whole deal about the vetsulin - or at least he didn't let me know that he knew the whole deal if he did.

Ollie is doing MUCH better at 2u bid - his numbers get to about 300 or just over pre-shot, but since his curve showed him dropping 80 points a unit, that's pretty good for starters. Once I get him on Levemir, I'm hoping to see a better shift in how long his numbers stay even keel.

Thanks again to everyone that helped me through yesterday. I was pretty stressed out by day's end and ended up having to take a pill to go to sleep around midnight...
 
Olliecat said:
Well - as for the vet - he's just going by what I'm saying and getting me the Levemir in cartridges. He wants to make sure he gets my money so he's pretty much doing what I ask for. He's a pretty good guy all around - very old, but good. Anyway, he got his supplier on the hook today and told me it shouldn't take long to get it in. He didn't know the whole deal about the vetsulin - or at least he didn't let me know that he knew the whole deal if he did.

Ollie is doing MUCH better at 2u bid - his numbers get to about 300 or just over pre-shot, but since his curve showed him dropping 80 points a unit, that's pretty good for starters. Once I get him on Levemir, I'm hoping to see a better shift in how long his numbers stay even keel.

Thanks again to everyone that helped me through yesterday. I was pretty stressed out by day's end and ended up having to take a pill to go to sleep around midnight...
Click to expand...

Hmm, "supplier?" All he has to do is write you a prescription for 5 3ml Levemir Flexpens pack, you take prescription to any pharmacy (maybe call ahead to see if they have it in stock or have your vet call in script), walla, you have your insulin! FYI, the 5 pen pack probably runs about $200 now. Depends on the pharmacy, call around for the best price.

Have you had a chance to read the info in the stickies on Lantus & Levemir Insulin Support Groups? You can post in either group and we'll help you out. Starting dose should be no more than 1U.
 
FYI - you can't count on a "per unit" drop. It doesn't work that way. There are so many things that effect how the dose works. First is diet, quantity and type of food, and exercise. Then there is stress (door bells, barking dogs, fire trucks roaring down the street....). Next, because it looks like he was rebounding, as you reduce the dose he will not climb as high at preshot it will just be insulin wearing off and not a reaction to a too high dose (which causes his body to release stored sugar as a safety measure). Well, I don't think I am explaining that very well and my brain just shut off for the night!

It's just a more complex thing going on, that involves several hormones - and a cat. Not a recipe for predictability.

Hope I didn't take the fun out of it for you :mrgreen: !
 
Olliecat said:
No kidding! - The part I feel bad about is that I've been blindly giving him that much for about 2 weeks now. No telling how many close calls there have been that I *didn't* know about!
Click to expand...

I'd tell you not to feel bad.. but it won't matter (this I know from personal experience :) ).. just know that there are plenty of people around these parts who look back at when they started and didn't know any better.. and feel like dirt.. can't change yesterday.. but can change today.. and you are taking the right steps in doing that.
 
I know it sounds like it wouldn't be easy, but I'd really recommend dropping the dry altogether (obviously transitioning everyone to wet first), it's just not good full stop.

If you go on the health links page, lots of cat nutrition info by Dr Lisa (only qualified vet on here)

As you've been doing t.i.d. dosing starting over at 1u with the Levemir sounds like the best plan.
However, please can you make sure you have the ketodiastix and can test urine for keytones.

I think what Sheila is saying you;ll save yourself some money if you shop around for the lev.

Good luck :-D
 
I dropped dry some time ago - I have it listed on my SS. Unfortunately it is just too difficult for me to make sure everyone gets to eat when I'm not home due to my FeLV+ boy. I can't leave out wet because it is too easy to transmit that way.... I'd like to stay away from dry but... besides, I just (before I saw some replies) bought 2 more bags (which makes 3 full unopened) of the wild blue wilderness with the lynx on the front. Gonna have to use it somehow! :sad:
 
OOOOHHHHHH AND.... thanks for bursting my bubble! Just when I thought I had figured something out. Ok - so if I can't go by an assumed point drop per unit, how do you determine how much to dose? Surely there is some scientific method with empirical data that suggests that if your curve looks like x then you dose y based on that. I can't believe that with all of the SS we have out there that someone hasn't been able to determine some sort of dosing...

For example, I only dosed 0.5u this morning because I knew that even though he was at 160, he would curve up in an hour or so and I wouldn't be home to give anything to him. It seemed to have worked out fine because he wasn't over the top - and actually at his trended number at PMPS. Surely there is some rule of thumb to go by if I can't calculate based on the curve. I mean this can't be that unscientific and unpredictable, can it?
 
Really - the best part of it all is watcching my man jump around and play again instead of looking like s**t! It makes all the tough times worth it!!!!!! He is starting to have fun again - it's amazing! :-D
 
You can't be that scientific; but you can 'experiment' and learn through experience how he will react at various preshot numbers and at various doses.

Reducing the dose at 160 was good; most have 200 as a cutoff point when first starting...

Jen
 
Don't worry about the dry/wet. I understand what your saying and don't suppose you want to keep Ollie separate?

Jen is right too, there is no exact method. You have to account for the ECID (Every cat is different)angle.

If your ever worried kitty is going to drop too hard, you can always reduce dose a little. What you don't want to be doing is do this every day. Another reason why we say increase in .25u increments is so you don't miss ideal dose and less chance for kitty bottoming out.

People who work 5+ day weeks of over 10 hours for eg, just dose based on the figures they get at the w/e for the following week. So this might mean sticking with 1u for more than 5 days.

I was generally fortunate as I could get back most days to get a +6 and also had a habit of staying up half the night to get the pm one. It allowed me to have tighter regulation.

Ollie is indeed not just a number, but your friend who you want to see happy, content and playful again :mrgreen: That's the oveiest part to see.
 
kate and lucky said:
If your ever worried kitty is going to drop too hard, you can always reduce dose a little. What you don't want to be doing is do this every day. Another reason why we say increase in .25u increments is so you don't miss ideal dose and less chance for kitty bottoming out.

People who work 5+ day weeks of over 10 hours for eg, just dose based on the figures they get at the w/e for the following week. So this might mean sticking with 1u for more than 5 days.
Click to expand...

I'm not sure I understand - I need to make sure I get this right too because I'll be switching over to Lev pretty soon. Right now, I'm not so bothered because of how steeply the vetsulin drops Ollie down but... thismorning I had to lower his dose again because he was even lower than yesterday so I stuck around 0.4 - 0.5 range. Unfortunately I'm away from the house for 11-12 or more hours every day so it is even hard in the morning to do the test - feed - shot routine. It all ends up bunched together or more frequently he's getting his shot whilst he is eating. So, once I switch to Lev, do I not lower his dose because of how long it takes to kick in? Or will I still have to worry about shooting a full dose when his numbers are where the should be? :?:
 
Re: Update on Vet and insulin script

Alright! Well here is a quick update on my vet and his supplier. Naturally his supplier didn't have what I wanted (Levemir cartridges) so he is going to call me in a script to the pharmacy he said he usually gets the best prices from. The best part is, he seems excited about learning new stuff and has made some calls to other vets for their experiences and has even saved some reading for me! I'm happy because at first it didn't seem like he was going to take that much of an interest in it (awfully close to hanging up his coat and in his late 60's or early 70's). This is a great thing for me in this small non-animal friendly podunk town!

Now - who can tell me what OTJ means? At first I thought it meant "off the juice" as in no more insulin needed, but on the last post I saw it on it didn't seem to be about that. And it isn't in that great acronym dictionary in here either.... :-(

Things seem to be going good for me so I'm becoming cautiously optomistic. Still not feeding any dry to the main populus at all - only to my FeLV as a supplement to his wet (which he mostly ignores the dry anyway - and who could blame him? that wellness smells like corned beef hash! almost good enough for me to eat!!! :lol: ) since he eats in a totally seperate room than the rest.
 
Hi sorry for delay.

Dose will be based on numbers. As you can't get a nadir (+6 test-usually the lowest number in the cycle)you may need to be more cautious.

If your already on .5u or less, sounds as if he is already on a downward spiral. What you don't know is how the vetsulin is working because of the FDA warning about it. It may not be working as it's 'supposed' to. At the moment sounds positive.

First of all I'd get the lev-you do want the 5 carts as it may 'anti-jinx' (yup superstitious here :mrgreen: ) that you won't use them all.
I would then suggest you start on an evening or when you know you can be home to get the +6.
It may mean doing this at night and setting your alarm to get up in the night to get the +6.

You still take your pre-shot number into account before hooting.
Don't want to confuse you as your doing great but information overload may confuse you.
Keep doing what you are and ask for advice when you have the lev. Also outline what your availability is to be home to test and 'we' (others on the board) can help advise you.

One more thing- You still want kitty to eat when hooting. I always did this after eating, but ECID. and this is fine. What is slightly different is that lev takes longer to kick in (onset)-when insulin starts working on bg's. This means say you have 150 at preshot, you might actually be hooting for a preshot of 200 by the time the insulin starts working. (Another way-bg number continues to rise for the next 2 hours)

It's when you start getting in numbers around the 120 or below mark people start (quite rightly) getting nervy.
Can be hard if you have changed from vetsulin (like we did) as action of insulin very different and numbers generally much lower. You soon get into it. I alsoknow we were fortunate cos I could get back oftenduring day to test and would stay up in night to get +6 also. Just as ECID so is every bean (us :-D )
Great that your limiting the dry.
Ask away anymore q's and yes you were right about otj-don't know what else it could stand for?
 
Nadir times on Levemir

Levemir cats frequently nadir well past +6, as late as hours +9 or +10, some even nadir AT next preshot time. And one spot check in the middle of a cycle doesn't reveal a whole lot. With only one spot check you may see that at least there's action but that's not something to base dose increases on, especially a +6.

Roz the best thing for you to do is determine nadir time within the first few days of using Levemir. That will mean checks every hour from +6 on to establish trend (how steep the drop) as well as nadir. You're looking for the lowest blood glucose within the cycle, but once an hour testing is fine. Testing at +1 or +2 can also be important to see if Oliver gets food spikes, assuming you feed at shot time.

Once you've established nadir time, you can target that hour to test if you can only get one spot check every few days. Unfortunately Levemir doesn't work well with a sliding scale like Vetsulin may, (sliding scale is giving preset doses based on preshot value, ie. preshot 200-250 give .75U, preshot 150-199 give .5U) rather than nadir. Levemir likes a regular schedule and a regular dose. That's why the dose determining stage is so important.
 
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