Hi Arnie's dad,
Welcome to Levemir.
As someone who's completely unfamiliar with Arnie's case and his spreadsheet, I hope you'll consider my observations with an open mind.
Has anyone given you an explanation as to why his PM preshot is almost always greater than 350? If so, can you please share that with us?
If you are comfortable with ketone testing, I would highly recommend dropping all the way back to 1U. Not only is it our recommended starting point when switching with Levemir (sometimes we even do .5U) but when I see signs of Glycogenolysis, otherwise nicknamed "panicky liver," I suspect rebound because the dose is too high.
http://petdiabetes.wikia.com/wiki/Glycogenolysis The greens he's had on Lantus blare out like a siren because of all the pinks. Something is not right there.
Admittedly I have not used Lantus, but unless Arnie is started out on Levemir at a dose below what might be his optimum one, he will continue to have the same types of cycles he's had on Lantus. Having a dose which is too high does not necessarily throw them in to hypoglycemia, so since you rarely see 40s, there doesn't seem to be a reason to lower dose, if you don't look beyond the black and white of the Tilly protocol.
The swings he's having are typical of too much insulin. Too much insulin will also extend duration, which he is also having. His curve in March clearly went for 24 hours. Very good of you for doing that. I'm sure it was hard!
The Tilly protocol does not really address this action of the liver, it merely says if nadir is within such and such range, raise the dose XX amount. But if there is extreme liver action, as I suspect here, you are basing doses on "artificially" elevated BGs.
I gather the "protocol" is to continue raising dose to try to break the liver. Breaking something to "fix" it doesn't make a lot of sense to me unless you're talking about horses.
Some cats need an extended period of adjustment to really show what a particular dose can do. I'm not sure if Arnie is one of those cats or not. It's very difficult to tell what his response was to any 1 dose, because his response has pretty much been about the same since his dose began being raised a year ago, continually increasing numbers as the dose was increased.
I'm sorry, I know you didn't post here looking for dose advice really, but after reading his spreadsheets, I am worried. Glad you got the refrigeration question answered. Levemir is good till the last drop, as long as it is refrigerated. You will save a lot of money too!
We can help you figure this out. Good for you for sticking to your guns about testing! You won't regret switching. And I'm actually glad the vet said to start with a lower dose, though it quite possibly is not low enough. If after a couple weeks (if we don't see any problems before that) he continues to have the same results he did on Lantus, I highly recommend lowering the 2U, rather than raising it.
