New to the board and on Levemir

Status
Not open for further replies.
Bisse

Bisse

Member Since 2014
My cat was diagnosed with diabetes on March 3 and I have been reading this forum every day since. It has helped me so much when I am stressed and overwhelmed.
He (Bisse) was started on insulin on March 6 and I had switched his food from all-dry veterinary to canned wet with high protein and low carb. No problems, he LOVED the canned and had no stomach issues. Since he had lost a lot of weight the vet said to let him eat all he can and he has now almost gained all of his weight (ideal about 6.5, now 6.1). I bribed him with a bit of cooked chicken at testing/shooting times.
He was started on caninsulin (vetsulin) since this is the law, but since I had read the Roomb/Rand etc. the second sentence out of my mouth at the vets was "Will you switch him to Levemir if this doesn't work?". He was switched after two weeks even though the vet thought it was too early, but I thought a longer lasting insulin made sense!
Now I am not so sure and would love some advice. He doesn't really seem to be reacting to the levemir, he actually did better on the caninsulin, but the short dips worried me. I am upping the dose fairly aggressively (a bit too quick, I know, but there were other considerations) now but he never goes below 10 mmol/L and is it really normal that he is now at 3 units twice a day with nadir barely 5 mmol/L lower than preshot?
I am thinking about changing to lantus or even back to caninsulin.
The testing and shooting seems to be going fairly well, I have noticed he might be drinking more after switching from caninsulin to levemir, but we also switched waterbowl (from extremely large to smaller) and he is using the litterbox a lot! We are in regular contact with the vet, but think they have limited experience with levemir as caninsulin is much more commonly used.
I would really appreciate some comments on his BG numbers they are here:
https://docs.google.com/spreadsheet/ccc ... _web#gid=5
and whether to stick it out and keep upping his dose or switching to lantus.
Bisse and Helle
 
I agree that the Levemir does not seem to be working that well. For the time being I would just keep slowly increasing the dose and see if it gets better
 
Hi there :cool:

Welcome!

Although I personally have not experienced caninsulin, levimir or changing from one to the other, there are members who have over on the Lantus ISG (insulin support group) who can offer experienced advice.
There are several Levimir users that post there daily as well, since the protocol we use applies to Lantus and Levimir.
also, there are almost always experienced eyes available to assist.
 
Welcome Bisse and Helle!

I'm not experienced on insulins or changing insulins. I'm here just for moral support. I have also be giving Levemir to Juno, but his values have been all over the place, and far from being regulated. I still have lots to learn, but from what I have been reading Lantus or Levemir are great insulins for cats and the probability of having a hypo shock is reduced compared to caninsulin.

I hope some more experienced people can help you deciding what to do.

Cristina
 
Goddag, Helle og lille Bisse, også. Ok, that's it! All that I remember from my semester in København.

Most of us have found that Caninsulin doesn't work as well for cats, but he did have much better numbers on the Caninsulin. The only thing I noticed on your SS is that you have been going in half unit rather than quarter unit increases and maybe he needs a little more time to adjust to the larger dose. There is a phenomenon called New Dose Wonkiness when the numbers go up after an increase instead of coming down. It usually lasts for about 3 days, maybe Bisse needs a little more time.

Lantus is more commonly used for cats than Levimir, but they work about the same. We switched because Tess got her nadir way too early on Lantus, now on Lev it is really late! The main difference is that Lev has a later onset, which means later nadir and a longer overlap. You don't seem to be seeing any of this though. You have got the U100 syringes, right? Although if you were still using U40 syringes he would be getting way too much insulin.
 
Hello, we started on Caninsulin, then switched to Lantus and then to Levemir last year. Most of here follow a protocol for modifying insulin doses. When kitty is seeing numbers under 11.1/200, we increase by only .25U amounts. Increasing too fast can mean that you miss the good dose. You should have gone from 1U to 1.25U because Bisse was seeing blue numbers then. I presume you are using the BD Ultrafine syringes with .5U markings? To get .25 you eyeball in between the half and full unit marks. If you take a look at the Lantus Tight Regulation forum, there are some sticky notes with images of the doses.

The other thing I'd suggest if you have time (maybe a weekend), is to do a curve overnight. Maybe every three hours instead of every two. My Neko, like many cats, loves to do her low numbers in the night time. It could be possible Bisse is getting into good low numbers and night and bouncing during the day time when you get most of your data. Bouncing is when the liver releases glucagons and counter-regulatory hormones to increase the blood glucose in what it sees as a low blood sugar. It may not be a low blood sugar value, just lower than what the liver has seen lately. On Caninsulin, it did seem like Bisse liked low numbers better at night time.
 
What food specifically?

If in North America, check out the food list at Cat Info and ensure the percent of calories (not weight) from carbohydrates is < 10%.

If in Europe, check the posts in this thread to see if the carbs are low enough.

There is a Tight Regulation protocol you may find helpful to review here.
 
Thanks all so much for the info and support. Just knowing we are not alone and people care means a lot.
I'll definitely pop over to the lantus tight regulation and ask for input. I am eager to get him on tight regulation.
I am using the U100 but had trouble finding the ones with half markings. I'll get them now and that's partially why I increased 0.5.
Also my vet suggested 2 in the morning and 1 in the afternoon.

Wendy&Neko you think I might have been seeing good numbers but only at night where I missed them and therefore am now seeing high numbers because he is bouncing during the day?
I absolutely love your theory! The thought had crossed my mind that I had been too aggressive but I thought I would have seen some lower numbers and wilder curves. They seemed to be pretty steady (and high).
I think maybe I'll go back and start from 1 U, do smaller increases and test at night, but that will have to wait until crazy time is over at Work, unfortunately. 1½ week.
Last night he gave me a nice low number and also this morning (hubby stayed home with him, because it was so low I worried) but now it's climbing.

He's getting Lux turkey (sorry BJM I couldnt follow the url for Europe, could you repost or something?) and has just started Mjau cat food last week. He was getting two Cans of Lux, twice what he required to maintain weight and now is getting one lux and one mjau, so about double the amount of food to maintain his weight. He used to love the lux but after tasting the Mjau doesn't eat it so willingly. I can now leave lux out (just in case) and mainly feed mjau. Both are recommended by diabetic forums (one in Denmark and one in Sweden) and lux is definitely less than 10%.

Thanks, it feels great getting some input as I felt really stuck!
 
I wasn't suggesting going all the way back to 1U for Bisse because that wasn't a dose for him getting him into greens before. If you go back, I wouldn't go back quite that far. What is important though is to gather more data at night. If you look at Bisse's spreadsheet, there is not much data from +4 through to the morning preshot test. I'm not suggesting getting up every night, but if you see a night like last night where there was a decent drop from PS to +4, set your alarm and get up a couple hours later for a quick test.

We do base our dosing decisions on the nadir, so it's important to try to find out how low Bisse gets on a particular dose. A decent drop from PS to +4 may tell you it's a cycle where you want to get more data. Most cats on Levemir have their nadir later than Bisse seems to have. That's good for you, it means more sleep!
 
Greetings Bliss

I have 3 cats on Levemir well 2 are on their OTJ trials right at the moment. :-)

But looking at his spreadsheet and going off my experience with Levemir I'd say his dose is way too high. My reasoning is he's dropping hard and fast before Levemir should even be kicking in. Unlike Lantus, Levemir doesn't normally even start working until +4-+5 and should nadir around +10 or later.

As you raise the dose the worse his numbers get. Personally if he was one of mine I'd roll him back to either 1u and exactly I'd probably go back to .5 and work back up a quarter unit at a time. I think you may have missed his best dose.

Mel and The Fur Gang
 
Status
Not open for further replies.
Back
Top