Okay a couple of questions about Lev vs. Lantus.

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MommaOfMuse

MommaOfMuse

Member Since 2010
Okay I know I should know this, or at least know where to look to find the answer but......I know what an ideal Lantus curve looks like, but I don't think I have ever seen what an ideal Levemir curve looks like. I'm assuming since the nadir is normally later in the cycle, so is the onset...Correct?

I know with Lantus you always want to shoot a rising number, but with Lev having a later onset, and Musette being a know spiker when it comes to food, once I figure out her new onset and nadir, would it be feasible to shot a still falling number? If I'm feeding her at shot time and she will reach her nadir before her onset, or basically is rising by the time that next dose takes hold?

Just trying to figure out a way to hold down her food spikes and the fact that I think her new nadir maybe pretty close to +11 at the moment because so far with the limited testing I was able to get in on her this weekend I'm not sure I haven't been shooting a still falling number and that might have been what set off that 380 this am.

The Plan for tomorrow and wednesday at this point is trying to figure out where the heck her onset and nadir are.
So tomorrow I'm planning on getting her preshots and the even plus hours, and wednesday her preshot and the odd plus hours.
Since I should be home all day for the next two days and DH should be out of town for work so I can stall as much as I need too if it looks like she is still dropping at +12 to find just where her nadir is. Plus I figure it will give me excellent fresh data to take into the Vet's on thursday to plead my case for getting my hands on a script for Levemir. :-D

Even though she is still higher than I would like she is sooooooo much stabler the last few days. I can work with these numbers and not feel like I'm playing Russian Roulette everytime I give her insulin. While I don't have enough data yet on her to completely predict what she is doing on this dose I can at least guess where she is heading most of the time.

Mel, Maxwell, Musette & The Fur Gang
 
I don't know exactly what you mean by an 'ideal' curve. Every cat is going to have something diff from the next cat.

Shadoe did not have a diff nadir on Lev than she did on Lantus, and Oliver has always had a late nadir.
Shadoe's have more of a range btn her high and low numbers, but Oliver has always had a flattish curve on both insulins.

A late nadir is great because I know that Oliver's numbers are rising.. and his curve is like a mountain..... rising till about +5 and then start heading down the other side. With him, I worry about his NOT rising much in the first few hours, because I know he's going to be dropping lower on the backside.

If you have a late nadir, it's a good idea to see if you can get a +10 or +11 so that you can tell if the ps is rising or falling.

For you, you have a flatter curve and that's the best kind. Now to lower that curve a bit, just up the insulin if needed.
 
Honestly? I think it is too early to tell what Musette is doing on lev yet - I mean, what her "normal" curve will look like. Gayle is right, ECID. I have seen early, mid and +12 nadir cats - and the really early ones are probably actually very late ones +13-14, not +1-2. Sometime a later nadir indicates a little too much insulin, but not always, and it's too soon to tell on that as well.

It might be a bit early for a curve yet, but that is between you and Musette :roll: I know Jeddie wouldn't stand for me doing two days of that many tests, but Beau would probably not mind (or wouldn't have, he really didn't care for it the last time I tested him). cat(2)_steam

Patience, grasshopper.
 
I could test Musette every 20 minutes if I was so inclined and she wouldn't care...lol As long as I kept the boiled chicken and cream cheese treats coming. :lol:

Running a couple of curves right now aren't so much for me to see what she is doing but to give me plenty of data for my vet to compare how she is doing on Lev as opposed to how she was doing on Lantus. So I can argue the point that I want her off Lantus and on Levemir. Since this vet I just trained off prescribing Humulin N and onto Lantus, now I have to go in and ask for something that I can almost bet that he has never even heard of being used in felines. At least I have a couple of great vets that will readily admit that they don't have much of a clue what they are doing when it comes to diabetes in felines, but are wonderful when it comes to general vet care. And for the most point are very willing to work with me on both Maxwell and Musette's diabetes care, but they still like to see data on why I want to do what I want to do, I think mostly to cover their hineys legally.

But I have to say I am way happier with her response so far on the Levemir as compared to the roller coaster ride we've been on with the Lantus.

This Morning amps was 207 so I'm a happy girl.

Mel, Maxwell, Musette & The Fur Gang
 
My dumb question is, but why do you need a script from your vet, when you get insulin from DCIN? I would just do it, tell your vet you did it and show her the results in a few weeks. Or do you need the script 'cause it's still cold out and DCIN can't ship it? Not sure how muchis in that pen you have, but it lasts a long time at .5U-1U BID.

Not that I think going against your vet's wishes is a good idea - you may need a script at some point, but since you seem to be in a time crunch, why not just wait? And if she's due for a 6 month check-up or something, just put it off another month.

Again, not that I'm advocating that, but using beginning BG numbers to try to convince your vet to write you a Lev script may work against you as they're not going to show much. From the times I've shown my vet Gandalf's spreadsheets they don't see in them what we can see. Most vets still have a lack of understanding of how the L's work and seeing any high numbers could make them think "what's the difference?"

Just sayin'....

But yeah, it's pretty much an ECID on comparing the two. Look at Gandalf's PZI vs Lev curve graph in the 101 stickie. That 16 day curve is what I would call a good overall view of what Levemir does with BG numbers.
 
Well basically her old script for the Lantus is out-dated now, so was just going to try to kill two birds with one stone while I was at the vet's since DCIN normally just orders her insulin from Canada, and will need a script to get that order, although I'm sure DCIN will be able to get me pens until I can get a script if needed.

But I sure have a different cat in just a few days of being on Lev. She is a lot more social and doesn't seem to be nearly as tense and crabby. She is a happier girl, purring more, talking more, not hiding when its shot time and not flinching when she get the injection. Also not acting like the injection site hurts afterwards. Before on the Lantus I would run my hand down her side to feel for wetness since she is so fluffy to make sure it wasn't a fur shot, and she would either growl or try to nip like it hurt her right afterwards at the injection site. Now I do the same thing and she rubs back and gives head butts while purring up a storm. :-D

So all in all I think so far the Levemir is a much better fit for her in a lot of different areas.

Mel, Maxwell, Musette & The Fur Gang
 
MommaOfMuse said:
Well basically her old script for the Lantus is out-dated now, so was just going to try to kill two birds with one stone while I was at the vet's since DCIN normally just orders her insulin from Canada, and will need a script to get that order, although I'm sure DCIN will be able to get me pens until I can get a script if needed.

But I sure have a different cat in just a few days of being on Lev. She is a lot more social and doesn't seem to be nearly as tense and crabby. She is a happier girl, purring more, talking more, not hiding when its shot time and not flinching when she get the injection. Also not acting like the injection site hurts afterwards. Before on the Lantus I would run my hand down her side to feel for wetness since she is so fluffy to make sure it wasn't a fur shot, and she would either growl or try to nip like it hurt her right afterwards at the injection site. Now I do the same thing and she rubs back and gives head butts while purring up a storm. :-D

So all in all I think so far the Levemir is a much better fit for her in a lot of different areas.

Mel, Maxwell, Musette & The Fur Gang
Click to expand...

Well then use that argument to get the script if you're worried. That is like the argument I used to get Lev in the first place without even having used it first - that after 2 1/2 years on PZI Gandalf was not himself and I felt it was because of the PZI. And I was right. So I think you are too.
 
I actually don't think they are going to give me too much of a fight, but I always like to plan for the worst and have my ducks in a row when I go in, although I usually don't need it. After the last 6 years of them seeing my animals they have pretty much figured out that I will have done the research and usually have a very good reason for asking for what I'm asking for. Just depends on who is in when we go in, the two small animal only vets that are there are great about letting me have my way the only one I normally butt heads with it the actual clinic owner, she is an excellent vet as well but her specialty is large animals. So when it comes to the dogs and cats she likes data before making a decision to think outside the box.

At this point if I get her on Thursday I will hold off talking about the insulin issue until I can get an appointment with one of my favorites there, afterall this appointment is only for a pre-dental exam and bloodwork, I can always bring up the insulin later or when I take her back in for her actual dental. And in the absolute worse case scenerio I can always ask my mom to order me an extra pack of pens on her script and then pay her for them. Since mom's insurance usually sends her more pens than she can use in a month, which is how I got my hands on the ones I have here right now. Mom is high enough dose that her script is open ended.

Mel, Maxwell, Musette & The Fur Gang
 
When is the dental planned for?

I had asked about doing this once for Gandalf, using bloodwork taken at the time of the check-up visit to base his dental off of, to save money. I think I was going to schedule the dental within 2 weeks or something reasonable and they said no, they would not do that because especially with elderly cats, something can change. They have a "dental package" and it's going to include bloodwork whether you just had it done 2 weeks before or what, but their argument made sense to me.

So now I am just wondering why your vet is doing a "pre-dental" exam ahead of time. Is there a question as to whether she needs one?
 
We haven't scheduled the actual dental yet, but since DCIN is paying for hers, they need a written estimate on what the charges are going to be, and since my vet has never even seen Musette yet he wants to get a look at her mouth and possible xrays to see if she has any that are broken off. And I'm having them recheck Maxwell's hear murmur to see if he is safe to put under for his dental. Neither of their vet records that came with them indicate that they have ever had their teeth cleaned or even looked at.

And well with Musette I just want the first time she sees my vet it to be one where I take her immediately back home, and don't leave her even for a dental, since the last time she saw a vet she didn't know her former people left her there to be pts. So while I don't know if cats rationalize it like this I will feel better if mom stays with her the first time her and her new vets meet and take her back home again, so hopefully she will understand that we are never going to just abandon her. Plus she is acting like one of her ears is bothering her, keeps shaking her head and pawing at the ear, but she is too squirmy for me to get a good look in there to see what it is, although I suspect either mites or yeast infection.

With Maxwell they want to check his heart since I was told by the vet that saw him for his travel certificate that he has a heart murmur. So they want to check that to make sure he will be safe to put under to even do a dental on him.

But at least as we had discussed, if everything looks like it is a go on Thursday when we go in, they will go back for their dental on Monday of next week.

Mel, Maxwell, Musette & The Fur Gang
 
I see. All makes sense to me! Thanks for the details. I had forgotten that Musette was "left behind." That is so sad.

And from everything you say, she's a dream to test, as long as she gets her treats :lol:
 
She is a dream to test as long as the treats are handy and mom is wearing the correct perfume...lol.

And since we started on the Lev she is a dream to shoot, she really didn't like those injections of Lantus, I don't know if they stung her or if she just anticipated that they were going to make her feel worse rather than better. But I would have to hide the syringe behind my back and have her whisker deep in her food to get one in her. And she would still flinch and growl at me when I went to tent. Now she just jumps up on her eating table and waits for them, and purrs like crazy.

Mel, Maxwell, Musette & The Fur Gang
 
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