Please share experience on Levemir use_Very concerned w/NPH

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Re: Please share experience on Levemir use_Very concerned w/

I still think you won't make any progress until you stay with .25u for at least 6 cycles (3 days). You keep the dose. We keep telling you that is not how to use levemir. I don't know what else to tell you.
 
Re: Please share experience on Levemir use_Very concerned w/

Sheila,
where a new topic needs to be started and under what subject?

On insulin doses we're following your example with Cami where you've injected 0.5 u for BG above 250. Similar we've noticed on your SS for Beau.
Are those SS not a good example to follow?
Thank you
 
Re: Please share experience on Levemir use_Very concerned w/

Each cat is different ... what works for one cat may not work for another. Thus, following someone else's spreadsheet may not work for your cat.

1. The dose is determined by the nadir, by how low he goes.

2. The dose is not increased, nor determined by the pre-shot test value.

3. Stay with 0.25u for at least 6 cycles (3 days).
 
Re: Please share experience on Levemir use_Very concerned w/

As for a new topic- at the beginning of every forum there is a button above all of the different threads- it says "New Topic"- that starts a new thread. Name it your question or your kitties name and the date.

Please stay with the same dose for AT LEAST 6 cycles. Any change should be determined by your +5, 6, 7, or 8 number- however low JJ goes during the cycle. While the pre shot numbers are needed they let us know if it is safe to shoot- but don't base the dose on it.
 
Re: Please share experience on Levemir use_Very concerned w/

Hi BJM,
We looked at nadir over weekend. First day we stayed within 3 digits mark. Sunday, it finally came down to the normal range and PS peeks are also under 300 (used to be up to 500+).
thanks for #3
 
Re: Please share experience on Levemir use_Very concerned w/

You've got to wait out the Levemir.
If you keep it consistent with the same dose every 12 hours, it will stabilize. Then you can determine if you need to increase or not.

The nadir looks promising, but you have not kept the exact same dose every 12 hours for 6 consecutive doses. You keep going back up to some version of 0.5 units. Every time you do that, you have to start over counting the 6 doses.
 
Re: Please share experience on Levemir use_Very concerned w/

and starting over, as BJ says, should be at .25u because she has dropped to the 40s on .5u doses.

It is always better to stabilize a little below the best dose (with BGs higher than optimum) than trying to stabilize a little above the best dose (with BGs below optimum). This is because BGs dropping low usually cause rebound high blood sugar and the swings start. You can't really stabilize the BG with too much insulin.

You can't use how I am dosing Cami (or Beau) as a guide to JJ. First of all, they are different cats. Second, Cami has a host of health issues I am trying to manage and is on medications (other than insulin) that effect her blood sugar levels. What worked for her in the past (before she went OTJ) does NOT work for her now AND all that I knew about managing BGs didn't seem to work either - it was, and is, a learning experience for me.
 
Re: Please share experience on Levemir use_Very concerned w/

It is always better to stabilize a little below the best dose (with BGs higher than optimum) than trying to stabilize a little above the best dose (with BGs below optimum).

Sorry, Sheila, we're lost here.
Are you reffering to nadir BG's or PS BGs?

What are those BG #s for "BG higher than optimum" and "BG below optimum"?
Click to expand...
 
Re: Please share experience on Levemir use_Very concerned w/

Glucose levels for a non-diabetic cat run between 40-120 mg/dL, on the average, with some cats going a bit lower, and many cats going up as much as 100-180 points when under stress.

When using insulin, a typical day may start in the 200s and should go no lower than 50 mg/dL. There are some cats that start higher than the 200s, yet their insulin dose brings them down to the 50s, so no increase in dose would be safe.
 
Re: Please share experience on Levemir use_Very concerned w/

If BG at +12 between 120 and 150,is injection needed or not?
 
Re: Please share experience on Levemir use_Very concerned w/

Sorry you didn't get a response, but this has been addressed earlier in this thread.

Because you don't have a lot of data, it is probably better to wait 30 mins and retest to see if she is climbing and how fast. When you have had low PSs before, JJ has always risen fast from that point, so if she is higher after 30 mins it is probably safe to give the shot.
 
Re: Please share experience on Levemir use_Very concerned w/

Sheila will be going on vacation soon. That means there will not be many experienced eyes the Levimir/Detimir forum. You may want to post in the ISG for Lantus TR. You do not have to be using lantus to post there as there are a lot of experienced Levimir users there also.

I'd just hate to see you not getting any responses when Sheila is gone.
 
Re: Please share experience on Levemir use_Very concerned w/

Deb,
thank you for letting us know. We tried to stay for the similar dose for the last 3 days. Still, morning PS BG were elevated all the time. Not sure what could be the reason. We're injecting insulin at consistent sides ( in the morning and evening) shown to us by our vet. Those sides actually were shaved for us and they 1 to 2 " to the side from JJ spine and 3 to 4" below her scruff. There is no blood we in the syringe during the injection. Hope locations of injection is not the reason for such a swing between morning and evening PS numbers.
 
Re: Please share experience on Levemir use_Very concerned w/

If a cat has a steep drop in glucose, a fast drop in glucose or drops to an unfamiliar low level, the cat may 'bounce' into higher numbers. This is because the body responds as if it were in danger of hypoglycemia, releasing hormones that release stored sugar from the liver.

If you can, get some tests overnight (I know - ugh!) and see if the glucose is going too low. If not, bounces often clear or level out after a few days.
 
Re: Please share experience on Levemir use_Very concerned w/

I think what is happening to cause the swinging numbers - instead of similar numbers morning and evening - is rebound. That is what BJ is referring too as a possibility as well.

There is no data to tell us where JJ is in the middle of the cycle. Where you were previously getting some mid cycle numbers, you haven't for about a week. You are probably giving her too much insulin every time you respond to the higher morning BG and raise the dose. She drops low (or too fast or too far) during the day and at night she is on the way up. That increase continues through to the morning fueled by rebound - all those released hormones and stored glucose in the body's response to save her from a hypo. Then you give .5u again and it starts all over.

This will continue to happen as long as you continue to raise the dose every morning. It will not stop until you shoot .25u each and every shot for at least 3 days - and maybe more like 5 days.

I keep telling you this. Others keep telling you this, but you keep doing changing her dose based on her PS and then can't figure out why her numbers keep changing.
 
Re: Please share experience on Levemir use_Very concerned w/

It is OK if the preshot numbers are elevated.

They are supposed to be elevated because much of the insulin has worn off.

Please keep giving only 0.25 units.

Please test at +6 to +7 hours (rough nadir) after the shot during the day.

Test between +6 to +7 hours (rough nadir) during nights if you can manage.

A cat's glucose often goes lower in the middle of the night.

The nadir is the number you need to watch.

If the nadir goes below 50 mg/dL, you decrease the dose.
 
Re: Please share experience on Levemir use_Very concerned w/

Just a short update. As of August 19th JJ is OTJ. Many thanks for all of your suggestions!
 
Re: Please share experience on Levemir use_Very concerned w/

Terrific!!!​
:RAHCAT :RAHCAT :RAHCAT :RAHCAT :RAHCAT :RAHCAT :RAHCAT :RAHCAT​
 
Re: Please share experience on Levemir use_Very concerned w/

Just dropping in here. have nothing to add, except... you would be VERY wise to listen to exactly
what Sheila suggests....even if it differs from what your vet said.
 
Re: Please share experience on Levemir use_Very concerned w/

Another update as of 10/6/13. BG are still below 70. Staying on wet food diet only.
Thanks to all for suggestions and support.
 
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