Recent switch to Levemir - input appreciated

Dandelion

Dandelion

Member Since 2015
Hi.

New here but not new to diabetes.... but I feel like I am!
Just switched Butternut:cat: to Levemir a few days ago from Lantus. I'd love some input about how his curves look since the switch and especially about his higher AM numbers. What are his bg's telling me? How do we get a grip on his morning bg's?
I'm still determining the best feeding schedule for both of us and whether that's going to require an auto- feeder, free-feeding, or something else.

Would appreciate recommendations about how to proceed with his dosages ....and grow some patience. I did read the TR info plus Tilly's pages but I don't yet feel I know the story his numbers tell and how to respond in the best and most timely way.
I'd like to understand better whats going on when he had that long blue-green curve then the next two days progressed to higher numbers. Just his body re-regulating?

Wish I had used the SS long ago :banghead: but we are jamming now and my head is spinning.

hypo on 7/8 - I was instructed to withhold insulin, then give 1 unit next day if bg>100. I did as instructed and dealt with wild numbers for a few days. The two days prior to the switch I tried to steady his numbers holding the lantus dose and micro-managing meal timing.

I deeply appreciate this forum, and the information and support that exists here. :) Thanks!
Val
 
Hi and welcome Butternut and Val to fdmb
Just some observations......
Looking at the SS it looks as if you are using both the human and the AT2 meter. It is much better to stick to the one meter because it is too confusing to chop and change and it is too hard to get a grip of the numbers if you are changing midstream.
We use the human meter here for our dosing method and our protocol. So it is better all round to choose a meter and stick to it.

Oh! I've just realised your SS is upside down. It needs to be the other way around with the old numbers at the top. I'll ask @Chris & China (GA) if she can help you with that.
So are you using the AT2 or human meter now with the last weeks numbers?

We recommend going up and down in increments of 1/4 (0.25 units) as it is safer for the kitty and you won't go past the best dose.
Depending what meter you are using, you earn a reduction in dose when Butternut goes under 50 for the human meter and 68 for the AT2. But if you are using the Start Low Go Slow method you would get a reduction at 90 on the human meter.

On 7/15 Butternut got a 47 @+8. That would have earned a reduction down to 1 unit.

So have a look at the yellow stickies at the top of the Lantus page and see whether the SLGS method or the TR protocol would suit you better. You need to be feeding an all wet diet to do TR are testing enough to do the TR.

I would not increase the dose having seen the 47 on the 7/15 with no following reduction. The depot could be really full and he could drop low with another increase.
The morning numbers are usually the last to drop lower. Yes patience pants! We all need those!
The higher numbers following low numbers are a bounce which is very normal. Buttercups body will go into panic mode with the low numbers and dump glucose and regulatory hormones into his system to save himself. Bounces can last up to 6 cycles. Nothing you can do about them but wait them out..

See what others think.
You are doing a great job....lots to learn with a new insulin..Levemir is a great insulin. I loved it.
 
I had the same reaction as Bron -- I was reading your SS upside down. We are completely creatures of habit (much like our kitties!) and we post the most recent numbers from the top down (earliest date at the top and newest date at the bottom).

Whether you increase depends on which approach to dosing you opt to use. With Tight Regulation (TR) you hold the dose for at least 3 days/6 cycles (unless numbers drop below 50, in which case you reduce the dose). If nadirs (the lowest number in the cycle) are not in largely normal numbers, then yo9u increase the dose by 0.25u. With the other dosing method, Start Low Go Slow (SLGS), you hold the dose for a week unless numbers drop below 90 which is when you reduce the dose.

TR is a more aggressive method which means you need to test more. It has been well research and the protocol has been published in a leading veterinary journal. SLGS was developed here well before TR. Both approaches have a good track record of getting cats into remission.
 
Thanks! Glad to be here.

I use the human meter and have for years. I got an AT2 some months ago when I found out the Relion strips were discontinued -thanks again to this forum as the pharmacist was clueless - and I was trying to figure out what meter I wanted to use next. *Thanks to the forum for helping me find replacement strips for the ReLion Micro too*. I now use the AT2 when he goes low for comparison but post results in the SS from the human meter. I have a separate SS for the AT2 whenever I use it.

@the 47 bg I fed him some hc canned as instructed to do if bg goes below 50. I did read about the reductions but I see I didn't understand them. Would the reduction be for that one dose or continued through following days until his bg's indicated he needed a change?

TR for us. He's been on canned and raw for years. I am available to test frequently if needed.

I was excited to see his response to Levemir but at the same time I get panicky, AFTER ALL THESE YEARS of dealing with diabetes, and think I'm going to kill him. He's not helping me either. He's terrorizing me. He's an old guy, a mixture of stiff and fluid body parts with some weakness in is rear legs so his gait is interesting sometimes. This AM he appeared as if he was slowly collapsing to the floor in a heap. I said..... WHAT. IS. HAPPENING?? The ER is 35 miles away and the fuel light is ON in the car!! :arghh: I grabbed the crate and when I returned to the room where he parked himself I found, on the floor, the reason he was behaving to strangely. It was a dingleberry. o_O *he eats grass* Ooohhhh. What I was witnessing was his geriatric version of butt-tucking-I-gotta-get-this-thing-off-my-rear end because it's following me!

Butternut is the only cat at the practice on Levemir so he's a test case for my vet.

Between bonks and highs and heat waves and getting up hourly to check him for lows and immersion into the forum information, I'm exhausted. Hoping for the best though. :)
 
Wait til @Chris & China (GA) comes along for the SS in case it all disappears:eek: I’m not good with SS ... the tech side.
If you earn a reduction in TR like a drop under 50 you take it when the next dose is due and then stay with that new dose unless he earns another reduction or needs an increase.
 
Ok just looking at the signature... it looks like he was diagnosed in 2013. Is that correct? If so, with reductions, he needs to drop under 40 once or under 50 three times because he has been a FD for more than One year
 
I made a copy of the SS before I tinkered. I will check it all to make sure it's good to go. Yes Butternut was dx in 2013.
 
Dandelion said:
will a sort on the date switch the SS around?
Click to expand...

Try clicking here
upload_2019-7-20_19-44-2.png
 
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