Rudy - First post in a long time - Switching insulin? Dose too high?

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Jen1218

Jen1218

Member Since 2017
Hi,

I haven't been on here in quite a while. It's just too hard to watch the other sugarcats do so well while Rudy still struggles.

I came here today because I'm at a loss as to what to do next for him. I posted on the Facebook page, but figured I might get more eyes on the post if I put it up on FDMB too, so it appears below. Basically - I'm looking for responses from beans who have switched from Lantus to Levemir...

My 7yo boy, Rudy, has been on Lantus for 5-6 months. His numbers were starting to look great and then he hit a brick wall. Bloodwork and UA show nothing unusual. He had bad gingivitis, so I had his teeth cleaned 2 weeks ago. I was hoping this would help get his bg lower, but I've seen almost no improvement. His numbers still barely move most days. I have increased his dose, but it's like I'm not giving him insulin. (Moving down only 30-50 points on 3 units is frustrating.) I test regularly, started a new pen, changed shot location, check for ketones regularly, etc. He eats Friskies pate/FF Classic and YA dry. I don't know what else to do - except maybe switch to Levemir. Has anyone switched from Lantus to Levemir? How were your results? I realize ECID, so I'm just looking for a little input.

Thanks in advance for the help. Safe surfing, everyone.

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*bumping*

Someone suggested that his dose could be too high...

Is that possible? What do I do? Do I reduce him? By how much? Help, please.
 
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I'm not able to advise about dosing, nor can I comment on Levemir as I don't have any experience with that insulin, I just recently started my cat on Lantus.

I noticed that you have SLGS method in your signature, and thought I'd extract a couple of key points from the sticky:

Hold the dose for at least a week:
  • Unless your cat won’t eat or you suspect hypoglycemia
  • Unless your kitty falls below 90 mg/dL (5 mmol/L). If kitty falls below 90 mg/dL (5 mmol/L) decrease the dose by 0.25 unit immediately.

After 1 week at a given dose perform a 12 hour curve, testing every 2 hours OR perform an 18 hour curve, testing every 3 hours:
Note: Random spot checks are often helpful to "fill in the blanks" on kitty's spreadsheet.
  • If nadirs are more than 150 mg/dl (8.3 mmol/L), increase the dose by 0.25 unit
  • If nadirs are between 90 (5 mmol/L) and 149 mg/dl (8.2 mmol/L), maintain the same dose
  • If nadirs are below 90 mg/dl (5mmol/L), decrease the dose by 0.25 unit
As your cat's blood glucose begins to fall mostly in the desired range [lowest point of the curve approaching 100 mg/dl (5.5 mmol/L) and pre-shot value around or below 300 mg/dl (16.6 mmol/L)], do lengthen the waiting time between dose increases.

In Rudy's spreadsheet, you have lots of test data, I guess I wonder why you bumped from 2.75 to 3u on August 29th when Rudy hit a nadir of 117 on the pm cycle of August 27th? That would have suggested keeping Rudy at the same dose...maybe a bit too much jumping around in dose too soon? Just my two cents, I would have kept with 2.75.

I'm sure more experienced people will be able to advise you soon, I understand it can be frustrating if you want to see consistent progress.
 
Hi Jen, good to see you and Rudy. Looking at the SS for today, he is flat yellow which is an indicator that he will have some downward movement in the next cycle or two. So be vigilant.

Being on Lantus for 5-6 months is still young in this sugar dance. Bubba didn't get OTJ until the 14 month mark, so please put on some patience pants and ride this out. I would not switch insulin at this point. He is only on 3 units and we do not even start to think about high dose conditions until after 5 units. And that said. 5.25 units was the point when Bubba started to get reductions, quickly and got off the juice.

Keep methodically raising his dose every 6 cycles ( unless of course he earns a reduction ) until he hits his break through dose.

I do know how frustrating it is to see other cats going OTJ but as I said in the beginning of this post, 5-6 months is still young. Hang in there.
 
Perfect! that answers that question :). Time frame as a guideline is to hold dose is at least a week on SLGS, the last few doses (2.5 and 2.75) were held for 5 days then 4 days...not that you can't make adjustments, but I have read others commenting on new dose wonkiness...maybe a bit of that going on? Hope you find some answers soon,.
 
Bobbie And Bubba said:
Hi Jen, good to see you and Rudy. Looking at the SS for today, he is flat yellow which is an indicator that he will have some downward movement in the next cycle or two. So be vigilant.

Being on Lantus for 5-6 months is still young in this sugar dance. Bubba didn't get OTJ until the 14 month mark, so please put on some patience pants and ride this out. I would not switch insulin at this point. He is only on 3 units and we do not even start to think about high dose conditions until after 5 units. And that said. 5.25 units was the point when Bubba started to get reductions, quickly and got off the juice.

Keep methodically raising his dose every 6 cycles ( unless of course he earns a reduction ) until he hits his break through dose.

I do know how frustrating it is to see other cats going OTJ but as I said in the beginning of this post, 5-6 months is still young. Hang in there.
Click to expand...

Hi Bobbie. Thanks for the reply. He's been nothing but flat yellow and a lot of pink lately. Just feels like the dental didn't help and the Lantus isn't doing anything. I don't know what else I'm supposed to do. He's happy and healthy otherwise, so I guess I'll stick with the Lantus and increases for now.

Why is Bubba back on insulin? What happened?
 
Jen1218 said:
Hi Bobbie. Thanks for the reply. He's been nothing but flat yellow and a lot of pink lately. Just feels like the dental didn't help and the Lantus isn't doing anything. I don't know what else I'm supposed to do. He's happy and healthy otherwise, so I guess I'll stick with the Lantus and increases for now.

Why is Bubba back on insulin? What happened?
Click to expand...
Well.... I had a dental done on 8/10th because his numbers were creeping up to the low 100's in the AM. Then after the dental, my niece and her husband and 7 year old child arrived 5 hours after I picked him up from the vets. They stayed 4 nights finishing our master bathroom tile job. Noisy, strangers in the house...... and like a dope, I did not test him while there were here knowing he would be higher........so when they left 4 days later I tested him and he was still in the high 200's . I gave it 2 days after they left and he hit 304. So, I had to start him back on insulin. He was responding nicely then he had a GI upset that set him back :banghead: We are just coming down again.......

Jen, you just started Rudy on the 3 units and he is flat . I think he is going to start coming down again. Remember, the new depot can take about 4 -6 cycles to fill. Let's see what this dose can do for him.
 
Hi Jen. :bighug: I don't think Rudy is on too high a dose. You just haven't reached his breakthrough dose yet. Rudy likes to bounce a lot. If you could get rid of the dry food, you could do TR which would let you keep him at a dose longer where he sees green. Getting comfy in his green swim shorts is what will let Rudy's body realize that green is good instead of freaky.

We suggest waiting six months before switching insulins, but if Lantus isn't cutting it for you, try Levemir. Many, but not all, cats are flatter on Lev. My Neko was flatter on Lev. Her second Lev cycle was flat blue and I fell in love. :cool: Most important, flatter meant more predictable and once I learned her Lev patterns, more sleep at night cause I could go longer between tests. Of course the first month after the switch I felt like a newbie again. :rolleyes:

There are some down sides to the switch. The typical Lev onset is +4 and nadir +8, Neko's even later. That meant it was tricky for me to get a before bed test that could tell me anything. Ie. the Lantus +2 was now +5. Nadirs at night were in the wee hours. Fortunately I get up at zero dark thirty for rowing 4 days a week in season so I was getting up around her possible low point and could test. The later nadir doesn't work for everyone's schedule. Later onset meant I could now have dinners out as nothing would happen for 5 hours. :)
 
Bobbie And Bubba said:
Well.... I had a dental done on 8/10th because his numbers were creeping up to the low 100's in the AM. Then after the dental, my niece and her husband and 7 year old child arrived 5 hours after I picked him up from the vets. They stayed 4 nights finishing our master bathroom tile job. Noisy, strangers in the house...... and like a dope, I did not test him while there were here knowing he would be higher........so when they left 4 days later I tested him and he was still in the high 200's . I gave it 2 days after they left and he hit 304. So, I had to start him back on insulin. He was responding nicely then he had a GI upset that set him back :banghead: We are just coming down again.......

Jen, you just started Rudy on the 3 units and he is flat . I think he is going to start coming down again. Remember, the new depot can take about 4 -6 cycles to fill. Let's see what this dose can do for him.
Click to expand...

Poor Bubba has had a stressful few weeks. I'm glad he's coming back down though. Hopefully, he'll be back off insulin in no time.

I hope Rudy decides to make one of these increases work. Getting really tired of feeling like I'm not helping.

Wendy&Neko said:
Hi Jen. :bighug: I don't think Rudy is on too high a dose. You just haven't reached his breakthrough dose yet. Rudy likes to bounce a lot. If you could get rid of the dry food, you could do TR which would let you keep him at a dose longer where he sees green. Getting comfy in his green swim shorts is what will let Rudy's body realize that green is good instead of freaky.

We suggest waiting six months before switching insulins, but if Lantus isn't cutting it for you, try Levemir. Many, but not all, cats are flatter on Lev. My Neko was flatter on Lev. Her second Lev cycle was flat blue and I fell in love. :cool: Most important, flatter meant more predictable and once I learned her Lev patterns, more sleep at night cause I could go longer between tests. Of course the first month after the switch I felt like a newbie again. :rolleyes:

There are some down sides to the switch. The typical Lev onset is +4 and nadir +8, Neko's even later. That meant it was tricky for me to get a before bed test that could tell me anything. Ie. the Lantus +2 was now +5. Nadirs at night were in the wee hours. Fortunately I get up at zero dark thirty for rowing 4 days a week in season so I was getting up around her possible low point and could test. The later nadir doesn't work for everyone's schedule. Later onset meant I could now have dinners out as nothing would happen for 5 hours. :)
Click to expand...

Thanks, Wendy. I feed the dry because my 2 girl cats like it. Rudy barely eats it now that he gets multiple rounds of canned food each day. If the girls didn't look for it - it wouldn't be there. Rudy's been on Lantus just about 6 months now. He was up to 5 units at one point before he started to come down at all. Then his gingivitis flared and all good numbers seemed to be few and far between. I guess I'll stick it out a little longer and adjust his dose as needed. He's feeling good. It's me. I have zero patience with this condition.
 
Hi Jen. Many kitties here, including my Bronx, are having a much harder time getting regulated than others here. It is frustrating and hard to keep the patience pants on, but coming here helps me keep my sanity knowing there are many in the same boat than me and the support/advice is second to none. The kitties doing better than Bronx gives me hope that we'll get there one day. Try to stop by more often, it is better than going it alone.
 
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