Semi-New, Levimir Help

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tollandjun

Member Since 2014
I'm sort of new -- was here years ago (couldn't even recall login, so made new). At the time I had 2 diabetic cats, sadly the one (Toll) passed on 11/5/2013 at the age of 11 years. Still heartbroken and feeling like a failure. Never gets easier.

Jun is still with me and was doing very well. In Jan. he had surgery to remove a grade 1 mast cell tumour on his side (thankfully caught in time and did not spread) and a tooth cleaning. He is almost 10 years old (bday in August) & has several health issues aside from being diabetic including IBD, mega-colon, EPI, lumps on his thyroid, slight heart murmur and previous bouts of pancreatitis. He is currently on Royal Canin diabetic cans and Hill's M/D dry, given several meals throughout the day and the M/D left out for free feeding. He was never a big eater. In fact, if he eats too much at once, he'll throw up.

After the surgery he had 3 major low blood sugar events during the overnight. We were all given miracles and we woke to find him in time. They were spaced about 20 days apart. His IBD flared up once and he was on a few weeks of Cerenia. Originally he was on 4 units of Levimir twice a day (8 am & 8 pm). He is currently on 2 units at 8 am only. His sugar jumps around -- 6/2 it was 387 (before 8 am feeding and insulin) and 344 (8 pm), on 6/3 353 (8 am) and 281 (8 pm), then 6/4 252 (8 am) and 242 (8pm). He is losing weight (was almost 14 pounds in Jan. at the time of surgery) and is now 11.8 pounds, and often comes looking for food.

He was on Humlin N for the early years of his diabetes, but it never worked well with his blood sugar going super high and then dropping normal/low. The Levimir has worked well for at least 3 years. Can the Levimir have stopped working? Is there another insulin that may be better? We are the only one at the vet on the Levimir (due to cost I'd guess), so I'm trying to find others and see what advice I can get to help get Jun back on track.

Thank you!

Rae & Jun =^..^=
 
Re: Semi-New, Questions

Hi and welcome back to the message board.

I've never heard of Levimir working well if only given once a day. I'm not a Levimir user myself, so can't say for sure. If you go back into your first post, and change it to add Levimir help, that might get you more responses.

A few questions for you.
How old is your vial/pen?
Always refrigerated?
Do you test Jun at the nadir (lowest point in the 12 hour cycle) or only at 8 am and 8 pm?
Do you know when Jun has his nadir?

What other medications is Jun on? For all his other health issues.
 
Re: Semi-New, Questions

Deb & Wink said:
Hi and welcome back to the message board.

I've never heard of Levimir working well if only given once a day. I'm not a Levimir user myself, so can't say for sure. If you go back into your first post, and change it to add Levimir help, that might get you more responses.

A few questions for you.
How old is your vial/pen?
Always refrigerated?
Do you test Jun at the nadir (lowest point in the 12 hour cycle) or only at 8 am and 8 pm?
Do you know when Jun has his nadir?

What other medications is Jun on? For all his other health issues.
Click to expand...


Hi Deb -

Thank you. I'll change the topic as soon as I type this - very good suggestion. Jun is my first use with Levimir. Toll was on Humlin N and it worked very well for him.

- This pen is about 15 days since first use.

- The pens are kept refrigerated till first use, then kept at room temp (that was the instructions in the box -- though surprised me as I was used to the Humlin N kept in the fridge all times)

- I'm not sure of Jun's nadir -- how can you find out? The vet hasn't done one of those all day studies in many years, they do the fructosomine (?spelling) now. If I were to guess, it is probably lowest sometime after midnight. I plan to test around midnight tonight when my sister gets home. Jun isn't keen on the check and you need 2 people to make it work, unfortunately. All low blood sugar events happened after midnight through 3 or 4 am. Since May I did random spot checks on his sugar. What is the best way (times) to test? He was so perfect for so long, we got away from testing (very foolish on my behalf & lesson learned).

- He is currently only on Pancrea-Plus tabs, one half tablet three times a day with meals (it's for his EPI).

Rae
 
Most of us here test our cat's BG using a human hand-held meter and test before each show and periodically between shots. That way fructosamine tests are not required. Without knowing BG between shots yo really can't tell how the insulin is working.
 
Both Lantus and Levemir last longer if stored on a stationary shelf in the refrigerator.
The nadir for Levemir when used twice a day is around +7 to +9 hours post shot and may even go as late as +12 when the next shot is due.
 
Well, your pen sounds fresh but I would keep it refrigerated from now on. The manufacturer does not recommend refrigeration of the pens because people that use the pens use the dial a dose feature and need that positive pressure within the pen to help 'push out' the insulin. We here use a regular insulin syringe to withdraw the tiny doses we need for our kitties so don't need/use that pressure within the pen.

Ok, it sounds like you got out of the habit of testing and will need to test a bit around the +7 to +9 our timeframe to try and find when Jun's nadir is. Maybe do a +7 and a +9 test one day, a +8 and a +10 test another day. You're trying to pin down that nadir which can be a slippery devil and it can take a bit of testing to find when Jun has his nadir. The idea is to catch the low point, and then catch the rise back up.

With once a day dosing, I'm betting that once Jun starts to rise, he keeps rising until the next shot.

Does Jun like any low carb treats as a reward after his testing? That usually gets a cat to be more cooperative with the testing if they get plenty of treats. My Wink for example loves the Halo Liv-a-little Freeze Dried Chicken treats and the Pure Bites freeze dried chicken.
 
Thank you for the info with the Levimir! That is a big help. I have been using the dial-a-dose ability of the pen as he's been on an even dose (1, 2, 4, etc.). How long would you say the pen lasts storing in the fridge? One thing for sure, the regular needles are much cheaper then the ones for the pen so that would be a help, and if the pen lasts longer - that's even better! While it's always been pricey (Levimir) last time I got the pens it was over $300 - yikes.

Ok - I'll check Jun on that schedule (+7 & +9, then +8 & +10) and then post the numbers here.

We stopped the evening dose due to those low sugar events (vet recommended) and started over fresh with his insulin (1 unit in the morning, test and see how the numbers are -- then upped to 2 units in the am, which is where we are now). These last few days of testing his +12 (8 pm which was when his 2nd dose was always scheduled) was 281 and 242. The vet was thinking adding a 1 unit dose at 8 pm (+12) as his morning pre-dose and pre-breakfast numbers are 300's (mid to high), but with those +12 numbers - would that be wise?

With Jun's IBD we have to stick to a strict diet, so he doesn't get any treats - with his IBD and EPI he can't digest people food. One bite of the wrong food and he has a relapse with things. He's always been a very sensitive kitty.

EDIT: To add - does it matter of it he eats prior to the +7, +8, +9 & +10 testing? Or should there be a delay between last feeding & testing?

Thank you for all the advice & help! I really appreciate it.

Rae & Jun =^..^=
 
With pre-shot tests, you want the 2 hours before to be without food. Otherwise, you're establishing what his normal pattern is so you can decide if any tweaking will help manage the glucose.

Also, if you ever get an unusual number, re-test. And if he is too low to give insulin (200 mg/dL on a human meter), stall - wait 30 minutes without feeding then re-test. If the glucose is rising, it may be safe to give insulin, but check here first.
 
Typically with depot insulins like Lantus and Levemir you want to give the same consistent dose every 12 hours so I would be reluctant to 1) only give one dose a day and 2) give different am/pm doses. So if you split the difference of the 2units plus the 1 unit then it would be 1.5u am and 1.5u pm. Those 8pm numbers are safe pre-shot numbers. Now many kitties go lower at night so it would be helpful to have some mid-cycle numbers to see how low and change dosing based on that. We don't dose based on pre-shot numbers. I see you are planning to do that - that's great.

If you store the pen in the fridge, it should last as long as you need it. Mine lasts 2-3 months and I usually can use all of it before it goes bad.

I recently got Lev cartidges out of Canada for $173 plus shipping. Much cheaper.

Sorry Jun can't have any treats. My sugar didn't like any treats at first so his reward was a good brushing. Boy did he like that!
 
Re: Semi-New, Levimir Help Added BG #s

I was able to get these numbers on Friday. He was being cooperative so I went for the set of three esp. since he'll get a two day break from testing.

+7 = 277
+9 = 230
+12 = 221


At next test day I was going to do at +12, +14 and then +16 if still going lower. Does that seem proper? Or should I go with the +8, +10 first? I can't test again until Monday due to my sister's work schedule, but then can do daily with other testing ranges after that (till the weekend).

That is most welcomed advice with Levimir being 12 hours and dividing the dose (ie 2 in am and 1 in pm = 1.5 each). I have to get some regular insulin needles as I only have the ones for the pen and my pen is only in even amounts. I was actually going to go with the junior one next order so I'd have the 1/2 doses, but now I won't have to worry about that.

Should I leave him at his current once a day dose till I get a complete set of numbers, then change the dose?

RobinCot - may I ask where you ordered it at from Canada? Was it online? I heard many say don't buy medicines outside the USA, so I've always been hesitant but with no prescription plan for the cats (or me), I keep thinking about it due to cost. Have you had any troubles with orders from Canada? I'm sure my next order from WalMart will be well over $300.

I am glad I found my way back to the board, as this is much more detailed advice on treating Jun and I know their random testing at the office was way off due to stress and fear. Jun's been through a lot in his near 10 years and I want to try and keep him going strong.

He does enjoy some extra petting and being talked too after the testing, and now I was feeding him right after, so that made him one happy kitty. I'll have to try the brushing or some play time with a peacock feather.

Thank you, everyone! I'll start a new post with all his numbers on Tuesday. Till then, I'll check this for replies/suggestions. Reading all the other posts are most helpful too.

Rae & Jun =^..^=
 
You'll want to get needles with these characteristics:
U-100 (this refers to the number of insulin units per mL)
3/10 mL
30 or 31 gauge (thinness of needle)
Half unit marked
Short or long - I prefer short as I'm less likely to poke all the way through the skin and out the other side. Others prefer the long needles.
 
I have had no problems with getting insulin from Canada except with my local post office who are inattentive to instruction. The insulin is fine and lasts just as long. Sometimes Canada represents insulin from Turkey. I have not used this insulin so I can not vouch for it.
 
Hi and welcome back,

My Levemir from Turkey worked just fine on 2 cats, both are OTJ now. My Pudge went into his 2nd remission (May 2013) after a brief stint of it. Little One stayed on it longer. Both had previously been ProZinc users, we switched due to a shortage of ProZinc.
Best wishes,
Sophie
 
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