Simba Update - leaving Levemir?

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Theresa and Simba (GA)

Theresa and Simba (GA)

Member Since 2010
After seeing really good results from other members here, I had high hopes for Levemir with Simba and it was effective for a short time. I had to increase his dosage about every 10 days until we were up to 6 units. After 2 months it was apparent that the insulin had expired and was no longer effective for him. This left me with 1/2 a vial of insulin wasted, $50.00 worth. I realize that it has a 30 day limit but, it was still showing BG results that is was working the full 2 months, after that it quickly teetered out. Sorry, I did not keep up with my spreadsheet here but his numbers were still similar to what he had with Vetsulin, towards the end they were higher and his urine glucose test strips consistently showed glucose in the urine. He continued to eat his usual large amounts of food throughout the day. I also feel that the excessive eating interferes with his BG results. ( older members here will be more familiar with our saga) He eats FF and Whiskas wet. We also give him meat scraps and very occasionally a few kitten chow kibbles which is the only dry he can chew. I realize the dry is a no no but this fellow requires lots of snacks.


For the time being, we have switched to the affordable Novolin, he is at 2 units now (starting out slow) and still showing glucose in his urine, he has always had UGs with glucose but, never had ketones, and we may not be at a proper Novolin dosage yet. Today his 6th hr BG check showed 172. I prefer the insulin that wimps out after 12 hours because he is hard to test and I have to rely on his UG levels and symptoms. I often wonder about the acromagely, but, cannot afford to do much about it at this time. (I also have an elderly dog who needs regular vet care) After 1 1/4 years on insulin it is apparent to me that Simba is somewhat resistant. Overall, he is still in good health and is thriving on the Novolin. We will try this for awhile and see how he does, if we have little success here, our next stop will be Lantus land. ( BTW, I thought you might find this interesting, his nadir on Levemir was at the 12 hr mark, shot time. His numbers would rise after the shot and then slowly go down as we approached shot time.) Thank you for your interest.
 
Re: Simba Update - leaving Levemir

Theresa, I am so sorry you are having a frustrating time with Simba's regulation. Here my thoughts as they occur to me:

Some cats are high dose cats. No reason like acro or anything, They just are. You may not have reached to proper dose on levemir yet.

Have you read about insulin resistance and Insulin Auto Antibodies (IAA)? There is some info and links on the high dose ISG: viewtopic.php?f=12&t=375
I think in both cases you keep up the dose increases, letting them settle for about 5 days between increases, until you break through the resistance.

In my experience, levemir will not "die" after 28 days, or 60 days, and it won't quickly petter out. Most of us use it until it is gone, if it is refrigerated it should last up to 6 months. It is much more likely that you have not reached his optimal dose yet and/or he has insulin resistance. I have seen a pattern where there is an initial response that then fades a bit to each dose increase UNTIL the optimal dose is reached.

Can you post his numbers - even the old fashioned way? It really is important for us to see them in order to see patterns. Old fashioned way being (example):

amPS 260 - shot 6u
+4 275
+8 190
pmPS 290 - shot 6u ...and so on

If he does have acro, or IAA, the high dose folks can help even if you can't get him tested. But they will want to see recent numbers too.

Dry food... is this really a must for him? Can you feed him more canned? Or boiled chicken pieces? Have you tested him on days he has eaten dry and days he hasn't to see if there is a BG spike from them? I feed Beau (OTJ) up to 12 kibbles of Evo every few days and could probably feed him 8 or so every day. I did that periodically when he was on insulin and did not see any reliable indication that those few kibbles made a difference - but I did check for it.

12 hr nadir is not unheard of. Melissa's PK nadirs at +12. Good that you are award of it and important to post that when "introducing" him to people here.

If he is a high dose cat for any reason, levemir will be a better, gentler insulin for him. I am afraid that the higher the dose of N the more bouncing and crashing his BG numbers will do. And there seems to be an equal and opposite reaction to BG drops: drop far and fast, spike high and fast, etc.

I hope some of that helped. I wish you luck, I hope you didn't throw out the rest of the lev and might return to using it over the N, and please let us know how things are going even if you don't return to lev.
 
Re: Thanks Sheila, stopped by the vet today...

you have always been so helpful! My vet has actually suggested that I could maybe use the 2 insulins together (using a low dose of the N as a night time booster at about the 14th hr.) With Vetsulin out of the picture he has been advising Lantus as he is more familiar with that product. I worry about both of those ideas because we would have to BG test even more. The vet wants me to go ahead and test with his one good ear because his paw pad just won't bleed much, wasting test strips, but, I worry that he could end up with another hematoma problem and I am just not willing to hurt his only good ear. At the moment, he is doing much better on the lower 2U of N, eating less, sleeping more. The trouble is, he always starts out that way. I agree that we may not have been giving the correct dose, but at 6U and Hi meter readings I could not let that continue. I stopped by and talked to the vet today about this, he felt Simba may have been rebounding due to overdosing, the excessive eating was probably keeping him from going too low and then making it high? Or something like that... I did save the insulin and it is refrigerated and kept in the box, away from any light. He also agreed that it is unlikely the Levimir was outdated. He likely was rebounding towards the end as they were consistently Hi not 500's, HI. That scared me for sure and I panicked and switched. I probably should have taken him to the vet 1st, but, it gets so expensive. I already had a script for the N that I didn't use because we went with Lev, but found out I didn't even need a script for N. I do like that am able to test less with N and was relieved to see lower #'s the few times I've tested him. The UG test strips still showing hi glucose this a.m. but the urine is clearer now and doesn't smell as strong. (it got dark and stinky) He gets very little kibble, not even daily, so I don't think that is an issue. It is more likely that he is doing better just with less insulin. It's just that his numbers continued to rise, so, I raised the doses a little bit at a time and it was probably too much too fast. He had a big roasted chicken breast for breakfast today and has been sleeping most of the day away. He has just asked for more food and we are 10 hours into it. The last week or two on Lev he spent most of his days begging for more food and drinking more. We have not tested him at all today. Just UG, which is super easy, it is a delayed result though. I must say, that we are soooooo fortunate that he hasn't had any other health crisis' and he is not in need of other medications. I see many of the other furbabies here and at the vet that do. He is only 13 though, many of these cats are older than he is. Right now we are just letting him take it easy to see if we can keep those numbers down. After a week or so we may take him to the vet for a proper curve, he has a little higher #'s there too but, doesn't struggle with them for testing since they are not poking at his feet or ears. I think he just likes all the attention he gets from the girls there. I will update here as we go along until I am sure of what methods we will use. Thanks again for your support and I am curious to see what your thoughts are on what I found out today.
 
Re: Simba Update - leaving Levemir

I agree with Sheila that maybe you need to give the Levemir more time and maybe he just needs more insulin. I would think with his hernia issues he would be more insulin resistant than most cats. Perhaps someone near you can split an order with you for the cartridges. Or maybe we could all split one at a later date. I believe a few of us will be ready to soon especially when the weather cools off for shipping.

I wonder with his appetite if he wouldn't do better on raw food? Besides being much healthier than canned food it might make him feel fuller and perhaps more satisfied.

You can get a sample from Feline's Pride to try (link in my sig). They have distributors all over and maybe there is one near you.

Please do keep us updated on how he is doing.

ETA - I just read your latest post and understand your plan of action. Again, please do keep us updated.
 
Re: Simba Update - PM UG better, maybe he was rebounding?

Whew... Simba's last urine test 8pm was down from 1000-2000 to 500 which is right about where it should be. He never really gets to the light green. It took a few days to get there. Maybe I should just feed him chicken... Pam thanks for the raw info and yes I think the hernia may have something to do with it, but, the vet says not really. When testing UG, I use the stix that have UG and ketone readings on them. The reading is delayed meaning he spilled less glucose in his urine in the last 12hrs than over nite last night. If his UG is high then his BG was high at some point since his last pee. I have him accustomed to a litter box with white toilet tissue and it makes the testing easy. Its almost as comfy as the any towel that is left on the floor he likes to pee on. He's does his #2s outside usually.

He had his 2U and more chicken for dinner, I have decided not to BG test today. He's been relaxed for the first time in a couple of weeks. I bet Simba was rebounding on Lev from an over zealous, overdosing, worrywart mom. Luckily, we feed anytime he asks so at least I didn't kill him. My poor kitteee... cat_pet_icon I have been reading more about rebound here at the board, just in case, so I don't do that again...
 
Re: Simba Update - leaving Levemir

Just read your three posts since I posted (boy, you have been busy!). My thoughts (again):

If he is like most cats and NOT a high dose kitty, then the 6u is about 3-4 times as much insulin as he needs and he could sure be rebounding from it. I see a lot of misguided information about lack of rebound with lev (and lantus). I have experienced rebound with Beau. It happens. Don't discount it. In fact, if people weren't saying cats don't rebound on lev it would not have taken me so long to figure it out. (Yes, this is a touchy subject with me).

Now, question: what is the lowest dose he has ever been on? What is the lowest dose he has been on since you eliminated most of the kibble?

Not to contradict myself :mrgreen: but maybe he is a low dose cat? Maybe he needs .5u or something? (or less) You are seeing such a vast improvement with the drop in dose over the past few days that I just wonder if you have always "missed" the dose by starting above it and rebound has set in from the get go with all of these insulins? I started Beau on .5u of lev and he dropped low on the third shot so I reduced him to .25u and his numbers went up so I started increasing - in tiny amounts - back to .5u and his numbers kept creeping up so FINALLY I figured out the rebound and started reducing. He was down to .1u for quite a while before I moved him to .05u (yes, that drove me nuts!), then OTJ.

I'm just trying to throw ideas out there for you to mull over.....
 
Re: Simba Update - doing good still

Today went well for Simba, had another good UG and his +6 was 114. Trying not to poke too much yet, tried to get an amps but that didn't work out too good, he is a squirmer. I cooked him some more chicken ( ground & gizzards) today and he enjoyed it. Still pondering using both insulins , but need to do some more research . Haven't found any cases here yet where anyone does that, so, although the idea makes sense, it concerns me a bit. I see it is common for human users to use 2 insulins. My BIL uses both Lantus and N. Maybe a lighter dose of Lev at night would have been better. Didn't do enough night time testing which may have lead to our dilemma. ( I work some late nights, I am a Karaoke DJ)
Sheila, I started him on Lev at one unit then worked our way up over 2 months trying to get a lower curve. He was on 4U of Vetsulin when we switched. He had only been raised 2U for the whole year at a rate of about .25U at a time. 1U of Lev had very little effect on him. He has never gotten much kibble. I only keep it around in case I feel he is too low or in case of emergency snack when wet has run out and I have to go get him some. I want to see how he stays on the N and if it looks like he needs dose increases again, we may have some insulin resistance going on. He was doing pretty well on Vetsulin, we only changed because we had to. Since he is not constantly eating at this time, I have to try to get some PS #'s so I know how much of a drop he is having to go through. I think all the food he was eating messed w/ his #'s. Gee, these little guys keep us on our toes. Just enjoying his calmness for now. Updating his SS now, will add to signature when I am done. Retrieving data from meter. laptop_smiley
 
Re: Simba Update - leaving Levemir

You may find that his PS and nadir are no longer at the same time, so don't assume they are with the new insulin. Just gather data - and don't raise the dose without at least 5 days of PS tests AND a curve. I know that is tough for you with his ear problems and squirming, but it is the only safe way to do it.

Do you know what rebound looks like? There is a great description on petdiabeteswiki of the typical BG curves on both long-duration and short-duration insulins: http://petdiabetes.wikia.com/wiki/Somogyi_rebound

It's unusual to be monitoring glucose right when this happens, and typical to just continue the overdose, leading to a repeated rebound situation. So it's good to learn to recognize the patterns of repeated rebound.

* A typical rebound pattern, most often seen with long-acting insulins, is a high, flat, unresponsive blood sugar over a period of days. Sometimes, often when raising dosage, this high flat curve will be punctuated by sudden drops to very low values, (with possible hypoglycemic events) followed by a fast return to high unresponsive numbers. (It's the sudden dip that distinguishes this pattern from inadequate insulin, but it doesn't always happen.)
* When using shorter-acting insulins, repeated Somogyi rebound may manifest instead as rapidly alternating high and low blood sugar[11] numbers with no apparent logic. The highs and lows will both be exaggerated compared to what you'd see on a smaller dose.
Click to expand...

I would not use both insulins together - at least not right now. This takes skill and a lot of testing to be safe - and is generally used in a cat that is at risk of ketones or DKA - like has had them before or is recovering from DKA. The N brings the BG down fast and the lev or lantus kicks in as it wears off to keep them lower. I have no experience with this technique and I would only attempt it if a) it was necessary and b) someone with experience was guiding me.

I will look for his SS when you get it linked up.
 
Re: Simba Update - leaving Levemir

The tests for acro and IAA are something like $45 and $12; you really should enquire at your vet to rule out the two conditions.

The value of the tests is that you will understand the resistance and know that Simba likely has a functional pancreas so you should avoid aiming for those green BG numbers.

I don't know how long you were using Lev, but it takes some time to build the shed and allow the cat to adjust, so you possibly may have jumped to the N prematurely. I am not sure that you would have much of a different reaction by trying Lantus but it will require the same shed build up as the Lev does.

Good luck with your current tx.
 
Re: Simba Update - leaving Levemir

1st thing, checking back I see he was getting 5U of vetsulin at the end before the Lev switch.

I got the SS up, guess I lost the June data in the meter, finally got a pmps test, not good. Actually, it sucks. Meter showed my afternoon test was at +5 not 6. Thanks for the pricing info, I figured the test weren't too bad but, add the office call and etcs. I always get hit for at least $100. add that to the $2,000 I have spent in the past year or so on Simba, plus the dogs... I see another vet bill in our future. Sorry if I seem flustered, well, actually I am. Then he snubbed my chicken for dinner, gave him his wet Whiskas and his 2U. ohmygod_smile He's content and sleeping now. I just don't know what to do. Guess we'll leave it be for a few more days till I can get some more #s.
 
Re: Simba Update - leaving Levemir

Boy, I wish we had those June numbers.... sigh.

Hard to tell exactly what is happening with so little data - observation, not criticism. However, with HI PS and low 100s at +5-ish, he could be rebounding already. It's the bounce to 600+ that really looks like rebound to me.

Your urine sticks measure ketones as well as glucose, right? I would be tempted to do a rebound check and drop the dose to 1u and see what happens. Try really hard to get PSs and an occasional spot check. Even if the nadir comes up a little - say mid 100s, if the PSs can come down below 300 that would be a better curve. Right now the 500 point swings must make him feel crappy.

BTW, what meter are you using?
 
Thanks ladies,

Sheila, we use the TRUE test meter from CVS. Seems pretty accurate, strips are affordable. Reasonable sample size too. He gets tested for ketones everyday and has never had them. So a rebound check is something we can do if we have to. I read up on booster shots on the old board but most of the data is old, I will go through the current tight regulation board and read some more. So far after what I read it doesn't look too doable for us. Much testing needed. I think there are times when Simba is cool with the test his # is better. When he is not, the # is always higher.

Gayle thanks for the info, I will take that to our next visit to the vet. In Simba's case, I think they may really be necessary.

Thanks for your help, I am sure we will get this to settle down. He is not showing symptoms so that is good. 4 hours into the shot tonight and he is snoozing away. When he is not well, everyone in the house knows it. Will update tomorrow and let you know how he is doing.

Just when you think you know everything, you realize you know nothing.
 
Re: Simba Update - leaving Levemir

Oh, come on look at all you know! Just 'cause there's MORE to know doesn't mean you know nothing.

OK, the meter... is that the TrueTrack meter (uses TrueTrack strips) or the TrueResult meter that uses TrueTest stips?

If you saw/read my "more meter tests" post - it is the TrueResult meter that I am having the trouble with. It seems very inaccurate. I started using it recently after using the TrueTrack meter for over 2 years. I like it for the smaller blood drop size and faster count down, but it doesn't "sip" very well - lots of strip errors and the numbers are low compared with the TrueTrack and the Bayer Contour meter I just got. Maybe I have a bad meter, I don't know. Have you tested yourself with it or compared it to lab results at the vet?

Sorry to give you another thing to maybe worry about.
 
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