Starting Levemir--no tilly protocol
- Thread starter Charliemeow
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Sheila & Beau GA & Jeddie GA
Member Since 2009
I posted in you original thread, but am copying it here:
Hi, Claudia. I am just posting to give you an idea of how the Lev ISG operates. We are very flexible on how you choose to post. Many of us either adapt the protocol to our cat's needs, or don't really use it. But it is a good place to start to get the basics down. And when things are just not making sense, it is a fall back. But you don't have to post all your numbers every day or anything like that. Maybe you could read a few posts over there to get a feel for how things work.
It's great that you have a SS and I think your amount of testing is fine. You will have to do a few curves, but not every day. Once you have an idea of how Charlie handles lev, getting PS tests and a few spot checks is good - as you seem to have been doing already.
Vicky, who posts on Lev, has to change her shot schedule twice every week for her work schedule, so there are ways to do that.
Hi, Claudia. I am just posting to give you an idea of how the Lev ISG operates. We are very flexible on how you choose to post. Many of us either adapt the protocol to our cat's needs, or don't really use it. But it is a good place to start to get the basics down. And when things are just not making sense, it is a fall back. But you don't have to post all your numbers every day or anything like that. Maybe you could read a few posts over there to get a feel for how things work.
It's great that you have a SS and I think your amount of testing is fine. You will have to do a few curves, but not every day. Once you have an idea of how Charlie handles lev, getting PS tests and a few spot checks is good - as you seem to have been doing already.
Vicky, who posts on Lev, has to change her shot schedule twice every week for her work schedule, so there are ways to do that.
Charliemeow
Member Since 2010
Thank you, Sheila.
Vicky & Gandalf (GA) & Murrlin
Member Since 2009
Hi Claudia,
You will be very happy switching to Levemir, despite schedule challenges.
Do you currently post on the PZI/Prozinc ISG? I'm just wondering how you got up to 7U. Is there a possibility Charlie has acromegaly?
There is a best-practice method to determining the optimum dose on Levemir and it requires some mid-cycle tests. I hope there has not been something about the Tilly protocol which leads you to believe you have to test as frequently as some members in the Lantus ISG do. You do not.
The main things are to determine approximately what hour their nadir is, although the optimum dose produces a very shallow curve and there is not always a discernible nadir, most cats have a lower point in the cycle anywhere from +7 to +11 or even +12. If you can test often enough to get an idea when the low point in his cycles are after he's been on it for a little while, you're good to go. In the future you could then test around that time occasionally for your mid cycle test instead of getting curves all the time.
Venita gave you some very good advice in your Lantus thread. PLEASE heed her information about the syringes. Levemir is a U100 insulin, so you need those kind of syringes. The syringes for U40 insulins like Prozinc are not to be used for Levemir or Lantus.
If you can explain more about the schedule inconsistencies you might have, we can help with that. I know what has worked for Gandalf, and I can explain that, but it is something which has to be tailored to each cat's reaction to Levemir. For example, I can lower his dose and give shots as early as +10 without too much disruption to his BG and I can give split doses (divide regular dose in half and given 2 hours apart) to extend his cycle a couple extra hours. Beyond that, too many changes to shot time aren't a good thing. I would not recommend doing it more than twice a week.
Hope we can help further when his infection clears up and you can start. Levemir will definitely save you money - you know about the flexpens, right? I used PZI in the beginning and was spending almost $100 every 3 months on it, plus the expensive syringes. Now I spend less than $200 and the 5 pens last us over a year, but Gandalf is on a little over 1U.
If you have any questions, please ask.
You will be very happy switching to Levemir, despite schedule challenges.
Do you currently post on the PZI/Prozinc ISG? I'm just wondering how you got up to 7U. Is there a possibility Charlie has acromegaly?
There is a best-practice method to determining the optimum dose on Levemir and it requires some mid-cycle tests. I hope there has not been something about the Tilly protocol which leads you to believe you have to test as frequently as some members in the Lantus ISG do. You do not.
The main things are to determine approximately what hour their nadir is, although the optimum dose produces a very shallow curve and there is not always a discernible nadir, most cats have a lower point in the cycle anywhere from +7 to +11 or even +12. If you can test often enough to get an idea when the low point in his cycles are after he's been on it for a little while, you're good to go. In the future you could then test around that time occasionally for your mid cycle test instead of getting curves all the time.
Venita gave you some very good advice in your Lantus thread. PLEASE heed her information about the syringes. Levemir is a U100 insulin, so you need those kind of syringes. The syringes for U40 insulins like Prozinc are not to be used for Levemir or Lantus.
If you can explain more about the schedule inconsistencies you might have, we can help with that. I know what has worked for Gandalf, and I can explain that, but it is something which has to be tailored to each cat's reaction to Levemir. For example, I can lower his dose and give shots as early as +10 without too much disruption to his BG and I can give split doses (divide regular dose in half and given 2 hours apart) to extend his cycle a couple extra hours. Beyond that, too many changes to shot time aren't a good thing. I would not recommend doing it more than twice a week.
Hope we can help further when his infection clears up and you can start. Levemir will definitely save you money - you know about the flexpens, right? I used PZI in the beginning and was spending almost $100 every 3 months on it, plus the expensive syringes. Now I spend less than $200 and the 5 pens last us over a year, but Gandalf is on a little over 1U.
If you have any questions, please ask.
Charliemeow
Member Since 2010
Thanks, Vicky!
We are currently using a combo of u-100 and leftover u-40 syringes depending on charlie's dose, so I do know that lev only uses the u-100s. I am also aware that he may be acro or iaa. But those tests are on the back burner for now. I know to be cautious about him dropping too low, so my goal is blue nadirs for now. That pretty much will preclude me from the tilly protocol since I obviously will do dose reductions without him ever seeing the required 40.
I can swing a few mid-cycle tests a few times a week, but there are days when it just won't happen. But I'll make sure that those critical first 3 days are days that I'll be around to test.
We should hear back on his urine culture today, so that'll give us a better idea of when we will start lev. He just started his abs for his toe last night, so he has 6 more days of those before we make the switch.
Thanks again!
We are currently using a combo of u-100 and leftover u-40 syringes depending on charlie's dose, so I do know that lev only uses the u-100s. I am also aware that he may be acro or iaa. But those tests are on the back burner for now. I know to be cautious about him dropping too low, so my goal is blue nadirs for now. That pretty much will preclude me from the tilly protocol since I obviously will do dose reductions without him ever seeing the required 40.
I can swing a few mid-cycle tests a few times a week, but there are days when it just won't happen. But I'll make sure that those critical first 3 days are days that I'll be around to test.
We should hear back on his urine culture today, so that'll give us a better idea of when we will start lev. He just started his abs for his toe last night, so he has 6 more days of those before we make the switch.
Thanks again!
Sheila & Beau GA & Jeddie GA
Member Since 2009
Claudia, just know that you can "use" the concepts of the TP in terms of raising and reducing the dose, but base it on different BG numbers or amount of dose change.
What I mean is this: with Beau there was no way I could make even .25u changes. His dose changes were in .1u increments. I also could not shoot low numbers, so I had a do not shoot number (I don't think that is even brought up in Tilly). Finally, I made dose reductions when he dropped below 50, not 40. He did, in fact drop below 40 a few times, but that was not my intention in order to "earn" a decrease.
What I mean is this: with Beau there was no way I could make even .25u changes. His dose changes were in .1u increments. I also could not shoot low numbers, so I had a do not shoot number (I don't think that is even brought up in Tilly). Finally, I made dose reductions when he dropped below 50, not 40. He did, in fact drop below 40 a few times, but that was not my intention in order to "earn" a decrease.
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