Starting Levimer 12-4-10

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Pam & Alley

Pam & Alley

Member Since 2010
When anyone changed to Levimer, did you wait a day or two? My vet did not see a problem giving Alley his usual N does tonite, then switching to Lev tomorrow morning. Is it safe to go directly from one to the other. Anyone have any thoughts or experiences about this? Thanks for your help.
 
I went right from vetsulin to lev with Beau. You gotta start somewhere, right? N gets out of a cat's system pretty quickly - less than 12 hours is normal, so you should be good.

A word of caution from my experience, start at a lower dose. Beau was of, I think, 1.2u of vetsulin and I started him on a half unit of lev - and he dropped into the 30s on the third shot. A half unit to 1u is a normal starting dose for lev.
 
OK, just checked Allie's SS. You might even think about starting her on a .25u of lev. She is getting some major BG swings on that half unit of N.

Either way get some sport checks in as you can the first few days.
 
Hi and welcome!

Levemir will be much gentler for him. Your spreadsheet epitomizes why we call N a "harsh" insulin. Ask any human diabetic how dropping blood glucose levels quickly feels. And cats BG can go much higher than people's safely can.

You can begin Levemir when it's easiest for you, but the day time would be better. Don't expect huge results the first few cycles while her body adjusts, although we've had some cats respond well within 3 days. Ask Sheila, that was her Beau, dropping to 30s on Day 3. That is also why she cautions beginning at only .25U - she is well experienced at beginning doses of Lev because of that and had Beau OTJ within 3 months.

Although that may not be the case with every long term diabetic who switches to Lev. Gandalf has been diabetic for almost 6 years now and although I credit Levemir with maintaining his health over 3 1/2 of those years, I am realistic about the possibility of him going in to remission - it's probably not going to happen. But Levemir is much better than other insulins because it maintains a steadier BG level for them, instead of those crazy swings like you're seeing on N.

Good luck and keep us posted!
 
I went from Vetsulin to Lantus to Levemir and never skipped a dose between insulins. Just shot regular time as usual.

I think it is wise to start a lower dose of Lev than you were giving of the N.

Good to see you here and welcome to the Lev board!

wishing you good luck with the new insulin :thumbup
 
I could use a little help from a Lev user..
First time user this am, low AMBS 377 gave low dose .5 the 10:00 am 192, 12:00 39, gave him K-D high carb food, then
at 1:00 he was 34, gave him chicken & beef in gravy, ate it all, no signs of distress but I am very scared. Will test him in 30-45 more minutes. HELP!! Anyone experiencing low readings like this?
 
Pam & Alley said:
I could use a little help from a Lev user..
First time user this am, low AMBS 377 gave low dose .5 the 10:00 am 192, 12:00 39, gave him K-D high carb food, then
at 1:00 he was 34, gave him chicken & beef in gravy, ate it all, no signs of distress but I am very scared. Will test him in 30-45 more minutes. HELP!! Anyone experiencing low readings like this?
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Hi Pam,
Well well, he likes Lev doesn't he?
I guess we know .5U is too much already.
30s on Lev is not a huge concern, just bares watching that it does not drop further so tests every 30 minutes are important. Lows can last for a while on Lev, the gravy food you're giving is excellent for lows. What brand is it?

Take a moment and breathe. We have ALL been there, maybe not on the first day. He could very well have a sputtering pancreas. Review Sheila's drop technique 'cause I bet .1U would be a good starting place. Very glad you started at only .5U.

Will see if anyone else is around.
 
You may already be aware of this, but the 30s will probably cause a rebound affect where he could go back to the 300s/400s tonight or next AM. I know that's hard to deal with, but it will be temporary.

What is his regular diet again? If you have recently changed his diet from a higher carb to a lower carb food, we need to know that as well. The gravy variety foods are usually much higher in carb, that's why we recommend using them for lows.
 
I just read earlier in the thread where Sheila suggested a .25U starting dose. Guess I should have gotten on board with that recommendation. Sorry. Sheila knows her stuff about starting low!
 
What time was the .5U given?

Since he ate all of the gravy food you gave, he was probably feeling the low. That is the only symptom of low numbers I've seen for Gandalf - they feel the need to eat. The lowest he ever tested was 21.

As long as he doesn't show any signs of confusion or glassy eyed look, he should be OK. I'd like to see him get above 50 on this next test. Is it time yet?
 
we're at 55 at 1:30, feeling better, he appears just fine. hope it does not go down again. Will not shoot him tonite, as the vet suggested.
Tomorrow dose will be .25 or lower, my vet wanted .7-.8, glad we ruled that out! The food I just gave him was Meow Mix market select with real chicken & liver in gravey, ate it all. UGH!
He usually eats EVO canned chicken & turkey with 7% carbs per can.
thank you for the reassurance.
 
Sorry, I keep thinking of things. If you have any maple syrup, you can give that if he's still in the 30s at this next test. It will bring him up quicker, but does not last long. The food takes longer to bring them up, which is probably why he was in the 30s after the KD, but the syrup only gets them up for a little while and the longer acting insulins can have extended lows which is why the food is better as it will keep them up generally.

Hope that makes sense. I see no problem with you giving him some syrup at this point, especially since you're just out of the gate and I'm sure he's giving you a heart attack with this!!!
 
Pam & Alley said:
we're at 55 at 1:30, feeling better, he appears just fine. hope it does not go down again. Will not shoot him tonite, as the vet suggested.
Tomorrow dose will be .25 or lower, my vet wanted .7-.8, glad we ruled that out! The food I just gave him was Meow Mix market select with real chicken & liver in gravey, ate it all. UGH!
He usually eats EVO canned chicken & turkey with 7% carbs per can.
thank you for the reassurance.
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The 55 is excellent!! He should continue to climb from there, as now you have a mix of food and rebound from the liver will kick in soon enough.

I wonder if you should maybe try a few no shot trials since his regular food is so awesome on the carb count. It's fairly obvious from this first shot of Lev that he was tremendously rebounding on the N. Unfortunately he's going to remain high from this for a cycle or 2 so I know it will be tempting to give him a shot, but he might be able to bring down BGs on his own once the rebound clears.

I would feel more comfortable with less than .25U if/when you do shoot. He dropped like a rock on .5U, that's pretty unusual for a first shot of Lev.
 
Have to add - what a great job you just did!!!! Hopefully you're breathing a sigh of relief now.

Gandalf gets acupuncture and the vet who does it is also an ER vet and she's seen so many seizing hypos that she freaked out when I mentioned Gandalf gets in to the 50s on Lev. "That's hypoglycemic," she told me. Perhaps on another insulin, but not necessarily on Lev. I consider 30s needs watching that it's not still falling, but it's not cause for panic.

You did great today!!!
 
3:00 ****Now at 151*** He probably will rebound. What exactly is that by the way?
I see you're in Quincy, IL, been through there many times. Just moved to Colorado from Beverly Shores, IN 3 months ago.
 
Pam & Alley said:
3:00 ****Now at 151*** He probably will rebound. What exactly is that by the way?
I see you're in Quincy, IL, been through there many times. Just moved to Colorado from Beverly Shores, IN 3 months ago.
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Best info on rebound here: http://petdiabetes.wikia.com/wiki/Rebound

Some people/"experts" question its existence. We sometimes call it a bounce. I have seen extreme rebounds in to the 500s though because of low numbers, so I cannot discount the effect of the liver.

Yes, I live near Quincy, work there. Nice area, especially if you like wildlife. This county, Adams and the one south, Pike, have the highest number of white tail deer kills during the hunting season of any counties in IL. Today on my travels which took me across the Mississippi I was on the lookout for Bald Eagles. Saw one juvenile, but that's all. I had an adult fly low over my house last year while one of my cats and I were outside. I couldn't help feeling it was stalking the cat as it seemed to follow her. Marvelous creatures, but supreme hunters.
 
Hi Pam! It looks like you and Alley had quite a day! I am glad Vicky was here to guide you through it with some great advice. :)

It is nice to see the Levemir working so well for him.

When you get a chance can you write up a Profile? It helps people to get a quick background of what has been going on with Alley since he became diabetic and before that with any health concerns, diet, etc.

You can see how to do it here http://www.felinediabetes.com/FDMB/view ... =6&t=17766.

Most of us who were on the old board (this new board was started at the end of last year) have our profiles linked through the icon next the the PM button under our name/location here.
 
Wow - and I thought Beau responded quickly....

OK, well, it looks like he needs less insulin (duh!). If it were me I would shoot a tiny amount tonight to get him down from the rebound highs. They are caused by the liver panicking and releasing stored glucose - plus all the high carb food you gave to get his numbers back up..

But I can understand you not wanting to risk/deal with another bout of low numbers overnight (been there, done that).

But test him at his normal time so you know where he is, and maybe again before you go to bed just to see what is happening and to have that data in your records just in case.

Good catch.

PS - just had a thought: I have wondered about insulin resistence with the faster insulins when they have been on them for a long time and have probably been overdosed on them. I think Beau had a good 6+ months of overdosing (up to 7u) on the vetsulin and I never really got him to great numbers on it over the next 18 mos. Then I switch to a compeltely different insulin his body doesn't "know" and he has a sudden strong response to it.
 
Sheila & Beau & Jeddie said:
PS - just had a thought: I have wondered about insulin resistence with the faster insulins when they have been on them for a long time and have probably been overdosed on them. I think Beau had a good 6+ months of overdosing (up to 7u) on the vetsulin and I never really got him to great numbers on it over the next 18 mos. Then I switch to a compeltely different insulin his body doesn't "know" and he has a sudden strong response to it.
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That's interesting and quite possible. So perhaps a way to break resistance would be switching insulins? Or at least going from a faster acting one which possibly is more prone to cause resistance, to a longer acting one, either Lantus or Levemir? I'm not sure that going from say N to Prozinc would do it.
 
I feel like I failed him on the first day of Lev. At 6:00 (regular check time after food) he was 303, ok, for him. I am so used to N failing him after 4 hours max, this is normal to me. He did have an awful lot of carbs this afternoon, did everything but bake him a mouse pie, so his numbers at 9:00 are at 394, I've had worse. Giving him a break, he is a real trooper. May do one more check before bedtime. If he is still high in the morning, I will wait again. Read the website about rebounding, can last up to 3 days, but probably not with Alley. He usually bounces back from everything quicker.
Good night everyone and thank you all again.
 
Oh, I doubt he will bounce back by the morning. There are hormones (cortisol is one) released as well as the stored glucose and that just takes a while to clear.

However, I am not sure why you would wait...?
If he is still high in the morning, I will wait again.
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While you don't want to give the same dose and start the whole process over again, you don't want him sitting in high numbers. He needs the insulin to bring him down. It's a little bit of trial and error, but you want to give him a more gentle ride than yesterday, but still get him below renal threshold (where the kidneys start dumping sugar into the urine and is somewhere from 180-220 or so).
 
I agree with Sheila, he needs at least a drop this AM. He needs to get down off the rebound ledge before trying anything like a food trial. A food trial is using food to see if their pancreas is producing any insulin. It's not going to work when there's all this glucose producing activity going on from other factors.

I'm off to work in a bit. If you give him any insulin, just leave plenty of food out.
 
What a difference a day makes, and a drop! Exhausting 2 days, but good day today. Everyone has been so kind and informative, Alley and I thank you all so much.

Pam
 
Woohoo!! Look at that! Even got 5 hours of hangtime! That's what we call steady numbers which don't change for several hours, usually around nadir. Very very good to see that. And not to worry that his nadir was above 150. After a few cycles you might see those nadir numbers come down even further.

You're very welcome for the assistance. Please give Alley hugs from us.
 
I saw just now on your speadsheet that your vet advised you to dose just once a day for now.

It looks like you are wavering on this advice. I can understand that given the number you had this AM. It would be a shame to lose the momentum you have gotten already from starting the Lev.

I am curious what his number ended up being tonight after the 109 at +8 and if you decided to give him a tiny dose?

If you did and just in case though do you have your hypo tool box ready? Not saying you are doing to need it but it is nice to know you have the tools on hand. :)

viewtopic.php?f=14&t=2354

I am sure some of the others will jump in here soon. You and Alley are doing great!
 
Did not want to lose momentum, we feel good so far. Only day 2, but his last 2 numbers were 173 at 10+ and 294 PMBS so we experimented for awhile today with the syringe, pretty sure his evening shot was .15 at least or lower, I mean a tiny tiny drop. Have my hypo kit always ready, I think this number (294) is safe. We will be up most of the night on test duty. I am glad you seem to agree that he needs his evening shot.
thanks
 
Proper dosing of Levemir is 12 hours, with the exception of the period when the cat is headed OTJ. You may soon reach that point, where you allow the numbers to dictate when/if you shoot insulin. But you should not see any 400s at that point.

24 hour dosing just does not work for cats. Their bodily processes/metabolism operate much faster than humans. And 24 hour dosing doesn't really work for humans either, I believe that was how Lantus and also Levemir were promoted in the beginning, as once a day insulins.

Sheila is a great resource for learning the guidelines when/if to shoot during that headed-to-OTJ period. I believe she set a BG value that she would shoot insulin above, and it was not always every 12 hours.
 
Really thought the lower dose for night would work, got it lower than .25.
PMBS was 294....+2 was 338, too little insulin it looks like. Will test again in 1 hour and if the number still goes up, try again tomorrow. Trial & error as said above. All in all a good day, darn!
P
 
Vicky & Gandalf said:
Proper dosing of Levemir is 12 hours, with the exception of the period when the cat is headed OTJ. You may soon reach that point, where you allow the numbers to dictate when/if you shoot insulin. But you should not see any 400s at that point.

24 hour dosing just does not work for cats. Their bodily processes/metabolism operate much faster than humans. And 24 hour dosing doesn't really work for humans either, I believe that was how Lantus and also Levemir were promoted in the beginning, as once a day insulins.

Sheila is a great resource for learning the guidelines when/if to shoot during that headed-to-OTJ period. I believe she set a BG value that she would shoot insulin above, and it was not always every 12 hours.
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I think we are all quietly thinking that Alley might get to this point (OTJ). Hopefully so. :)

The 173 at +8 to the 294 preshot was quite a jump. As you know he was on his way up at that point and he was out of insulin and had nothing in reserve - no 'shed' buildup as some would say. You probably would have been safe to give him the same dose at that point and hindsight is great with this disease, but this is all about learning and collecting data so you will be comfortable shooting this insulin. You only just started so I think your approach to go slow and take it easy is fine. :) You will get there.

Good for you for experimenting on the very small doses. Sheila describes it well in her post. Sounds like you are getting the hang of it. :)

See what tomorrow brings.
 
Pam & Alley said:
Really thought the lower dose for night would work, got it lower than .25. PMBS was 294....+2 was 338, too little insulin it looks like. P
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One thing to remember when shooting long duration insulin as opposed to the short duration is that with "the shed" theory it is thought that the reaction you see NOW is from a shot you gave 12 hours ago or longer.

Some believe that is only applicable with the higher doses of 1u or over and that with microdosing you see what you are currently shooting right now...I'm not sure where I am on this, but I wanted you to be aware not to think like short duration when you are shooting long duration.

Another reason we give such long settle time ( the shed) before we see "true results" with long duration insulin.

Lev is a twice a day insluin, however as Vicky wrote, there IS a time when Lev can be given once a day, when kitty is flirting with OTJ, but getting numbers down and more even I think, is your current goal.

I microdosed Vetsulin to get PK OTJ....I was shooting what I referred to as a sniff... .1u! I think I even thought I was shooting .05u at one point. ( half of one tenth)

Right now I shoot about .3u Lev as consistently as possible and that keeps him between 100-300 usually. If he gets less than the .3 his BG soars to 200-400, if I give him more thant the .3 he plummets to 20's and then skyrocket's to 400!

So, microdosing, while trying, actually DOES work...

Hang in there!
 
Has had three low numbers in a row +7 (48), +8 (43) and +9 (39). Did not panic, made his Evo available to him and he ate most of the afternoon. Same dosage for the third day. Note from Sheila's reply, she had the same problem on day 3, made me more aware this could happen, no sign of hypo, jumping on and off the couch and playing, very alert.
Does anyone use the Levemir pens? If so, do they measure in 1/10ths?
Very much appreciate all this help
Pam
 
Good job not panicing ( or is it paincking or paniking?...okay, I can no longer write the English language!)

anyway, glad you offerd the low carb food- how did numbers turn out the rest of the day?

As for the pens- several of us use them, but we use regular syringes to draw the dose from the rubber stopper. There is a picture around here somewhere that hopefully someone will post ( I am SO limited by my dial up!).

Some of us buy the cartridges or pens from a Canada supplier ( mine is www.canadadrugsonline.com) for about $140 for 5 pens or carts....the carts last me about 3 months or more...you guys toying with OTJ might not want to invest that much, or buy them and then have a celebratory sale of them when they are no longer needed! :-D (knockwood, antijinx)

Others buy from local pharmacy for just a scoch more, but prefer to have the local contact so don't mind paying the extra. I can't get them locally for under $250, so I stick with online or sometimes buy one from a member here.

Keep up the great work!
 
Pam & Alley said:
Has had three low numbers in a row +7 (48), +8 (43) and +9 (39). Did not panic, made his Evo available to him and he ate most of the afternoon. Same dosage for the third day. Note from Sheila's reply, she had the same problem on day 3, made me more aware this could happen, no sign of hypo, jumping on and off the couch and playing, very alert.
Does anyone use the Levemir pens? If so, do they measure in 1/10ths?
Very much appreciate all this help
Pam
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I would think he would have been at a number that was too low for your comfort level at shot time tonight with that +9 at 39 (probably mine too!). Unless all of the Evo food you gave him made him shoot up to a higher number.

Just so you know though, try not to feed him the two hours before shot time so that you are not shooting on a food spike number. You want a 'real' number to decide what to shoot on.

But the 39 does warrant a dose decrease anyway.

Here are your choices when you have a number that is too low for you to shoot comfortably from the Lantus ISG forum Stickies:

viewtopic.php?f=9&t=147

Let us know how it went!

Question: Did he eat his normal amount today? In other words, did he get enough to eat? Just checking to rule that out. That is quite a drop on such a small amount of insulin. That is good though. :) He seems to like the Levemir so well. :)

ETA - just saw your spreadsheet and the 85 number at shot time. I don't blame you. Everything is too new in the game for you here to comfortably shoot that number. Read the link I gave you above and see what tomorrow brings. :)
 
Pam, I would suggest that you start a new thread - this one is getting too long.

OK, things are looking very interesting (!). Frankly, I doubt you are going to be needing to buy any pens, but they don't measure 1/10th units anyway. You are going to have to practice the microdose method I described (twisting the barrel to get drops).

I got Beau down to .1u bid (following the protocol of decreasing the dose every time he dropped below 40-50) and when he dropped low (30s) on that after a week or so, I dropped him to .05u bid. When he dropped low on that I tried skipping shots, but he climbed back up again. As he went into remission I set a "do not shoot below" number. I think it was 140, if I remember correctly. I arrived at it by trial and error. I shot his microdose of .05 and got spot checks. I discovered that below 140 he could drop into the 30s, so I would skip that shot. Often at the next PS he was above 140 and I gave him his insulin. Sometimes he would get two shots a day, sometimes only one. I can't remember if we went 36 hrs between before stopping altogether.

Good for you in not panicking (it's the "k" in their that throws everyone). And I agree about not shooting the 85. Many people can and do shoot full doses on numbers like 85, but they have the data to show that it is safe.
 
I thought there should be a k in there, but it just didn't look right....working the last week outside in 20 or below, I believe my brain is suffering frost bite!

Well, then, Miss Pam! Your Alley is getting quit the kick form very little Lev, but I see during the switch where you went a few days without insulin, the number skyrocketed.

From that I would guess he still does need a tad of insulin, but just a tad! I think you are going to have to learn how to get him to sniff the rubber stopper!

Okay, jokes aside, the suggestions to measure the .1 and so on are great ones, and I would second the suggestion to practice the .1u now.

My theory for my house is that I am not always going to be HERE to feed a drop, so it is important to me that I get enough insulin into PK to keep him from skyrocketing but not so much that he will plummet when I am not around to feed....that said, sure you get good numbers from the .25 u, but you had to feed the daylights out of him to keep him high enough!

BTW, you may expect some higher numbers today in case he had panicKy liver overnight...don't let them throw you and make you want to raise the dose! Stay steady with hunting that LOWER microdose to get things evened out.

I have a lobg day away form 'puter today, but hopefully those that work at home may be around more...If you have an emergency, though, b/c his forum moves a little slower you may end up needing to pop pver to Health..however, I think you are handling the lows with the finess of an oldster, so don't foresee that you'll need to go there...just fyi in case, though. ;-)

Looking forward to seeing how thing pan out today later this evening!

(((hugs)))
 
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