Stopping in to say hi again....and need some advice

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donnahc

donnahc

Member Since 2011
I posted over on PZI too....

Just wanted to stop in and say hi and give our well wishes to all the sugar kitties and beans out there.

Also wanted to let you all know I have a vet appointment tomorrow for our civvie Alby (just a check up and rabies vac) and while I am there we will discuss the insulin change for Asher.
I emailed my vet a bunch of links/information on both the L’s last week and I think I blew his mind @-)

So we will keep you posted on what the decision is. Our PZ spreadsheet is updated and you will see we raised our dose a couple times. Kitty daddy Tom insists Asher needs more insulin so we agreed to try it.
His mid day numbers are good (unless he’s in a bounce) but the preshots still have too many 300s for my taste. So I dunno. Still think we have to try an insulin with more duration for the gray fur baby.

If anyone here has a suggestion on what a starting dose might be for Asher on Lantus or Lev (I think my vet wants to do Lantus but a decision hasn’t been made yet) we are all ears.

I already have U100 needles. I am lobbying to get the flex pens of the new insulin instead of a vial of the new insulin. I am assuming that’s what most people here use. Any other starting out tips you guys have would be way appreciated.
I’m a newbie all over again :)

Hugs and greetings to all!
:mrgreen:
 
Have he had his teeth checked recently? He seems to just lack any duration on the current dose, but he did very well on less at the beginning of the year. I just wonder "what changed?". He is getting a significant response to it - almost 300 points the other night. It is possible that he is getting too much insulin as 2.2u had better numbers at the end of Jan./early Feb.

I would suggest starting him at 1u on either insulin. I think the "formula" for a restart from his current dose would be more like 2u, but I think that is too high for an insulin that will work so much differently than what he is currently on. Plus, he might be getting too much now.
 
He had his second dental in less than a year in January of this year. Previous dental was April 2011. I really hope he isn’t having teeth issues again.

It is possible he is on too high a dose. We are just at wits end trying to figure out what his PZ dose should be since he had this dental in January. We can’t seem to shake the 300 preshoots no matter what and I am trying to keep him in decent numbers for as much of the day as possible.

If you look back into last year, it appears he was “regulated” but we were one of those people caught up in the Freestyle meter mess so probably for at least 6 months he was not regulated even tho we thought his numbers were good. The Freestyle lied to us. We had no idea (since his clinical signs have always been good) until another friend on PZI found out about the strips being changed and the meters reading lower than they should.

After that in January, the vet discovered new bad teeth so we went thru another dental. The dental/pain drugs seemed to keep him in good numbers for a week after that, but then we have been struggling trying to get him regulated since.

Thanks for your input about a dose on the new insulin. I was thinking one unit to start but didn’t know for sure. Don’t want to loose any slight momentum we have, I am not sure we even have momentum now.
 
Just a thought on his teeth - if he needs frequent dentals, does he tend to have red gums? Maybe he has resorptive lesions? http://en.wikipedia.org/wiki/Feline_odontoclastic_resorptive_lesion. Or possibly, if a tooth was extracted, part of the root nerve was left and he has pain? I just wonder because you say he has not been well regulated since the end of ABs and pain meds.

I would be really PO'd about that meter problem. I got a nice new meter and thought it was great, but soon discovered it read low and the maker was not receptive to my complaints. It was a True Result meter. I next got a Contour (Bayer) and am happy with that - but, boy was that frustrating and maddening!
 
Hiya Donna!

I think I know the answer to this question, but has Asher ever shown you any ketones? It's something you'll want to keep an eye out for when switching, especially if you are considering a significantly lower dose to start.

Sheila, the "formula" you mentioned that indicates that 2.0 is logical.... do you know where that is (on the board somewhere?). I understand your thinking on the numbers Asher was getting on the 2.2 dose a while back. But isn't this a "but what have you done for me lately?" sort of thing? He may be dropping low in the middle lately (nice greens in there recently!), and the higher PS numbers could be bounces from those lows, at least in part. They could also be short duration related, which shouldn't be a problem with an L insulin. But would it be better to maybe start higher (like 1.75 ish?) and feed the curve as needed, hopefully to lower the preshots as a result without risking the low dives in the middle?

I'm just "learning" about the L's, but any feedback would be appreciated!
Carl
 
I already have U100 needles. I am lobbying to get the flex pens of the new insulin instead of a vial of the new insulin. I am assuming that’s what most people here use. Any other starting out tips you guys have would be way appreciated.
I’m a newbie all over again :)
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Donna,
You know there's always a bright side that I always manage to find..... if/when you switch, you'll be able to toss that u40 to u100 conversion chart, and you'll have more room on the fridge door for refrigerator art! :smile:

Carl
 
Thanks Carl! Yes, it will be nice to not have to use the conversion chart! I still look at it EVERY time we draw insulin, I don’t ever want to make a mistake even tho I have most of the conversions memorized by now. @-)

Touch wood, Asher has never shown any sign of ketones. I still check every so often tho, and note it in our spreadsheet when I do.

I think Asher is doing better, at least mid cycle, on more insulin. But it seems to me he bounces often, and sometimes zooms up quickly into the 300s, which makes me think too that he has a duration issue with PZ.
Some of those bounce days indeed could be construed as looking like too much insulin, so not being an expert, I am clueless. I am just trying to keep him in decent numbers as many hours a day as we can.

I think we can do better, but I don’t know if we can do better on ProZync. I think I have been patient and have tried everything I can think of on this insulin. We are really consistent with his food, feed only one type of low carb food, only baked chicken for snacks after testing, and police him so he doesn’t steal his brothers food :shock: ohmygod_smile
 
We are really consistent with his food, feed only one type of low carb food, only baked chicken for snacks after testing, and police him so he doesn’t steal his brothers food
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I know he eats at shot times of course, but at what other point(s) in the cycle does he eat? I'm thinking the "feed the curve" method, which is used by many L users, may help no matter what insulin you are using. Buffer the "drop" so that it doesn't happen quickly or drop too much. Yes, you'd have higher nadir numbers most likely, but it can stop or lessen the bouncing. Even if you get a nadir of 125 instead of 85, if it slows or lessens the bouncing, then you'd get more "real" PS readings.
If you have a curve with 350 at start and finish, and a nadir of 90, he's most likely going to bounce. But if you have PS's closer to 250, and a nadir of 150, then you're spending most of the day under the renal threshold, and giving his body more time to heal, I think? The "feed the curve" thing is most likely something you'll need to do on the L's, if I'm understanding what I've been reading.

Carl
 
We could feed the curve many days, but not if we have a job outside the house where Tom and I would both have to be gone for the day. Most days one of us is here tho. And we do have an auto feeder we rarely use...but we have two cats ohmygod_smile

Our snacks during the day and at night are after we test him, and if he pesters us so much that we have to give him something. That usually is about 3 times a day between feedings on average. The only snack we give him is small 1/4” chunks of chicken, maybe 3 of those per snack. We also feed a snack once overnight, usually between 2 and 3 am when he asks me for it :roll: ....so his snack has little to no carbs in it. The only other time we feed him something other than his regular 1-2% carb wet food, or chicken chunks, is when he goes low, usually at night, I give him a forkfull of higher carb gravy lovers wet food.

So maybe I need to think about feeding (or put in the auto feeder) a mid carb snack at some point during the cycle?
 
The other thing that comes to mind about feeding the drop, we don’t know which days he is going to drop, so if we feed him one day when he’s high, his numbers will be even higher.

Also, the vet put Asher and his brother on a diet in January in hopes of them loosing a few pounds, so feeding more than we do now kind of negates a diet. (he cut their food by 1/3 overall)
 
Well, I was thinking that if his nadir is at +6, if you fed him some low carb regular food at +4.5 perhaps, that might stop the nadir from going low enough to cause a bounce? But still give him a decent number at +6...
If you switch to Lantus or Lev, you'll most likely have to figure out when his "normal" nadir is on that particular insulin. Apparently most cats have a later nadir on Lev than on Lantus? And it might be a different time than his Prozinc nadir regardless. It's sort of like starting all over, but not really. You already have a great deal of experience dealing with the disease and now you'll just have to "re-learn" some of the particulars that are associated with a new insulin. So the "routine" might need to be altered.
Carl
 
donnahc said:
The other thing that comes to mind about feeding the drop, we don’t know which days he is going to drop, so if we feed him one day when he’s high, his numbers will be even higher.

Also, the vet put Asher and his brother on a diet in January in hopes of them loosing a few pounds, so feeding more than we do now kind of negates a diet. (he cut their food by 1/3 overall)
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Oh, you may not need to feed more. Just distribute the portions differently, like 2/3rds at shot time, and 1/3 later on? I'm sure lots of L users can help with that logic. Bob was easy, he just pigged out 4 times a day based on when I could dump food in his bowl since my schedule was never the same week to week. I kept his shots fairly close to 12/12, but on PZI, it was easier to be flexible on that, even more so than on Prozinc. PZI was a 8-10 hour duration insulin.

Carl
 
Hi again -

Since I'm SOOOO experienced in Lev... ahem... (today is day 26)... let me share not MY wisdom, but that which I was told:

I believe it was the doc at the NCSU vet school... or maybe even the "infamous" Dr. Lunn. My starting dose was 50% of what he'd been getting on ProZinc. Because Grayson has all the indicators for Acro, we increased more rapidly than the standard protocol. Likewise, I had to chase him around w/ a stick :o :lol: :lol: frequently, as I was SOOOOO fearful of ketones, given the reduced dose. Since he was on 6u ProZinc, we started at 3u Lev, and increased about every 7th cycle. Today I increased his dose 20%. [Grayson is also insulin resistant - or at least he was w/ ProZinc], so we are trying to stay on top of the insulin anti-bodies.

Another thing you asked was about the nadir. On ProZinc, Grayson barely had a nadir. .. heck, we barely had MOVEMENT! He lived in pinks for most of March through May. Things are different for him here. We've had strings of yellows (and not just the high yellows!), AND even 2 blues last week!!! As his dose has increased, his nadir has decreased, however he's still having some high pre-shots (and he's still trying out his new recipes... yesterday he had egg noodles - ugh!). But I've seen as much as a 300 point drop during his cycle... more often 200. For him, that's HUGE!

His nadir seems to be about +7.5 or +8.

One other thing you asked about... pens vs vials. My vet wrote the script for Lev (I had my choice). I priced both pens and vials at a local pharmacy, Walgreens & Wal-Mart. Walgreens had the best prices on the pens. Paperwork says to discard the vial after 42 days (I think that's correct). I had read something about 28 days. If kept refrigerated, it will stay good. Pens come in 5-packs of 3 mL each. Vial is 10 mL. With the prescription savings club at Walgreens, I saved $35 off the first prescription - which was the cost of the club membership - and it applies to me and other stuff there as well. Big picture, about $180 for the 5 pack, which is 1.5x the qty of the PZI... which I paid $120 for. So it's pretty much the same, unless you were getting a really good price on it at your vet.

...so that's it for my experience. You can only have SO many successes and wise things to share in not even 4 weeks! FWIW - I hope this helps some.

Lu-Ann
 
Carl, I don't know where the "formula" is for calculating the dose when changing insulins, but I have seen 70% posted a few times in different threads. The thing is that so many cats have an immediate and significant response to lev.

I don't like "feed the curve" as a safety net for chronically overdosing insulin. If you are testing, get low numbers, by all means feed the cat to stop the drop - and then look at reducing the dose a bit depending on what other factors might have caused the low numbers. I don't think that dosing for low PSs and then feeding to prevent a hypo on a daily basis is a good idea. With lev, at least, lowering the dose usually stops the swings and things even out. If, at that point, the nadir is too high, very slow and very small dose increases with work to bring the whole curve down.
 
Unless the cat is on a fairly high dose of previous insulin like Grayson was and there's a possibility of Acro, the starting dose of Levemir should be no more than 1U. Period, end of story. And if previous insulin dose is less than 1.5U, the starting dose of Levemir should probably be no more than .5u. I stated that in the stickies and I stand by it.

I really wish starting dose would not become a debate on the board. I think those of us who post regularly on Levemir agree with the 1U standard. I get concerned when any formula comes up, either the 70% thing or the ideal weight thing from Tilly/Rand. Cats don't read formulas.

Start with 1U, hold the dose the necessary days, no less than 3, get a curve after 3 days and go from there. Yes, I realize not all cats even follow that but it's a pretty good standard, just as the 1U is.
 
Hi Vicky,
I really didn't see any of this discussion as a debate, but rather as a simple request from Donna (and me I suppose) for a logical explanation of how a starting dose is determined, and "why"?
Even if I had seen it in the sticky, I would still want to know why. If I were thinking of switching, having a cat who has been on insulin for a year or more, with doses as high as 4 or more units....this is a huge decision, and I would be questioning each and every thing.
If you wanted me to drop from 3u to 1u, and your reasoning was "end of the story. Period"? I guess my response would be that anyone who is a parent would tell you that "because I said so" only works until about three years old and junior learns to ask "why?"
I'd ask for hard data. I'd want to know -
"Of all the cats who have switched, who came here on a dose higher than 1u, what percentage of those cats end up on a higher dose of Lev than 1u?" I would want to know how long that took, and how much longer my cat was going to live above the renal threshold, since that's my primary concern and the reason I'm considering the switch in the first place. I'd sure want real data supporting the logic.
People aren't trying to debate or question a protocol that appears to work well. They're just trying to understand.
As long as "ECID" exists, "end of story, period" doesn't make logical sense to me.
Carl
 
Carl, one (or two) reasons I can think of off the top of my head are:

Most cats switch to lev from PZ or lantus. On PZ, there is a lack the duration and doses get raised to try and keep numbers from zooming up at the end of the cycle - so that dose is like comparing apples to oranges for figuring out a true starting lev dose. When they come from lantus it is because they don't do well on it and tend to bounce all over the place, with doses being given to try and counter the expected bounce - again, not a "true" working dose - and also a sign of over dosing. I mean, they would not be switching if the insulin/dosing worked, right?

Lev works differently than both above mentioned insulins. No matter what anyone says about it being similar to lantus, it isn't. The mechanism of slowed release is different. We see so many cats taking a nose dive on the 2nd or 3rd shot, that it is just safer to start low enough so that isn't an emergency, up all night testing event. And once the cat has started the drop low, rebound high cycling, it is much harder to stop it and get the rebound response to back off.

Just like with a newly dx cat, you want to start lower and work up. With a more experienced care giver, the steps ups can be quicker, but should not be done without testing, a settle period, and a curve.

For all that Vicky and I have explained about stating doses, percentage increases, looking for patterns of bounce and reducing to stop that and then work back up very slowly with lev, it seems like very few people "listen" to what we have to say. The forceful TR method gets pushed more and then next thing we know the cat that hit the 30s (or 20s) on .5u, when we suggested .25u, is at 1.25u - or more - with high numbers that *surely* indicate the need for even more insulin. It's exasperating. I think that is where "Period. End of story." comes from.
 
Thank you Sheila,

So going back to the questions I would ask - would you say that you foresee that Asher's "ideal dose" would be someplace in between 1u and 70% of his current 2.8u dose (2.0ish?)? And that ultimately Donna won't have to go above that 70% of his current dose on the new insulin? And if so, is the standard practice to up by .25 after 3 days until he reaches his breakthrough dose?

I wasn't advocating "feeding the curve" to avoid hypos caused by an excessive dose above. What I was suggesting is to use food to raise the nadir and/or slow the drop to avoid a bounce. I guess what I'm asking is if there is a alternate method to avoid bounces than simply lowering the dose. It seems that if she were to get less of a drop, he wouldn't bounce so readily, which would give her lower preshots and keep him under the scary 300-400 numbers all day long.
From what I have seen with "P" kitties, sometimes an apparent "short duration" cycle is really not a short duration cycle. It's a cycle that went too deep and caused a bounce, giving the impression that the insulin just pooped out early. Then a day or two later, the same dose gives you a cycle that doesn't drop too far, and lasts beyond 12 hours, which sort of throws the "short duration" thinking out the window. (In spite of what appears to be common thinking, Prozinc is a 10-14 hour duration insulin, not an 8-10 hour one). In those cases, feeding before normal nadir can avoid the bounce, and ultimately lead to a flatter cycle of good numbers instead of a bunch of reds and greens.

Carl
 
Carl,

I can appreciate someone wanting those exact statistics. But if ECID means you need more than "period, end of story," ECID also makes a portion of those statistics meaningless because your cat may react completely differently from the majority of others.

Switching insulins is like starting over. 1U is the logical choice. It's what's recommend to newbies on Health. No one has a magic formula based on X number of cases. They might have a formula but ECID pretty much means it's a crapshoot. 1U is a good standard. It helps to set a baseline for how the insulin is going to work for the cat and a dose can be raised rapidly if there is little response in the first 3 days. If someone switches at 1.5U of Levemir for example, there is a huge space of doses that weren't tried first. Levemir simply works best by starting BELOW the optimum dose and working your way up slowly and not necessarily in time, but also in dose amount. So I ask, "How did a particular cat react on a dose of 1U?" Well, we don't know because it wasn't tried.

Starting at 1U eliminates that guessing game. It's all about collecting data no matter what dose you start at, but not starting at 1U may mean there's a black hole of, "Gee maybe they're getting too much insulin."

BTW, when I mentioned the dose debate I wasn't really referring to this particular thread, but the board as a whole. And I'm sorry I don't have any kind of statistics for you. I just can't provide empirical evidence for each and every recommendation I make. I'm also not here to catalog case studies. I am here to share the knowledge I accumulated while caring for a diabetic cat over 6 years, 4 of which included using Levemir. That seems to be less and less appreciated.

I'll let Sheila answer your other questions because maybe she has some sort of crystal ball with which she can see Asher's ideal dose. And the "standard practice" to raise by .25u is outlined in the Tilly Protocol. Given how the cycles go, it's not always what we would recommend however. Some cats need finer adjustments.

Donna, my deepest apologies for hijacking your thread.
 
No worries Vicky and everyone else. I WANT to hear what folks have to say. I appreciate your taking the time to explain things to me since I do feel like I am starting over here. And as you will see later in the post I kind of feel alone in this, but I know you guys will help me thru....

This will be a quick post since I have to dash off to help my Mother today, I’ll post more tonight.

Saw our vet yesterday (Wed) We are switching to Lantus. He does not know enough about Lev to let me switch to that. He only uses PZI in his practice but has heard Lantus is good from colleagues.

He suggests we start the new dose at .25. I went to him b/c he is cautious since my last vet tried to overdose my cat, but I am thinking .25 is a little low. I agree with Vicky, around 1 unit would be good, but now don’t know what to do.

As soon as I find the best price, the vet will call in the script. My prediction is we’ll start the change madness next week sometime.

Bad news is I found out yesterday we are loosing this vet whom I love. He is moving to Jersey which is way too far to take the cats in the car (about an hour and a half from here), or I would just follow him. I am driving 45 mins now. Just can’t go longer.

So now I have to find a new vet too. Insulin change and new vet. My head is spinning....
 
Oh, dear- that is a big blow to your kitty care!

Does he recommend anyone? What about the colleges he's heard of Lantus from- are they close enough?

A good FD vet is getting harder, not easier, to find these days. Good luck in the search.
 
Vicky & Gandalf (GA) & Murrlin said:
Carl,
BTW, when I mentioned the dose debate I wasn't really referring to this particular thread, but the board as a whole. And I'm sorry I don't have any kind of statistics for you. I just can't provide empirical evidence for each and every recommendation I make. I'm also not here to catalog case studies. I am here to share the knowledge I accumulated while caring for a diabetic cat over 6 years, 4 of which included using Levemir. That seems to be less and less appreciated. .
Click to expand...

We empower the FDA to decide what drugs do and don't do (both human and animal) and they carry this out through rigorous laboratory testing and ultimately clinical trials on hundred and and sometimes thousands of patients. With the FDA's approval, then and only then are drugs deemed both SAFE and EFFECTIVE to use and then and only then can those statistics be used to make claims, make dosage and administration, warnings, cautions, etc.

Not a single insulin in any of these discussions were approved for cats. This means that if anyone is demanding a specific, approved, and labeled protocol to follow - it's completely out of line..... one just doesn't exist. I'll even go further as to say anyone needing that type of info will be waiting a long time as I can't fathom any pharmaceutical company is going to spend hundreds of millions of dollars for an animal indication. Until then, all we have is experience and that is EXACTLY what this board is all about.

Vicky, I don't think it gets said NEARLY enough. Both you and Sheila are priceless and have helped so many of us understand Levemir. Your instincts and experience is our evidence.....and it's truly and genuinely appreciated.
 
Jessica,
Actually Prozinc was/is a part of this discussion, and it is approved for use - and was created solely for - use in cats. And there is a scientific protocol for both L's. I guess I don't understand your point? I guess what I was hoping for was that someone at some point had kept some sort of "records" for cats that have been thru the FDMB over the years. It'd have to 100 times the number of cats that the protcol we follow involved, and that sure would be a more substantial sample size, wouldn't it? I wouldn't want the pharmaceutical companies to spend millions on pet research for human insulin. Their products already cost way too much. Besides, who believes what they say anyway?
I think Vicky is the bomb:-) I certainly value her wisdom and experience. The fact that she posts here daily trying to help people speaks volumes as to what a great person she is. If I didn't value her experience and her opinion, I wouldn't ask for it.

If the data doesn't exist, it doesn't exist. That sucks, but it is what it is.
Carl
 
The PZI that was approved and studied in animals has long since been discontinued in the United States. The available sources of Prozinc today are variations or more often, compounded variations, so no, we don't have any insulins available that have the relevant, approved data for that specific formulation.
This however was never "my point" ......you were asking specifically about data related to dosing Levemir in cats?
by Carl & Bob in SC
If you wanted me to drop from 3u to 1u, and your reasoning was "end of the story. Period"? I guess my response would be that anyone who is a parent would tell you that "because I said so" only works until about three years old and junior learns to ask "why?" I'd ask for hard data. I'd want to know -
"Of all the cats who have switched, who came here on a dose higher than 1u, what percentage of those cats end up on a higher dose of Lev than 1u?" I would want to know how long that took, and how much longer my cat was going to live above the renal threshold, since that's my primary concern and the reason I'm considering the switch in the first place. I'd sure want real data supporting the logic.
Click to expand...

Did you get that hard data when you chose whatever version of Prozinc you are using? Did it hold true for every cat? I suspect the answer lies in your own experience with Prozinc and I also suspect that you offered advice on that board based on your experiences....because after all, ECID.

by Carl & Bob in SC
And there is a scientific protocol for both L's.
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The study originally done was on 55 uncomplicated diabetic cats whose owners joined the online German Diabetes-Katzen Forum, and the protocol was developed by those lay people,who were members of that Forum. It has since been adjusted by different groups (lay people), based on their experiences.

The bottom line seems to be that you're looking for something that could not possibly exist in this forum. We're not dealing with doctors treating uncomplicated diabetic cats on a strict protocol with someone keeping meticulous data. Every cat is different here and every person treating that cat is different. - we're just average folks helping each other out, doing the best we can with our individual situations. I'm genuinely sorry that you think that sucks..... because for me; it's what I love most since switching to Levemir!
 
Jessica,
Take a step back maybe? Try to be a little bit less self-defensive?

1 - I used compounded PZI. Prozinc is NOT PZI. It is a human rDNA insulin that was created to replace the "old PZI" which was not compounded, but made from pig and cow pancreases. A study was performed by the makers of Prozinc that compared how it worked against "old PZI", so that they could be sure that it was good enough to replace it. It was. They also found it had a 2-4 hour longer duration, and a less harsh nadir and drop. I didn't say "PZI". I said "Prozinc". They are not the same thing, although far too many non-prozinc users toss the names around like they are the same thing. Compounded PZI is still available, in limited supply, but if I had to guess, it won't be for much longer. The lab that made the PZI I used is no longer making it. Prozinc is in fact approved for, and made specifically for, use on cats. It isn't "compounded".
Did you get that hard data when you chose whatever version of Prozinc you are using?
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I didn't choose Prozinc. I was given compunded PZI, and I never considered anything different. I didn't even know or care that there were other choices for insulin. My vet prescribed that, and I walked out of her office in a total daze, worried that my cat was going to die (he nearly did a week later when he went DKA). Before that day, I had never even heard of feline diabetes. So data meant nothing to me. By the time I found, joined, and posted on FDMB for the first time, my cat was 6 weeks into treatment, and four weeks from going OTJ. So it was working really well for Bob, and by the time I learned that insulins like Lantus and Lev existed, I couldn't have cared less, because switching was never even a consideration on my part. So the answer to your question is "no". I didn't need, want, or care about data relating to PZI, Prozinc, or either of the "L's". I wasn't here when it might have mattered to me.

The study originally done was on 55 uncomplicated diabetic cats whose owners joined the online German Diabetes-Katzen Forum, and the protocol was developed by those lay people,who were members of that Forum. It has since been adjusted by different groups (lay people), based on their experiences.
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Actually, the study was not on 55 cats. It was on 73 cats. 55 of them were given Lantus, and the other 18 were given Levemir. I've read the study until my eyes bleed. And the remission rates were 84% and 82% respectively. And I'm not 100% sure on this, but I don't think any of the 73 cats was switching from one inuslin to an L. I think they were all newly diagnosed kitties.

The bottom line seems to be that you're looking for something that could not possibly exist in this forum.
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The bottom line is that you don't really understand what it is I was looking for. What I was looking for is not scientists to tell me anything. I was looking for some sort of statistics that I was hoping existed "here". How many cats have switched from Prozinc to Levemir? How many of them, after starting Lev at a reduced (more than 70%) dose compared to their "P" doses ended up going OTJ with a dose what was lower than the P dose when they switched? How many of them ended up needing a higher dose of Lev than they had with Prozinc? That's what I was hoping to get.
Because with that data (and it most certainly does not matter if it holds true for every cat, by the way - no data collections hold true for every cat. That's why they are looked at as percentages).

For instance, if someone had said that "75% of all the cats that have switched from Prozinc to Lev ended up going OTJ, or becoming regulated (or whatever yardstick you want to measure by) at a LOWER dose than they had been on with Prozinc. And of those 75% cats, 70% of them were at a lower dose than 70% of their prior Prozinc dose." Do you understand how powerful that data would be?

It would justify the thinking that a cat should be started on Lev at .5u or 1u, instead of (in this particular case of Asher) some people thinking that 1u is not enough, and 1.75 or 2.0 makes more sense (which would be closer to the 70% of dose that Sheila mentioned to begin with). And most importantly, it would justify it statistically. It wouldn't be just a "because this is what we've always done" kind of thing. On the other hand, if the numbers/percentages did not say that, but said instead that only 25% of those that switched ended up doing better on a lower dose to start, not only would it help Asher, but it would help every cat that switches in the future. It might save some people the time it takes to go from .5 or 1.0 in small increments based on the protocol until they get to an effective dose.

The argument is not that the 1u dose is too low, although that seems to be the impression most people reading this have. The point is that if someone had collected data over the several years that Lev has been used by members of FDMB, this whole discussion would not have taken place. That is what sucks. The fact that nobody has kept records. That doesn't mean that anyone is at fault. It just means that a useful tool was never developed. Which sucks.

I don't understand why you seem to be taking this personally. None of it is your fault, or anyone's fault. People have to make decisions that affect their lives and their pets lives on a daily basis on the board, and unfortunately, there aren't cold hard facts that could exist at their disposal.

I completely understand that every cat is different, and more important to me - that every bean is different. In fact, I think I understand that better than many people on this board, at least judging by a lot of the advise I see tossed around every day.

The only thing that really matters to me, and the reason I posted in this thread to begin with, is Asher getting better, and Donna not driving herself insane trying to make that happen. Because she happens to be a dear friend.

Carl

Carl
 
Carl I'm not defensive, protective maybe of the peace that exists over here at Levemir and the response that was given to Vicky- it was out of line, but defensive, definitely not.

Prozinc is the brand name for protamine zinc insulin - although I am not going to argue this point with you as this is just a tangent and was not what the conversation was about.

On that note, I'll agree that I don't get what you're looking for.

Donna - I'm genuinely sorry to have hijacked your post.
 
Um, my crystal ball is on the fritz just now.....

Looking at Asher's SS, I think 1u would be an ok starting dose. If you, or the vet wanted to be super cautious, you could start at .5u and be prepared to both test for ketones and to gather enough data to raise the dose as needed after 3 days.

Dose changes should be thought of in terms of percentages in the 20-25% range - and then rounded off. I have seen too many kitties jumped from .5u to .75u, which is a 50% increase, and then start bouncing. Alas, what then happens is the higher numbers prompt a bigger increase. Anyway, something like .5u ---> .6u ---> .75u ---> .9u ---> 1.1u ---> 1.3u ---> 1.5u ---> 1.75 ---> 2u ---> 2.5u ---> 3u would be a good plan to follow, but as numbers settle and changes slow down, smaller changes to fine tune would be good. Say you are getting mid 100s for a nadir on 1.1u, going to 1.2 or 1.25 might be necessary.

Donna, when is this vet leaving? Would it be worth waiting until you find a new vet and see if you can talk them into giving a script for levemir? Did you by any chance think to print out a lev kitty's SS to show him? I mean, if he is "allowing" you to switch to an insulin he has never worked with, what difference does it make to him which one it is? Maybe a lev success story (like, um, Beau :roll: ) might persuade him. There should be info on lev use in cats in the information he gets from vet organizations, conferences, etc. My vet is great, but not the most up to date with new medications and even she had heard of lev when I switched Beau to it three years ago (and yes, that is right, I made the switch without her "permission" and told her after the fact. I bought my lev from Canada). Just a thought.
 
Thanks for that info Sheila. I never thought about increases that way but it makes sense. Truthfully we have never shot so little insulin so increasing by .2 was no big deal at all :-D
(and we are using a U40 insulin in U100 syringes with the conversion chart so our increments can be smaller) I realize now once we change I will be using U100 insulin in U100 syringes.

Asher has never showed ketones (touch wood), but we do test for them regardless.

The vet told us he is leaving the practice within a month or so. I can contact him buy email for a bit after that. He has followed along with Asher’s numbers all along. I gave him the link to Asher’s spreadsheet and I take him printed copies when I see him in person and we discuss anything. So he is very hip to us testing as much as we do and all of the great things we have learned over the last year and a half at FDMB.

I gave him the info from the stickies on Lev and info from the Lantus stickies and some other research I have found. He was interested in the Lev stuff, but it seems unless he has personal experience or a vet he respects has personal experience with something, he won’t go for it. And in his defense, we chose him because he was cautious, since my last vet insisted on overdosing Asher and yelled at me until I cried when I reduced the dose without her permission. :shock:

The practice he is at now only uses ProZync. So if we stay there, and I doubt we will for any length of time because it is 45 minutes away, the other vets may be iffy with us even using Lantus. I have to be careful there if I do leave tho, because we take my Mom’s cat there and Mom is 83 so I take her and her cat to her vet appointments. I love the staff, just don’t care for one vet there, but there are two others I haven’t met yet. Mom’s cat goes in next week for his once a year deal so maybe I will meet one of the new vets.

I guess I feel I have to make a change with Asher sooner than later. He isn’t in great numbers and hasn’t been the last 6 months. I have a way to change him, and if it is Lantus, well, I guess we will try it. I just want the best for him and with the situation we are in now, I feel I have to do this or we will be waiting more months in bad numbers. There is no way I can interview and pick a vet within the next week or two. We are kind of in a rural area so good vets are few and far between.

Thanks again for your suggestions, I truly appreciate them!
 
Jessica & Boo Radley said:
Vicky & Gandalf (GA) & Murrlin said:
Carl,
BTW, when I mentioned the dose debate I wasn't really referring to this particular thread, but the board as a whole. And I'm sorry I don't have any kind of statistics for you. I just can't provide empirical evidence for each and every recommendation I make. I'm also not here to catalog case studies. I am here to share the knowledge I accumulated while caring for a diabetic cat over 6 years, 4 of which included using Levemir. That seems to be less and less appreciated. .
Click to expand...

We empower the FDA to decide what drugs do and don't do (both human and animal) and they carry this out through rigorous laboratory testing and ultimately clinical trials on hundred and and sometimes thousands of patients. With the FDA's approval, then and only then are drugs deemed both SAFE and EFFECTIVE to use and then and only then can those statistics be used to make claims, make dosage and administration, warnings, cautions, etc.

Not a single insulin in any of these discussions were approved for cats. This means that if anyone is demanding a specific, approved, and labeled protocol to follow - it's completely out of line..... one just doesn't exist. I'll even go further as to say anyone needing that type of info will be waiting a long time as I can't fathom any pharmaceutical company is going to spend hundreds of millions of dollars for an animal indication. Until then, all we have is experience and that is EXACTLY what this board is all about.

Vicky, I don't think it gets said NEARLY enough. Both you and Sheila are priceless and have helped so many of us understand Levemir. Your instincts and experience is our evidence.....and it's truly and genuinely appreciated.
Click to expand...

Thank you, Jessica for the bigger picture. While I am not completely trust worthy of the FDA as some human drugs have come on the market after approval which have proven to cause serious harm and even death to patients, the FDA is the best we have. All the bad drugs get the press, but there are many good ones which help many many more people than the bad ones harm.

And thank you for the thumbs up.

Donna, you are right to be skeptical of starting at .25u. That is too low in Asher's case. I'm sorry the vet wouldn't prescribe Levemir. Lantus has certainly helped a lot of kitties, so he'll be fine.
 
Thanks Vicky, I knew it sounded low, but like I said, this vet has no previous experience with any of the L’s and we chose him because he was cautious, unlike my last bad experience vet nailbite_smile

I value your experience and what you said makes me feel better about the whole thing.

peace all!

:YMHUG:
 
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