Thinking of changing Gilbert's insulin?

[Christy & Gilbert]

Gilbert has been on Lantus for 3 months & is due a new vial soon. His numbers are not where I would like for them to be & I was thinking of trying Levemir? Any thoughts for me & could some of you more experienced diabetic owners look over his SS & see what you think. Thank you so much!

 

[Amy & Papaya (GA)]

Hi Christy! Nice to "meet" you and Gilbert, sorry I don't think I've posted in his condo before!

I don't know how different Levemir would be, hopefully someone else can comment on that, but what I do see is that you're not getting very many midcycle tests. Can you take a look at my spreadsheet for Papaya for a moment? Look at the last couple of months and imagine it without the midcycle numbers. If I only had the preshots her numbers would look TERRIBLE because I wouldn't know that she was actually hitting green pretty much every day. She's super bouncy but she is actually spending a lot of her time in good numbers . . . but without those midcycle tests I wouldn't know that. I probably would think I had to keep increasing but she's actually been going down, down, down in how much insulin she needs.

I think you might be very close to finding a good dose for Gilbert, but the only way to know for sure is to get consistent midcycle tests so you know whether you need to go up or down with the dose. I was looking through some of your older posts, and I know someone suggested that a while ago, I think back in June? I do see on your spreadsheet around June you were getting lots of midcycle tests at different times. The numbers weren't that great back then, but you're at a much higher dose now so it would be really helpful if you could some more tests at various times, and then everybody here can give you some more input on what you might need to do with the dose.

Just my two cents! Sunday is sometimes a rather quiet day on the board so at least this will bump your question back up to the top so more people will see it. Take care!

 

[Amy&TrixieCat]

I agree with Amy...more mid-cycle tests would better tell you how Gilbert is responding. That 59 on 9/1 is definitely noteworthy! Personally, I would have held off on raising his dose after that number. The 552 you got the next morning was most likely a combination of bouncing off that 59 and the skipped shot. Since Lantus dosing is based on the nadir rather than pre-shot values, I would definitely try to see what is happening in the middle of the cycles before changing insulins, or increasing his dose again.

Also, I noticed that you have a lot of late evening shots. When that happens, do you shoot 12 hours later the following morning? Lantus (and Lev, too), definitely likes consistency, in both timing and dose. It would definitely be helpful to note how late you are shooting when you have the late shots. Shooting less than 12 hours after your previous shot is pretty much the same as increasing the dose, and shooting more than 12 hours after your previous shot is the same as decreasing your dose.

Sundays are quieter here, so definitely be patient...hopefully others will chime in soon. Have a great evening!

 

[Sienne and Gabby (GA)]

Lantus and Lev work much the same way. They are both depot type of insulin and the dosing protocol is identical. The biggest difference is that the nadir with Lev is much later than with Lantus. This may be a factor when you consider switching to Lev. I've given a switch some thought for Gabby but it won't work for my schedule.

I do think you need to get some closer to nadir tests. I also think that until you give the Tight Regulation Protocol a fair chance with Lantus, you'll be disappointed with Lev if you opt to not follow the protocol once you switch.

 

[Christy & Gilbert]

Really good info guys...appreciate it! Is nadir for most around +9? Gilbert is a skiddish outdoors boy (he hates it indoors) which makes this all the more difficult. We live in the woods & him & his bubby, Pete, stay in a big dog kennel @ night because of all the coyotes & bobcat. It has been really hot here in Arkansas & I hate to keep them in the pen all day. I have a tarp on 1 side, but I like for them to be able to roam freely for a while & find good shade & cool spots. Once he is out for the day he is impossible to catch until evening when he gets back in the pen & here lately that has been a real process! My late shots have mostly been around 9pm & the mornings are usually 7-7:30, but I do try to get it around 8ish on mornings following late nights. I hope w/ a little cooler weather I can start getting more mid cycle readings. Thanks for explaining a few things to me & I think I will stay w/ Lantus @ the moment. I have had a hard time understanding & processing all this information that goes along w/ having a diabetic cat, but I am trying. Thanks again everyone! You guys are the best.