Time to return to Lantus?

[Melissa and Celle]

I'm losing faith that we'll ever get Levemir to work. She can't seem to hold any low value with Levemir for more than 2-3 hours. Is it likely that this is due to a change in her tolerance for low values that would be replicated if we went back to Lantus or is it likely just the reaction she has to Levemir?

I think now that our problem there was only dealing in 0.5 unit increments so we could never find a dose that worked. Here is here data from Lantus:

https://spreadsheets.google.com/spreads ... utput=html

Obviously we weren't testing very often and so we shot pretty much no matter what her pre-shot value was on the theory that we were usually shooting blind anyway. I realize that testing so infrequently was pretty risky.

To understand our dose changes, our goal was to find a dose that kept her above 100. I didn't want to have to keep getting up in the middle of the night or worrying every day that I went to work. (This is still my goal.)

 

[Vicky & Gandalf (GA) & Murrlin]

Well, considering how poorly she's done on these lower doses of Levemir, even with the infection involved, she probably just needs more insulin, whether that is Levemir or Lantus, the protocol for increasing dose is going to be the same, so I really don't see a good reason to go back to Lantus.

I know that increasing the dose is Pamela's opinion and she has done very well for Tigger by increasing his doses systematically, as the Tilly protocol does.

You may very well be right about how large the dose increases were on Lantus. But I noted that she began to do better at 4U, so even those increases changed something.

The Tilly protocol works, that's been proven. But because we also know it does not work well for some cats, we want to rule out that doses above 1U are too high first. I think you've pretty much proven that less than 1U does not work for Celle.

So now the dose needs to raised systematically. Tilly would actually call for .5U increase with the nadirs you've gotten the past 2 days. If you're not comfortable with that much, then increase to .25U. Smaller increases should help you find a dose which works. But you have to be systematic about increases - increase the same amount, re-evaluate at 3 days and if nadir is still above 300, increase again. 5 days would be the most amount of time to wait between increases, but if you're only able to test to get nadirs on the weekends, then we re-evaluate the increase every weekend.

How does that sound? Remember, it's easy to get concerned over 1 BG number. Like why she's dropping at +3. But that is one value. The rest of the cycle is way high but the low number is not low enough to have caused a rebound. We sometimes see what we call previous dose "sign off" at about +3 for some cats. But because she goes high after that it means the new dose is not enough to maintain that kick.

So please consider raising the dose in small but consistent manner, rather than going back to Lantus. The method of determining dose would be the same on it anyway.

Hope that helps ease your mind. I see no reason Levemir can't work as well as Lantus for Celle.