Tresiba starting dose…?

[Angela Horton]

Hello
With Levemir being discontinued and MoMo deciding that she wanted to reduce her dose by 2/3 I’m now looking at Tresiba rather than Toujeo for her. She is an acro cat who is responding well to Cabergoline. Her current Levemir dose is 2.31 units, down from 6.75 in November 2025. What do you suggest her starting dose should be and as much as ECID what is the average nadir for a cat in Tresiba?
Thank you for your help with this as I believe we will again be the first client at our vets practice to be on Tresiba…

Link to Excel SS here https://1drv.ms/x/c/af00ac982d34d7ab/IQCr1zQtmKwAIICvSGUGAAAAAQXgCMLdegNfcUnlEHS1oDE

 

[squeem3]

@Wendy&Neko

 

[Wendy&Neko]

Sorry, not really sure what to suggest. We normally say that when switching from one depot insulin to the other, you start the new one at about 70% of the dose of the previous one. But we don't have a lot of data points.

If you look at Luci's SS, 9/03/20, you'll see what happened when she went from Levemir to Tresiba. Sam's SS on 5/13/2018 shows a similar switch.

 

[Wendy&Neko]

Adding to above, Luci was switched back to Levemir cause Tresiba wasn't a lot different, then back to Lantus this year.

 

[Angela Horton]

Sorry, not really sure what to suggest. We normally say that when switching from one depot insulin to the other, you start the new one at about 70% of the dose of the previous one. But we don't have a lot of data points.

If you look at Luci's SS, 9/30/20, you'll see what

happened when she went from Levemir to Tresiba. Sam's SS on 5/13/2018 shows a similar switch.

Starting doses particularly with Sam seem to change quite quickly. Is that common for Tresiba? Do you not need to hold a dose for 7-10 days?

As a rough guide you’re saying the starting dose should be 70% of 2.31? Approximately 1.617?

 

[Wendy&Neko]

Starting doses particularly with Sam seem to change quite quickly. Is that common for Tresiba?

I don't have experience with Tresiba so can't answer that question. Just remember that as you transition, the depot of Levemir will still be influencing the first few days of Tresiba. Meaning that you need to spend some time at the starting dose to see what the Tresiba by itself will do. Unless you are seeing high numbers all the time. Which might have been why Sam's caregiver increased sooner. We don't typically hold a dose any longer than 7 days. And less than that if following Tight Regulation for dosing.

A comment about the Levemir dosing with an acrocat. Don't hold doses as long as you have. If she's not seeing numbers under 200 after 6 cycles, you need to increase. Also, full 0.25 unit increases are best at this size of dose. I'm also not sure when you decide you need to decrease the dose. With our more conservative dosing method, it's when kitty goes under 90 and I don't see her anywhere near that.

 

[Angela Horton]

I don't have experience with Tresiba so can't answer that question. Just remember that as you transition, the depot of Levemir will still be influencing the first few days of Tresiba. Meaning that you need to spend some time at the starting dose to see what the Tresiba by itself will do. Unless you are seeing high numbers all the time. Which might have been why Sam's caregiver increased sooner. We don't typically hold a dose any longer than 7 days. And less than that if following Tight Regulation for dosing.

A comment about the Levemir dosing with an acrocat. Don't hold doses as long as you have. If she's not seeing numbers under 200 after 6 cycles, you need to increase. Also, full 0.25 unit increases are best at this size of dose. I'm also not sure when you decide you need to decrease the dose. With our more conservative dosing method, it's when kitty goes under 90 and I don't see her anywhere near that.

Interesting about how long I’m holding doses for as if you look at her SS you’ll see she tends to settle into a dose after around four weeks. I decreased her dose on 30 March when she gave me a low AMPS and popped it back up on 9 May when there hadn’t been much improvement on the lower dose.

Your increasing doses sooner than around 10 days for a depot insulin is different to the advice I have received on other forums. I’m still waiting to hear back from there.

Following her vet visit on Wednesday the heart murmur of one that she had has now increased to three out of six so this is something else I’ll need to address. We’re going to move her to Tresiba in the next 6-8 weeks.

 

[Wendy&Neko]

There is someone trying to find a home for Levemir on the Supply Closet Forum here, should you wish to stay on it a little longer.

 

[Wendy&Neko]

you’ll see she tends to settle into a dose after around four weeks.

In the mean time she's in a lot of higher numbers. My cat would start to see glucose toxicity if she stayed more than 5 days in higher numbers, I had to keep on top of increases. Especially with acromegaly where the tumour can start ramping up in a short period of time. Neko also had IAA, a complicating factor.

We don't use the preshot values to determine how to change, but rather the nadirs. In some Levemir cats that can occur around PS time.

Are you planning to get an echocardiogram? A good idea with a acro kitty.

 

[Angela Horton]

There is someone trying to find a home for Levemir on the Supply Closet Forum here, should you wish to stay on it a little longer.

If it’s the same post I saw, they’re US based aren’t they and I’m not sure if posting it to the UK would be viable?

 

[Angela Horton]

In the mean time she's in a lot of higher numbers. My cat would start to see glucose toxicity if she stayed more than 5 days in higher numbers, I had to keep on top of increases. Especially with acromegaly where the tumour can start ramping up in a short period of time. Neko also had IAA, a complicating factor.

We don't use the preshot values to determine how to change, but rather the nadirs. In some Levemir cats that can occur around PS time.

Are you planning to get an echocardiogram? A good idea with a acro kitty.

 

[Angela Horton]

I appreciate that. Today when I was considering an increase she gave me a lower PMPS. So I held off. But it’s on my list to review.

Yes, an echocardiogram is on our list to sort when the cardiologist next visits the vet practice.

Tbh I’ve not been as in top of it all as I normally am following her vet visit on Wednesday as I found out that my oldest friends partner passed away unexpectedly the day before and I’ve been supporting her and my second diabetic cat had just finished a pancreatitis flare up and then had a suspected IBS flare up on Friday so I’ve been managing that as well. I plan to look at both cats tomorrow and get back on top of it and email their vet.