Hi Bridget,
Not visited before, I've been AWOL of the board for a bit.
You have had some excellent advice from a number of folk. I agree that taking the dose back to 0.5u would be a Huge mistake. Smudge is stuck in some pretty ugly numbers, and I agree with your thoughts on where his dose is likely to end up.
The issue with taking him down to 0.5u and going slow, is that you are going to see him stuck in these nasty numbers for far too long, and with ketones popping up here and there, it wouldn't take much for DKA to rear it's ugly head. A mild UTI/tooth infection/ appy goes off and before you know it you are facing an uphill struggle and an emergency situation.
Frankly DKA worries me more than a hypo. And starting at 3-4u of Lev, given the data you have diligently collected, is not going to end up with Smudge having a hypo event.
As Wendy has said, sometimes a swap of insulin can see a stronger reaction, but given that you did not experience that before when you swapped, it seems less likely in Smudges case.
None the less, doing the swap when you can monitor closely for the first few cycles is recommendable.
I'm not sure how best you can discuss the dosing with your vet. I basically didn't take any dosing advice from my vet when I started Lantus, she hadn't used it before, she did trust me, and trusted I had done my research. So I think when you next discuss it with her you need to show her that you have done your research, reassure her that you are not being blasé about the dosing and that you are going to keep a very close eye on Smudge and that you have plenty of support from experienced Lev users. Talk to her about the risks that Smudge is facing at the moment stuck in these hi numbers, how dialling back the dose to 0.5u (this is the starting dose fore SLGS for a cat that has never had insulin/not the case for smudge) does not seem reasonable, you need to look at the data you've got, show her the swap from vetsulin to prozinc, how dialling back then back the dose then, did Smudge no favours, his numbers have been worse on these lower doses of Prozinc.
At the end of the day you hold the syringe, and you can decide on the dose, some folk here have taken the nod and smile approach and done what they thought best, that wasn't me I preferred to work with my vet. Ultimately I think it depends on your vet and your relationship with them on how best to handle them.
I would say that whenever I have seen folk dial back the dose dramatically when swapping insulin it's a
waste of precious time at best, and at worst a medical emergency.
I chose to do TR, George had pretty ugly numbers when we started too, never threw any ketones, he was always negative. My reasoning for TR was that I wanted to get him quickly and safely into a normal range as this was going to protect his organs and keep him healthy. It was also going to give him the best chance of remission, but I have to say I didn't dare let myself think about that at the start, I just wanted to see healthy numbers.
I can tell you after weeks of reds and blacks the first time I saw a blue I was a nervous wreck, though it turned out to be a non event.
To do TR with Lev, you would have to scrap the dry (Yes even the LC dry/sounds like he's not fussed by it, clever kitty, he knows wet food is better for him
) In your situation I would consider TR, at least until you start seeing better numbers, if you then want to ease of and SLGS, you can always start taking a slower approach if your nerves can't deal with TR. But honestly, you will find that once you start seeing blues and greens, those pretty colours on your SS will become quite addictive.
I wanted to say that with Lev and Lantus, you usually get a warning that the numbers are going to start coming down. Whenever you change the dose, you will not usually, see thefull effect of it for a few cycles, the effect of the dose builds slowly as the depot grows and stabilises. Both dosing methods, give you enough time to assess the dose before you change, and in the begining you will have a lot of support from a lot of folk, the Lantus and Lev forum is very active. The depot is really going to be your friend, and you will grow to love it once you can wrap your head round it. It is what contributes to those flat curves that Lantus and especially Lev are so renowned for. Enlisting your DH will be very useful, it will give you peace of mind when you are out of work (I was the main CG/ but DH did his bit too), I would try to get him trained up asap, be ready for Smudge to behave differently for him, George sits calmly across my lap when I test him, but gets up to all sorts of shenanigans when it's someone else
.
