What should we expect?

Meridith and Zeke

Meridith and Zeke

Very Active Member
Currently Zeke is on Lev but we are going to do a switch to Tresiba and see if we can finally get him staying in the blues and greens.

I have been looking through the posts, and obviously there isn't many of us yet on this insulin, so is this just gonna be a play it by ear experience? I figure since it is listed as a depot insulin that protocols would be similar to Levemir and Lantus. Right?

What should we expect?

Between my daughter and I, we can test when ever and how often we need and always keep hypo supplies on hand.

Thanks for all help and info we can get.
 
Ok, when I click on Zeke's SS link it takes me to the tab labeled Zeke 2020, but all the dates on there say 2017.

What's up?
 
Rofl, I must have forgotten to update the year when I made my 2020 tab. :)

Fixed now. Thanks for pointing that out.

Btw, we have paper sheets that we list numbers on throughout the week and enter them on the Google SS when that sheet is filled.
 
Thanks, just wanted to make sure I was looking at the correct data.

Not sure we have anyone left on the message board that uses Tresiba. Sam & Esse where the last members to use Tresiba, and Sam went OTJ in July 2019.

Jessica & Conan before that. Only a handful of people.

You might want to ask over in the Lantus/Levimir forum if someone has experience with Tresiba.

Taking a quick look at Zeke's SS, it doesn't look that bad.
There were a couple of reductions you missed. 2/11, 2/13, 2/21.
Does Zeke not hold his reductions well? Is that why you did not reduce on those dates?
 
Deb & Wink said:
Thanks, just wanted to make sure I was looking at the correct data.

Not sure we have anyone left on the message board that uses Tresiba. Sam & Esse where the last members to use Tresiba, and Sam went OTJ in July 2019.

Jessica & Conan before that. Only a handful of people.

You might want to ask over in the Lantus/Levimir forum if someone has experience with Tresiba.

Taking a quick look at Zeke's SS, it doesn't look that bad.
There were a couple of reductions you missed. 2/11, 2/13, 2/21.
Does Zeke not hold his reductions well? Is that why you did not reduce on those dates?
Click to expand...

Thanks, I will ask over there in the morning.

Yes, he doesn't hold them very well so we wait til his 3rd 30's number before we reduce. Otherwise he flies high. I know we could regulate better if we could do a scheduled feeding, but we have a cat (Max aka Fatboy) that would destroy the house if we withheld food. Believe me, we have tried! Nothing is safe from him, if it moves and isn't on the floor, he will knock it off until we finally give him food.
 
I can't recall anyone on the LBL forum who would be there now that has Tresiba experience, so I doubt you'll get responses there. As for what you are doing currently, I'm a little worried about you waiting until the 3rd under 30's before reducing, given how many times your first test after preshot is in the 30's. Who knows where he was before that.

I wouldn't count on the same dosing methods working for Tresiba. Sounds like it has a later nadir and longer duration. Have you searched FDMB for both Tresiba and Degludec? There have been a few discussions so far.
 
Hi Meridith! @Meridith and Zeke :D

It's so exciting that another kitty is going to be trying Tresiba! Looking at his spreadsheet, Zeke is a bouncy boy. Hopefully Tresiba will level out those numbers.

I can only speak about Sam and mine's experience with Tresiba, and what held true for Sam might not for another cat ;) But it would certainly make things easier if it did lol!

Firstly, I started Sam on a token dose, just in case of any allergic reaction. I fast-tracked his increases sooner than would be recommended over on the L,B&L ISG. :blackeye: Honestly, those first 2 weeks on Tresiba, it seemed like I was injecting him with bactine-scented water. It could be because of the rapid dose changes, or that I started too low, or that it took two weeks instead of the usual 6 days (for Lantus and Lev) for the depot to fill. If I recall correctly, when Jessica switched Conan to BID dosing, they encountered the same 2 week stall/treading water phenomenon. Not fun at all. If the two week lag is something usual with Tresiba, I would be hesitant to ever recommend it for a cat with a history of DKA/ketones.

Second, if Zeke ends up following close to the same pattern as Sam... you'll always be shooting low numbers. I was not able to do the testing to back up my intuition, but my belief is that instead of having a smily-curve, Sam had what I called his Tresiba 'pout'. Near or at his nadir at pre-shot, a very gradual climb for the next nine hours, then a drop back down to nadir in time for his next pre-shot. Feeding him at +9 to +10 usually helped lower his pre-shot by 10-20 points as well. But I want to stress, it took time for this pattern to emerge. Once he got there, though, he really stopped throwing me surprise numbers :rolleyes: It could be argued that I didn't catch low numbers because I wasn't testing, though.

Third -- please rethink setting Zeke's reduction point at 3x in the 30s once he starts Tresiba. My gut feeling is that Tresiba creates a huge, lurking depot that no one has the experience to understand right now. Sure, Tresiba is supposed to help prevent hypo episodes :bookworm: But once you get into that low-number territory? I'm afraid there's a monster depot only too happy to *keep* those numbers pushed down. Personally, I have a great fear of asymptomatic "low number events". There's been current research claiming that brain damage is being done even if there are no noticeable symptoms of hypo -- so why take a chance? When using the AT2 I kept Sam's reduction point at 67 -- except once, because I could tell he wasn't ready for a reduction yet. When I switched to the Arkray, I rather 'upped' his reduction point to below 60 -- not only because with my lack of testing I might have missed a lower number at +11 or +1, but because I wasn't willing to take a chance with the depot.

:eek: The depot... Don't assume that skipping a shot will "drain the depot". You might notice the results of a skipped shot, oh, say a week later :p Because Tresiba works by constantly breaking off from the ends of its 'strands', I don't feel that its depot is as subject to variability as Lantus or Lev. It's sorta hard-core time-released... I thought of it as, I'm not shooting just this morning, I'm shooting all of today, tomorrow, and the rest of the week. And that single shot will be releasing the exact same amount of insulin on each of those days.

A big plus, I loved drawing Sam's dose of Tresiba. I don't have much strength in my hands, so there was always a little air bubble in the syringe. However, a small tap on the syringe always moved the bubble to the top of the syringe -- and it never split! I know the Tresiba strands are microscopic, but I'd swear that Tresiba loved sticking to itself so much, it would never let air split it apart lol!

So, in conclusion... don't freak if you don't see any improvement in Zeke's numbers the first two weeks. :nailbiting: Maybe freak if you don't see improvement after 3? During the transition time while the Tresiba depot builds, get ketone tests! Just in case. Give serious consideration to raising Zeke's earned decrease point; until you know how he responds to Tresiba, you might want to lower dose the first time he goes under 50. In a month or two, if he still fails reductions, then you might consider only lowering if he goes below 50 three times, or below 40 once.

:bighug: I'm always constantly lurking on FDMB :cat: So if you have any questions, or ideas, or whatever, feel free to ask! It might take me a bit to write back. It takes me a lot longer to write than it used to, and I might not always be clear :oops: Just let me know I wasn't entirely clear, and I'll try again :cat:
 
Wendy&Neko said:
I can't recall anyone on the LBL forum who would be there now that has Tresiba experience, so I doubt you'll get responses there. As for what you are doing currently, I'm a little worried about you waiting until the 3rd under 30's before reducing, given how many times your first test after preshot is in the 30's. Who knows where he was before that.

I wouldn't count on the same dosing methods working for Tresiba. Sounds like it has a later nadir and longer duration. Have you searched FDMB for both Tresiba and Degludec? There have been a few discussions so far.
Click to expand...

I will be doing the searches today. The reason for the waiting is because of how Zeke handles reductions. At +6 he is dropping, so before then, he would have been higher. That is why we chose +6 to be our first test after his shot. Depending on how low the preshot was determines if we need to do a +3. He has been on Lev long enough that we know how it does with his numbers. Every time we have reduced the first time we see a 30's number, we would have to chalk it up to a failed reduction and often times he would start staying even higher. So we wait and see if he is going to keep doing the 30's and then we reduce. We won't be doing this when it comes to the Tresiba since it is new to him. :)

Sam & Esse said:
So, in conclusion... don't freak if you don't see any improvement in Zeke's numbers the first two weeks. :nailbiting: Maybe freak if you don't see improvement after 3? During the transition time while the Tresiba depot builds, get ketone tests! Just in case. Give serious consideration to raising Zeke's earned decrease point; until you know how he responds to Tresiba, you might want to lower dose the first time he goes under 50. In a month or two, if he still fails reductions, then you might consider only lowering if he goes below 50 three times, or below 40 once.
Click to expand...

Thank you for the response! And great info also.

I will definitely be doing more like a newbie when it comes to the reduction numbers etc. with the Tresiba like you mentioned. We are only able to be that way with the Lev due to the experience with him on Lev. I think it was your post where you were talking about the bounces doing so much better that helped sway our decision to try it. My daughter jokes that Zeke is her "bouncing baby boy" because of his bounces lol. We would love to have him staying in better numbers. Frustrating that even after this long we still see so many pinks thanks to bounces etc. Luckily my daughter and I can swing it so we can test how ever often we need so we will learn how he does with it. Probably spend the first few weeks testing every 3 hours until we get a better feel for it. I will be posting daily here in the forum too. I will defiantly be watching his ketones when we start. I have one of the blood test kits for ketones since catching pee is much harder to do now that we are using covered litter boxes.

Excited to try a new insulin with Zeke, but definitely nervous too since there is much less info here then compared to the other insulins we commonly use for our sweet kitties.
 
Been reading through some info. Though most seems to show that Tresiba is best for twice a day, it can be only once a day for some kitties. So thinking it will probably be safer to start with once a day dosing and see how it does for him, in case he is one of the few who can do only once a day.
 
Thank you. Been looking over both Sam's and Conan's info since they are the only 2 here that I have seen info on so far. We have been at this for almost 3 years with Zeke so ready for him to finally level out. We adopted a steroid induced kitty last summer and was able to get him into remission within 2 months of getting him. Before Mr. Kitty came along, I was starting to worry that I was just missing something or doing something wrong with Zeke since he wouldn't ever get very stabilized in numbers. We call him the bounce king and my daughters "bouncing baby boy" lol.
 
Do you know how to tag someone? Sam & Esse said they would help, but are not on often. So tagging them would be the best way to get their attention.

To tag someone, it's the @ symbol followed directly by their user name. The more you start typing after the @ symbol, the shorter the list grows of matching names.

p.s. There may be quite a few folks lurking here. To see how things go with Zeke on his Tresiba journey.
 
Hi Meridith :)

Meridith and Zeke said:
I will definitely be doing more like a newbie when it comes to the reduction numbers etc. with the Tresiba like you mentioned. We are only able to be that way with the Lev due to the experience with him on Lev. I think it was your post where you were talking about the bounces doing so much better that helped sway our decision to try it. My daughter jokes that Zeke is her "bouncing baby boy" because of his bounces lol. We would love to have him staying in better numbers. Frustrating that even after this long we still see so many pinks thanks to bounces etc. Luckily my daughter and I can swing it so we can test how ever often we need so we will learn how he does with it. Probably spend the first few weeks testing every 3 hours until we get a better feel for it. I will be posting daily here in the forum too. I will defiantly be watching his ketones when we start. I have one of the blood test kits for ketones since catching pee is much harder to do now that we are using covered litter boxes.
Click to expand...

So glad to hear you'll be resetting to newbie reductions when you first switch over :D Although I'd used Prozinc and Lev with Sam, using Tresiba felt like a whole different beast -- like dealing with a cryptid that snuck in through the doggy door ;) For Sam, the Tresiba put the brakes on his bouncing, hard. Cheryl noted that Tresiba had the same affect on her Yoda; it's a shame she never shared his spreadsheet. Conan still had quite a bit of movement, but there was significant improvement. I think that for any cat that can't be regulated on the more usual insulins, Tresiba is worth a shot. The caregiver just has to be used to making their own dosing decisions, and have a very good understanding of all the different insulin protocols and methods, because there's really no dosing advice to be had in the Tresiba ISG :joyful: It can be a lonely place.

Meridith and Zeke said:
Been reading through some info. Though most seems to show that Tresiba is best for twice a day, it can be only once a day for some kitties. So thinking it will probably be safer to start with once a day dosing and see how it does for him, in case he is one of the few who can do only once a day.
Click to expand...

My memory isn't quite what it used to be, but from what I recall it was only one or two kitties in the German group that were able to regulate on once a day dosing. I think it's fine to start at once a day, but if you're noticing it's not lasting long enough don't hesitate to go back to twice a day. Conan started on once a day, and the odd thing is -- his spreadsheet shows the insulin bringing his BG down, then wearing off. So I have no idea why the switch to BID causes that two week 'Why aren't you working, you stupid insulin?!' period. I have my fingers crossed that Zeke will skip past that part :)

Hi Kat :)

SnowKat said:
Absolutely fascinating stuff. It's amazing the improvement Sam experienced on Tresiba.
Click to expand...

I'm always grateful Sam finally responded properly to an insulin. I figure, if a cat doesn't respond well to one insulin after giving it a fair go, there's no reason not to try another lol!
 
Deb & Wink said:
Do you know how to tag someone? Sam & Esse said they would help, but are not on often. So tagging them would be the best way to get their attention.

To tag someone, it's the @ symbol followed directly by their user name. The more you start typing after the @ symbol, the shorter the list grows of matching names.

p.s. There may be quite a few folks lurking here. To see how things go with Zeke on his Tresiba journey.
Click to expand...

Thank you. I do know how to tag though, just been a long time since I was on the board regularly since we have been on Lev for so long now.


Sam & Esse said:
My memory isn't quite what it used to be, but from what I recall it was only one or two kitties in the German group that were able to regulate on once a day dosing. I think it's fine to start at once a day, but if you're noticing it's not lasting long enough don't hesitate to go back to twice a day. Conan started on once a day, and the odd thing is -- his spreadsheet shows the insulin bringing his BG down, then wearing off. So I have no idea why the switch to BID causes that two week 'Why aren't you working, you stupid insulin?!' period. I have my fingers crossed that Zeke will skip past that part :)
Click to expand...

I have learned that nothing is normal with Zeke. :smuggrin: That's why we are gonna go safe with the once a day at first. I have no problem doing raises as needed though and Zeke has always seemed to want a little longer for settling into a dose, so gonna be an interesting experience!
 
Hi all. It’s been a long time since I posted. But I wanted to update since I saw us mentioned in the post above. I am sorry I never posted Yoda’s numbers, but I am pretty computer illiterate, and I could just never get the spreadsheet to work right. Yoda is still on Tresiba. But what I have noticed now that she has been on it a couple years is that the very stable numbers only come within the first 10 days to two weeks of a freshly opened pen. As the pen ages, she starts to bounce more. But I cannot buy a new pen every two weeks. I have given up on trying to level her bounces with the Tresiba alone. I have very little tolerance for allowing her to stay too long over the renal threshold. Perhaps that is because I am a nurse, and in humans, you don’t allow them to sit high for days, let alone weeks. I rarely even allow her to sit that high for hours. She has been diabetic for 4 years now, and I am way over slow changes in doses that allow her to sit high for any length of time.

I began adding Humalog (Lispro) to my toolbox with her. Humalog is a rapid acting insulin. It starts to lower her in about 30 minutes, and is usually out of her system in 5-6 hours. At first, her nadir on the Humalog would hit at about 2.5 hours, and it was out of her system in 4 hours. But after more than a year of using it, her Nadir now seems to come at 4-5 hours. But it might just be that that is because her Tresiba is really starting to kick in in addition to the effects of the Humalog at that time, or perhaps it happens because I will keep and use my Humalog pen for several months instead of buying a new one every month. After being on the Tresiba for so long now, her nadir on just the Tresiba frequently seems to come at around 12 hours, but then she rises fast. Usually, if she is over 280, or over 230 and rising, and I will be home most of the day to monitor her, I will give her the Humalog. 0.25 units if she is still in the high 200’s, JAD if the low 200’s, and 0.25-0.5 units if she hits the 300’s (based on my gut feeling of what she needs), and if she hits the 400’s (which is extremely rare, but did happen with her anal gland infection), then she definitely gets 0.5 units of Humalog plus a 0.25 unit increase in her Tresiba dose. Her usual Tresiba dose runs 0.75units or 1 unit. I have trouble keeping her at one dose or the other for long, because if she stays at 0.75 units for several days, she will usually start to go too high. And if she gets more than 1 or 2 doses of 1 unit, she goes too low (40’s, and rarely the 30’s). She gets the Humalog 1-3 times a week, depending. Sometimes she is more stable than other times, and there seems to be no rhyme or reason to it. I do know that if she hits the 40’s, she will bounce too high (200’s, and if I don’t chase her down right away out of the 200’s, she can hit the 300’s) her next insulin cycle.

I also have given up on trying to do fats and skinnies. Let’s face it, if I am giving approximately 0.75 units, it is really just a guess at what dose I am really giving since there are no markings on the syringe at that dose. It could be anywhere from 0.6 to 0.9 units. Plus, every syringe brand I have ever tried has a scale that fluctuates from syringe to syringe and box to box by at least a fat/skinny. You know how the zero line isn’t always at the true zero point on many of the syringes? Well I finally had one syringe manufacturer admit to me that the FDA allows a 0.3 unit fluctuation in the accuracy of where the scale is stamped onto the syringe. That can make a huge difference in the kitty’s resulting BG. So sometimes, even if I am trying to give one unit, if the scale is off at all, I have to try to eyeball where one unit would actually be. So maybe Yoda bounces so much because she never truly gets a steady dose. She is very sensitive to the slightest fluctuations in dose. Maybe someday, if they ever invent a pen that can accurately automatically give doses in the 0.5 to 1 unit range, so we don’t have to do it manually, then maybe we will find that the kitties don’t bounce so much. (By the way, I have tried the caliper thing, and the measurements at 0.75 units to 1 unit are just too small for my aging eyes to be able to see and accurately mark the syringes, and my hand is just not steady enough to get that minutely accurate).

All that being said, Yoda is mostly doing well on the Tresiba with the occasional Humalog dose. She bounces regularly, and I chase her, but overall her doses remain very low, and she mostly stays less than 180. And she still is doing better than she ever did on the Lantus or Levemir. Therefore, I am glad we switched to Tresiba. And, after 4 years of being diabetic, I think all hopes of remission are gone. So I just try to give her whatever amount of insulin she needs, when she needs it, I monitor her BG’s 4-7 times a day most days, and I don’t worry about it.

I am considering trying the Freestyle Libre continuous monitoring system with Yoda since my vet has started using it with some success, just to see if I can get her more stable, but it is so expensive for the vet to monitor it (the actual supplies are not that expensive, but for the vet to monitor it, it is). And, according to my vet, it continuously reads 20-40 points lower than the actual BG, because it is monitoring interstitial glucose levels (levels of glucose in the fluids between the cells), not actual glucose levels in the blood. So I would still have to poke Yoda’s ears several times a day to see how accurate it is. Plus, it supposedly doesn’t read if it detects levels below 60. Well, if it already reads 20-40 points low, that could mean it potentially doesn’t give a reading if her BG is really 80-90. And our kitties are frequently in that range, so that would mean still a lot of blind time where I am still having to rely on ear sticks to know where her BG is. So I am still debating about trying it. If anyone has experience with using the Freestyle Libre system, I would love to hear about it.

In the meantime, I wish the best to all of you with your beloved sugar babies!
 
Thanks for the update @Cheryl and Yoda You are the first one here to use a bolus with a Tresiba so interesting to see how it works.

Also very interesting that you got a manufacturer to admit there can be a 0.3 unit fluctuation in the stamped scale on the syringe! I think many of us have found there is easily that much difference on some. Which is why some of us are now using digital calipers to measure the dose. It helps with fattening and skinnying the dose too. More info here if you are interested.
 
You must log in or register to reply here.
Back
Top