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Insulin Kinds of insulin, action profiles, use in dogs, where to buy, etc. |
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#1
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Grace,
The Pet diabetes wiki has one case, Molly: http://petdiabetes.wikia.com/wiki/Case:Miss_Molly Molly has been using Levemir for over a year and is having good results. I don't see that Molly's person has left any contact information with the case information. There are a lot of Levemir cases, but the rest are cats, who have a much faster rate of metabolism than either dogs or people. A cat can use NPH as quickly as a person or dog uses R/Neutral. A lot of the cats with wiki cases were switched from Lantus to Levemir with better results for quite a few coming from the Levemir as opposed to the Lantus. http://petdiabetes.wikia.com/wiki/Ca...:Levemir_cases Can suggest that you take a copy of the Rand-Fleeman Lente/NPH/PZI/Levemir protocol and go over it with your vet: http://www.uq.edu.au/ccah/docs/diabetesinfo/link1.pdf Being able to contact Molly's person would help a lot, I know! ![]() This is an older post where we were talking about Levemir: Quote:
![]() Kathy |
#2
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Kathy, thank you for that protocol, I saw it in your previous message about 10 seconds after I posted
![]() I think Patty sent me some info from Peggy (Molly's mom) about diet and the change to Levemir (decreasing effectiveness of the Lantus), but there wasn't too much else there. I know Breanne (Kramer's mom) from CDMB used Levemir once with her dog, and 1U was almost too much. I am a little confused about the post you quoted - it said the 600nmol/cc detemir was equipotent in dogs (but less effective in humans), but now it is formulated as 2400nmol/cc for better efficacy in humans. Is real-world experience showing the 2400nmol forumulation to still be 4x as effective in dogs? I know the protocol says to use the same 0.5U/kg dosing as NPH, but between Kramer and Molly, it seems like it probably is more effective. Grace |
#3
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Grace,
The real world insulin is sold in 2400nmol/cc formulation--four times as potent as the one they classed as equipotent for dogs. They worked with the insulin for years and until they discovered the 2400nmol/cc formulation, it was doing nothing really for people in their testing, and that's the population they intended to market it to. Since you can't dilute either Levemir or Lantus according to both Novo and Sanofi Aventis, I'd say be cautious. You or your vet might want to e-mail Dr. Rand asking about the 0.5 iu/kg starting dose indicated in the protocol: j.rand@uq.edu.au Kathy |
#4
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Sorry for the delay in updates, Rolo and I have been busy with insulin! She's switched over the Levemir now, and seems to be doing very well on it! Her bolus needs have dropped dramatically (from 0.5U to 0.1U) and I'm actually adding in some rice to her meals to keep her stable with the bolus (I can't accurately measure out less than 0.1U otherwise I'd just give her a smaller bolus). Her Levemir seems to be doing fairily well on 0.9U (a smidge under 1.0U), twice daily. 0.75U was not quite enough, and we were only getting 10hrs duration, and 1.0U had her dropping too low by 6hrs. I have a good magnifying eye piece that I use, though I think I will have to look into something even stronger so I can keep her dose consistent. We've had a few rough patches with rebound (on the 1.0U and a larger bolus) and some spikes when the duration of the Levemir ran out, but she seems to be setting in okay now. Fingers crossed that this keeps up!
Grace |
#5
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Grace,
Not sure if you can use this or not; page was written by members of the Feline Diabetes Message Board who've become experts in fine doses by necessity. http://petdiabetes.wikia.com/wiki/Fine_doses http://romlin.com/jock/SyringeFineGradations/ Fine Dose Pictorial Guide What Steve's set up should look quite familiar; his Jock has been on Levemir for a long time. HTH! Kathy |
#6
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Wow Kathy. That's really good info.
And the link that's given to the board on syringe accuracy for those small doses is very interesting to read: http://www.felinediabetes.com/phorum...php?22,1462377 I use BD syringes. I found, for me, they slide better than the Monoject/Relion ones. But I swear the top of the plunger is diagonal sometimes! Glad it's not just me that's seen this. On the romlin.com site, I understand the amount in syringe. For the amount in tip are they talking from the neck of the syringe to the zero line? How do you vary the amount in there besides with an air bubble? I can't see the difference in amount of liquid in this space on the picture. Glad you're working out the kinks Grace. Patty
__________________
Patty and Ali 13.5yrs 47lbs diagnosed May '08 Ali earned her wings October 27, 2012, 4 months after diagnosis of a meningioma ~ Time is precious ~ |
#7
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Patty,
Think you need to ask Steve these questions because he's really VERY good in the "Art of Fine Dosing". When we started working on the Pet Diabetes Wiki in late 2005, Steve was living in Sweden. I understand that since then, he's now in London. The last e-mail address I have for him is this one: http://petdiabetes.wikia.com/wiki/User:Steve_and_Jock steveandjock at petabit dot com. (Done this way to prevent bots from harvesting it.) He hasn't changed the address for sending him diabetes case studies (You can do your own without contacting him.), so I'd believe he's still connected with petabit.com http://petdiabetes.wikia.com/wiki/He...ing_Case_Study Am not seeing anything further in a search of FDMB with "fine doses" so don't think he's added anything more there which isn't on the Fine Doses wiki page. Those who are using either Levemir or Lantus at FDMB have also learned how to get the most "bang for their buck" when buying insulin. With most cats being smaller than dogs, the amount of insulin they use is considerably less and a vial of insulin will lose potency long before they're done with it. So they buy their insulin in cartridge form because each cartridge is good for the expiration date stamped on the package if it's kept according to the maker's specifications and not opened. They draw their fine doses from individual 3ml insulin cartridges, getting the job done and saving quite a bit of money at it; you're not starting a 10ml vial of insulin and tossing most of it out because of potency issues this way. Would give a try to the e-mail address above and see if it's valid. If not, he was last at his Wikipedia Page at the middle of April. You can leave him a message there by using the "Discussion" tab. http://en.wikipedia.org/wiki/User:Steverapaport Kathy |
#8
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Alright, after practicing for a looooong time last night with an old syringe and a bowl of water, I think I've mastered the microdoses. I successfully found a droplet size that is about 1/20th of a unit. I did it over and over (and over and over...) and consistently got 19-22 drops per unit. Rolo got 0.9U Levemir this morning, and 0.2U of the NovoRapid. It really feels like I'm giving her nothing when I push the plunger down but her BG numbers say otherwise. I feel much better about this - I tried to give 0.9U yesterday eyeballing it, but she was high 200s all day, and the duration was only 10-11hrs, so I know she got more like 0.75U. I've had to toss some of my syringes - for most of them, the plunger lines up well with the 0 line, but there are some that are crooked or have extra room above the 0 line, and given our tiny doses, they are obviously not going to be accurate enough. Hopefully we will start having more even numbers now that the doses are more accurate.
Grace |
#9
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I did try it with the Levemir this morning, and got the same size drop. I am thinking that as long as it is the same droplet size, it doesn't matter if it's insulin or water, it should be the same volume.
The drop I made was tiny, tiny, tiny! Maybe 3x the width of the needle, only. I tried to eyeball it yesterday, but it obviously didn't work out as planned. I played with the syringe for over an hour yesterday, lining up the plunger with a 1/2U mark, then just repeating the drops over and over. If I was using NPH I wouldn't go with such a tiny drop, but with the Levemir, i really think it makes a difference. 1/20th of a unit is about 1/5th of a NPH unit, so that's a big jump, really. I was doing 1/4U changes for Rolo and they were almost too big. Rolo's going to my mom's for a whole month in July while I am on vacation, so she's going to have to get really good at measuring that drop. I'll make her practice and grade her!! I am actually hoping Rolo needs 1U exactly, then i wouldn't have to do any droplets, but it's not really that big of an issue. Grace |
#10
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Just thought I would update everyone on Rolo. She is doing well with no change in insulin. I'm giving her 35g rice with every meal, which leaves me with a tiny rise 2hrs after eating (about 20-30 points) on 0.2U NovoRapid. When she gets more reguated I might decrease the rice a bit, but it's fine for now (I l like having some wiggle room while we continue to increase the Levemir).
Blood sugars yesterday were 227 at fasting, 209 @ 5hrs, 216 @ 10hrs, but then 362 @ 12hs. I have no idea why she gets that big jump between 10 and 12 hours, and it's definitely not the first time it's happened. She does get a small snack at 5:15 when I get home from work (tiny piece chicken jerky and a few green beans), same snack that she gets at lunch. She didn't want her green beans yesterday, so if it's anything, it's the chicken causing her to spike. Otherwise, we're just not getting 12hrs duration out of our daytime dose (though she does fine overnight and we have good morning fastings). I'm going to do a curve on Saturday (day 5 of the same doses) and leave out her evening snack to see if it's the snack or lack of duration causing the spike. If it's the snack, she'll just have to deal with green beans only. If it's duration, I'm not going to worry too much now since she'll probably need an increase in the Levemir anyway and that might increase her duration. When she gets to the right Levemir dose, if she still has duration problems, I will move up her dinner and adjust her NovoRapid dose so the bolus covers the gap (so 7:30am: breakfast, NovoRapid, Levemir; 5:30pm: dinner, NovoRapid; 7:30pm: Levemir). Or, I could go with breakfast/NovoRapid/Levemir at 7:30am and dinner/NovoRapid/Levemir @ 6:30pm if I am getting >12hrs with the evening dose and at least 11 with the daytime. Does that sound like reasonable plan? I'm really happy with the Levemir otherwise, I'm seeing some real consistency that we've never had before. Grace |
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