Hello! Rolo and I are new here.

[grace.device]

Re: Hello! Rolo and I are new here.

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

[grace.device]

Re: Hello! Rolo and I are new here.

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

[k9diabetes]

Re: Hello! Rolo and I are new here.

It sounds like you added rice to give the bolus insulin something to do... is that right? If so, does she need bolus insulin at all?

Those plans should work - will be interesting to see what the curve says.

Natalie

[grace.device]

Re: Hello! Rolo and I are new here.

Natalie, I have no idea what happened with our bolus. When she was on the Lanuts, 0.5U NovoRapid was perfect, and kept her steady over 4hrs. Once I switched to the Levemir, she's needed so much less! I dropped her to 0.25U, then about 0.1U, and without the rice, she was still going down 50-100pts over 2hrs, then back to fasting levels. I figured the same thing, that the Levemir must have a strong onset, and she didn't need a bolus. I tried one night without the NovoRapid and she shot up about 150pts in 2hrs! So we went back to 0.2U (bottom of the 0 line, so easy to measure) and I am adjusting the rice to match that amount. I can't for the life of me figure out why she has such different bolus needs now.

Grace

[We Hope]

Re: Hello! Rolo and I are new here.

Grace,

What's said when you talk about Lantus vs Levemir is that Levemir has more consistency in both the same patient and from patient to patient than Lantus does.

There's also the way each one does its job. Lantus forms crystals under the skin and after that, they absorb very similarly to the way the rest of the suspended insulins do--by the crystals being absorbed gradually. Levemir's action is to bind to the albumin in the blood to produce its effect, so there's nothing to "break down", if you will, as in Lantus and the suspended insulins.

With Levemir, there's no waiting for any crystals, whether they're in the vial and injected or are formed under it after injection by the reaction between Lantus and the pH of the skin. Levemir's "suspension" takes place in the bloodstream, with the binding to the albumin in the blood.

Some people put the knock on Levemir because it's approved for being used once or twice a day, depending on the patient's needs. Lantus is approved for once daily use. But when you talk with people who use Lantus, it becomes clear that many of them didn't work out with once daily dosing; they're on twice daily split dosing, which would be considered "off label" (nothing wrong about using a drug off label). Have a friend who has been using it twice a day for a long time--once daily didn't work for her.

The big "sell" on Lantus from Sanofi-Aventis has always been once daily dosing. The big "sell" on Ultralente insulin was always that it was once daily dosing. That more often than not didn't work out for the people using it, and they needed to use it twice daily. Both Novo and Lily discontinued their Ultralente insulins in the period between 2003-2005 because neither of them were selling enough of it to keep up production.

I'd believe the Levemir onset is because of its action.

Kathy

[grace.device]

Re: Hello! Rolo and I are new here.

Kathy, most of my reading about Lantus vs. Levemir came from human boards since it just wasn't common in animals. Levemir actually seemed to be preferred because of a flatter action and more predictability. Lots of people had split their Lantus as well with better results (though that's not really off label). It really doesn't make a difference to me to give it once or twice a day, Rolo is getting 4 shots as it is. Thank goodness she's patient with me!

Considering almost all of her activity occurs between 7:30am and 7:30pm, maybe that's why she is not getting the duration in the day, but is okay overnight. Or it has something to do with a lower heart rate overnight. Or my dog is just weird.

Grace

[We Hope]

Re: Hello! Rolo and I are new here.

I think you might be on the right track with the snacks. Rolo's not getting any "extras" overnight while you're both sleeping and that might be why she's doing well come morning.

We have a member here whose dog was having problems with chicken making for higher bg's:

http://k9diabetes.com/forum/showthread.php?t=515

Bailey--BaileyBear

If you take a look at Ida's (LabLover) thread, you'll see she was talking about chicken and bg's just recently:

http://k9diabetes.com/forum/showthre...?t=624&page=23

Just some places to look--I do believe you will get Rolo figured out on the Levemir!

Kathy

[grace.device]

Re: Hello! Rolo and I are new here.

Thanks for those links. I hate to think the chicken is doing it (she loves her chicken) but I know it's a possibility. It's weird she doesn't get that spike at lunch but maybe it's a combination of the chicken and the insulin being near its end in the evening. It seems weird that it would be duration, considering she gets adequate duration overnight. Also, she goes so high so fast! From 12.0 (216) to 20.1 (362) in only 2 hrs... wouldn't a lack of duration wear off more slowly than that?

And I don't want to barge in on another conversation, but I use the Freestyle Lite strips in my AlphaTrak with super results. I have done many, many, many back to back tests with the Alphatrak strips and the Freestyle Lite strips (and usually 1 or 2 with ever new container I start). Sometimes with really high readings (>350ish) they would be a bit off, 20 or 30pts, but really, 320 or 350 or 380 isn't that big of an issue. Below 300, they've never been more than 10 points different.

Grace

[Patty]

Re: Hello! Rolo and I are new here.

Hey Grace,
Looks like you're getting things figured out, just tweaking now. I would bet your spike is from a combination, like you said, of chicken at the end of insulin.

If I so much as give Ali 1 tiny cut green bean in the last few hours of her insulin, she will usually spike (that is if we aren't having some wierd day where her same dose of insulin is lasting 13.5 hours ). It's like the energy it takes to process that small piece of food uses up the last of her reserves.

I'm glad you posted about the Alphatrak and Freestyle Lite strips. Ida had asked me about this as an alternative to the costly alphatrak ones. I knew several people had used them in their meters with good results.

Take care,
Patty

[We Hope]

Re: Hello! Rolo and I are new here.

Grace,

First of all, if you post to someone else's thread, it's not barging in at all! We decided to have it "one dog, one thread" because it's a lot easier to read through the one thread if you need to look back on something for that particular dog than it is to run searches trying to find it. So post away!

When AlphaTrak came out, I'd often thought you could use FreeStyle strips with it because everything about it looked so much like the FreeStyle. A lot of people here have AlphaTraks, but they hesitate to use it a lot because of the cost of the AlphaTrak strips, so they buy a human meter whose strips are cheaper for everyday use.

Since Levemir works a little differently than the other insulins, let me see what I can find out re: a Time Activity Profile for it; when we started putting the wiki together, it had not yet been approved in the US and there weren't any graph-type ones for it. Those who were using it for their cats and were in the US were ordering it either from Canada or the UK before that, since the US was very late to approve it.

My thought would be that Levemir, just like all the other insulins, "tails off" and doesn't abruptly "stop". It would be similar to driving along and running out of gas--you'd gradually get slower as opposed to driving and hitting the brakes, where you'd stop suddenly.

Kathy

[janspack]

Re: Hello! Rolo and I are new here.

I'm glad you posted about the Alphatrak and Freestyle Lite strips. Ida had asked me about this as an alternative to the costly alphatrak ones. I knew several people had used them in their meters with good results.

Take care,
Patty

Does this mean that you can use the Freestyle Lite strips in the Alphatrak? I was trying to find the original post to find out but just can't seem to find where it was.

I have bought an Accuchek now as well as the Alphatrak but I haven't started using it yet. I'm a bit chicken about changing over until I'm certain I have Dazzle pretty stable. I'll have to do some comparison tests alongside the Alpha so that I can work out how different the readings are. Like others, the cost of the Alpha strips is worrying me a little.

I keep meaning to try to get the money back from the vet fee insurance but haven't done so yet.

[grace.device]

Re: Hello! Rolo and I are new here.

Since Levemir works a little differently than the other insulins, let me see what I can find out re: a Time Activity Profile for it; when we started putting the wiki together, it had not yet been approved in the US and there weren't any graph-type ones for it. Those who were using it for their cats and were in the US were ordering it either from Canada or the UK before that, since the US was very late to approve it.
Kathy

I'd appreciate anything you can find! I've found some things saying the duration is 6-24hrs depending on dose. None of my nursing or pharmacology texts even mention detemir (I didn't think I was that old, but apparently I am). I actually thought it was approved in the US before Canada? My texts are from 2004/5 and are Cdn.

Does this mean that you can use the Freestyle Lite strips in the Alphatrak? I was trying to find the original post to find out but just can't seem to find where it was.

Jan, I have not seen any difference between the AlphaTrak strips and the Freestyle Lite strips except in price! At higher levels (>350) there is some discrepancy (<50pts) but even two back to back tests with the same meter will not be the same every time. I do 2 checks with every new box of FreeStyle strips just to make sure they still match, and they always have. Just make sure your AlphaTrak meter is coded to "7" for dog (from the AlphaTrak box), but that never changes. I also have an Accuchek Aviva, which I like. It runs about 35% lower than the AlphaTrak, but it does have good precision.

If I so much as give Ali 1 tiny cut green bean in the last few hours of her insulin, she will usually spike (that is if we aren't having some wierd day where her same dose of insulin is lasting 13.5 hours ). It's like the energy it takes to process that small piece of food uses up the last of her reserves.

I think that is what's happening... it's too sudden a spike to be from lack of duration, but the chicken alone can't cause that big of a spike all the time. I tested her pee today (giving her a break from poking!). Trace @ 5:15pm, got chicken, but no green beans, and was "2" @ 7pm for our walk. I'm going to try green beans only tomorrow and repeat the pee test. I can decide what to do on Saturday for our curve after I see if the green beans affect her as well.

Grace

[grace.device]

Re: Hello! Rolo and I are new here.

Good news. I didn't do any BGs today or yesterday (Rolo needed a break) but I did urine test.

Yesterday she was between negative & trace urine glucose @ 5:15; got chicken, but no green beans, and was between 1&2 @ 7:15pm.

Today she got green beans but no chicken; urine was negative @ 5:20 and negative again at 7:10.

Looks like the chicken was the culprit, so she will still get her green beans for now. We are doing a curve tomorrow, so hopefully that goes well.

Grace

[Patty]

Re: Hello! Rolo and I are new here.

Glad you figured it out

Hoping the curve goes well!

[forloveofandy]

Re: Hello! Rolo and I are new here.

Grace I will be hoping for the best curve ever tomorrow! Gosh you and Rolo so deserve it. But no matter what, it is step in a process from a very dedicated Mom. One step, one day at a time.

I found with Andy that even small bites can have big effects on his BG. I am very careful with snacks. I can remember early on when Andy would run low, like at 60 BG, I would panic and feed him. He then, of course, went high.

I only learned recently that a bite or two of meat or tiny bit of cheese is all it takes to run him up 50 points when he is between meals and insulin. I really like to keep the Gerber baby meat sticks around as just one of those works very well.

So I guess 50 calories for a 20lb being is a lot more than it would be for us.

I am excited about your curve tomorrow!