My Baby Boy Greyson!

[momofdecker]

Re: My Baby Boy Greyson!

My boy has been using levemir since May. He also eats Wellness Core RF diet. He's 87 pounds and currently on 4u to 4.5u though. He's been as high as 10u of levemir and 4u is his lowest. We've not noticed any lethargic behavior related to insulin. He was overdosed on NPH early on and when his bg would swing 100+ points within and hour or two, he would become very lethargic. His drinking and potty needs would increase during those times as well.

Decker is fortunate to get 12 hours+ duration from the levemir. Seems a lot of dogs using it are not getting a full 12 hours duration. Because Decker gets a bit of overlap he does not get much of a food rise either. Other dogs using levemir also have noted large food rises. When Decker could go on walks he would often drop 100 points on a longer walk. When he was on the NPH his bg would spike right back up, making it difficult to lower his bg. The spike back up has been absent for him on the levemir. Surprisingly, the quick drop did not seem to bother him either. It only seemed to be the swing from high to lower back to high in a short time that caused the lethargic behavior.

A few questions for you:
1. Do you have a 3.5u NPH curve you could share?
2. Do you have the .5u levemir curve you could share?
3. Was there any activity/exercise/excitement between 9a - 11a (unlikely at the vets, but hey, you never know what one might happen upon if there was a potty break during that time).
4. What are Greyson's fasting times?

Holli

[Patty]

Re: My Baby Boy Greyson!

Good to hear from you Brittany! I would reinterate what the others have said in that Levemir is more potent. 1 unit Levemir is equivalent to 4 units of active insulin in a dog.

I wouldn't raise his dose based on a fructosamine again, especially 1/2 unit of Levemir (~2 units insulin).

Curious to know how he doing lately? The lethargy may be due to dropping too low later.
Patty

[momofdecker]

Re: My Baby Boy Greyson!

I just had a thought regarding use of the 1u of levemir. That drop in the first hour would lead me to believe the 1u might be too much. I'm wondering if there is a way you can interrupt it though, to allow use of the 1u but provide a bit of extra food within that first hour or two time. Maybe the extra food would stop the large drop and level things out for the 12 hours? Same deal in the evening?

Here is something I recently experienced with Decker. He is 87 pounds and gets 1c food at each meal. He's struggled with weight all his life. He has mobility challenges and we recently started him on steroids in hopes that it helps with his mobility.


Example from Thursday night: His fasting bg at 6p was 328. Much higher than normal. His evening fasting usually runs 150 - 200 range. He'd gotten 4.5u that morning. Knowing we were starting the prednisone, combined with his fasting being more elevated than normal, I went with 5.5u of levemir. He was fed/injected at 6p. Gave him the prednisone at 7p.
Bg at 7p was 297
8:40p - 239
9:13p - 154 (not a bad number but a fast drop for him in a three hour window as he will drop till around midnight - gave him 1/4c food).
10:32p - 187
11:12p - 202

If I had not given the 1/4c food when I saw the 154 he likely would have dropped down into the 60 range. I would have had to intervene at that point and because his insulin would not have been so strong, his morning fasting would have come in over 300. Giving the food early brought his bg up but kept him more level for the rest of his 12 hour cycle.

I realize you are not able to check the bg numbers, but perhaps try giving a small amount of food and see if you note a difference in the behavior, combined with what you may see on the urine strips? Just a thought I wanted to pass along.

By the way, Greyson is a cutie! Holli

[Rubytuesday]

Re: My Baby Boy Greyson!

Hey there, He is sooooo cute. OMG.

Sorry I didn't see your post for so long. I used to micro dose Ruby, but we only feed once a day so dosing became mini-micro dosing for the part of the day she didn't eat and I gave up.

My observation with levemir was once it got going (could take a few hours though) it would hold things pretty steady until the duration of the insulin was gone. Although it is a long acting insulin it wil have dirrent duration in different dogs and at different amounts ( meaning the higher the dose the longer the duration).

There are a couple of possibilities:
*not enough duration with the levemir causing him to go high prior to shot. A 12 hr. curve would be needed to determine this.
*the night time dose may be dropping him too low. The high in the am may be a result of his liver panicking to the low and shooting out stored glucose. You would need to run an overnight curve to determine this. I don't think the daytime dose is dropping him too low as he stays nice and steady for a long time. In those first 2 hrs. he drops 255 point which isn't ideal, but his body doesn't seem to be reacting to it as far as the numbers are concerned.
To try to figure the high fasting out you could either do the curve, or reduce the nightime dose by 1/4 unit for a few day and reevaluate (testing). Lastly would be increasing the nightime dose by 1/4 unit to see if he just needs more overnight, but I wouldn't be comfortable doing that without getting a middle of the night test between 1-4 am, as the numbers are pretty steady that far out from injection.
*He may be getting a large food rise before the levemir has gained speed raising those first numbers. A fasting number would be needed to see if he was high before food or if the food caused the number.

I know I am telling you all things that need either a lot of testing at the vets or you starting home testing, but unfortunately that is all I have experience with. It is a great tool. I am sure I have saved my self many hundreds of dollars as Ruby is a difficult diabetic. Either that or we never would have gotten this far. Happy to help you get started with that if your interested.

In the future I would only recommend increasing the levemir in 1/4 dose increments.

Tara

[Shellie]

Re: My Baby Boy Greyson!

My goodness...isn't he the cutest little bugger?!! LOL

As to the levemir (Hank is about 16 pounds..small like your guy)...I'm currently using it and am not entirely happy with it myself. We started at .75 or as near as I could figure with a magnifying glass. A 12 hour curve revealed that he was dropping to nearly 40 in the middle of the day so we backed off to a half unit. That didn't seem enough however since he was rising too quickly in the evening so we settled on a smidge over half a unit.

At this point, I believe one of two things are happening with Hank...the levemir is working but is running out at ten hours due to a severe rise I see at the end of the cycle OR his body is freaking out and raising the levels. Since my vet is resistant to adjusting things with humalog or R, I think we'll be going back to the NPH and doing three shots a day, eight hours apart.

My point here...microdosing with such a powerful insulin in small dogs is really, really hard. I would have no question of using it in a larger dog but with small...it's nearly mind boggling with the adjustments. If I had a day where he refused to eat at all...how on earth do I dose for that? Go to one drop? Nothing? A quarter unit? Small dog dosing with this insulin is tough.

I can't be sure that it's not the rebound effect or running out that is occurring with Hank. I'm assuming it's running out due to that seeming to be the problem with the NPH but not sure.

My main suggestion here...learn to test. With using levemir in a small dog...you really MUST test. The occiassional random test or a fructosamine is no way to adjust this insulin ever. It's just too darn powerful in such a small animal. I have a BIG feeling that Greyson is being overdosed and THAT is the reason you are seeing such lethargy in him. I don't want to say that levemir is a bad thing...because I really think it's fantastic in the right dog but especially with the smaller dogs...it's just so darn powerful so you have to be extra careful. I would go back to the half unit right off and start testing. Better high than low...always! Good luck and hugs to you both!