Help with Mocca's levemir dose

[moccasgrampa]

First post piggy-backing on this thread since it is about Levemir. NOTE: Administrator seems to have segregated my posts into their own thread now - thanks

I need some very quick advice. Dog sitting (Nov 13 to 22 or 23) my daughters 9 year old female mixed breed, 72 pound dog that has been diagnosed for a couple of years I believe. The dog is on Levemir and we were told to administer 20 units !!! twice daily after feeding. She is also on antibiotic for a bladder infection ?

The dog crashed Wed evening Nov 15, so we took her to emerg vet. I have to convert readings from mmole/L to mg/dL with 0.0556 conversion ratio for you guys. Emerg vet said she was at 1.7 / 31, kept overnight on IV and discharged Thurs evening at 23.4 / 420. Taken to her reg vet Friday morn at 33 / 583. Vet gave her 20 units Levemir and we were told to give her another 20 units at dinner.

Picked up our daughters AlphaTrak2 blood glucose meter on the way home (she's out of town). Started to take readings:
5:49PM BG around 8 / 143
7:30PM given dinner
7:43PM gave a reduced shot (our decision) of 11 units
8:20PM BG 8.8 / 158
10:50PM BG 14.5 / 261
.......................................
Sat Nov 18
7:25AM 3.6 / 65 so gave breakfast
7:40AM gave 10 units
10:31AM BG was 9.1 / 164
1:33PM BG was 8.7 / 156
6:50PM BG was down to 2.8 / 50 so gave dinner but no shot
8:44PM gave 1/4 more of a normal meal

will recheck BG before bed and decide on any shot for overnight

we need some advice from any vet on here that can interpret this sequence of readings/feedings and make suggestions

thanks

update: 10:23PM Bg was 25.3 / 455 so gave 4 units

[stylynjm]

Re: Levemir?

Wow, just popped in.not on much

How much does pup weigh...20 units levemir is a lot
..!!!!
My 12 lb pup was on 1 to 2 units levemir ...

[jesse girl]

Re: Levemir?

levemir is 4 times more potent than NPH and vetsulin as far as dosing so that would compare to 80 units of insulin for a 72 pound dog that is an extreme amount as compared to those other insulin's

how long has the dog been on 20 units ? i tend to agree with your decision to drop down to 10 units at a maximum especially since you have already have seen a hypo event

[moccasgrampa]

Re: Levemir?

dog is 72 pounds and yes I think this vet is out to lunch

we are new to all this, having it dropped in our laps knowing nothing about treating diabetes. There's a big hole in our wallet though from that emerg vet stay!!!!!!

emergency internet searches about Levemir indicated a starting dose would be 0.1 units/kg twice a day, so that would only be 3.2 units each shot!

compounding our confusion was the meter was set at code 36 as obtained and used for our first couple of tests before I read the literature and found that the vial of test strips said code 6 for dogs. Changing the code and retesting showed a result about half the original value. I'll have to check with my daughter when she gets back as to why it was set at code 36

[stylynjm]

Re: Levemir?

It's a process...I would definitely cut levemir back..I'm not good at conversions, but 100 to mid 200's is a good. Goal.. just give each insulin change time to settle....5 to 7 days, unless you get to low... keep karo syrup handy,lol...

[stylynjm]

Re: Levemir?

If you're using alphatrak strips,it needs to be set for code on strip vial... some people use another strip (forgotten what kind) in the alphatrak meter, then code is different..

[MikeMurphy]

Re: Levemir?

Wow. Like everyone is saying, 20 units of Levemir twice a day is way to much for a 72 lb dog. Even 10 units twice daily may be way too high.

The normal starting dose for a 72 lb dog, using NPH, would be around 14 units. With Levemir being 4 times more powerful than NPH, the starting dose for Levemir would be around 4 units twice daily.

[moccasgrampa]

Re: Levemir?

UPDATE from previous post

10:23PM last night BG was 25.3 / 455 so I gave Mocca 4 units Levemir since I did not give her any shot at dinner because reading was 2.8 / 50 at that time

8:10AM this morning BG was 26.4 / 475 so I can only assume things were relatively stable overnight. Based on this reading, I gave her 5 units Levemir and only gave her half her breakfast and will give her the other half in an hour or so to keep the feeding spike(s) minimal. From reading, it takes 4 or 5 hours for the injection effectiveness to "ramp up" to its plateau level.

I feel that we are starting to reduce the swings and getting a handle on a uniform quantity which seem to be in the 5 unit range, maybe a bit more, we'll see throughout the day.

Thanks for all replies, we are flying blind and forums like this are a great help.

[stylynjm]

Re: Levemir?

I would pick maybe 5 units amd stay with it for a bit to see what it does...and not vary the insulin time unless you get a serious low....then go from there...
Good luck,it seems like you are starting to understand the system and the importance of consistency ..

[moccasgrampa]

Re: Levemir?

Hopefully one last question. Lets use a theoretical injection amount of 10 units twice a day. In an effort to reduce the oscillations in BG, what are the opinions on an injection of 1/2 the chosen quantity (5 units) before the meal (so it has a head start on metabolizing) then the second 5 units a while after the meal as opposed to the full injection of 10 units after the meal? Do this for both meals of the day.

I interpret all this metabolizing of food & insulin as superimposing two wave forms on top of one another so the peak of one influence tends to be counteracted by the trough of the opposing influence (wave form physics). More wave forms means more complexity but I don't see that it would have any negative medical impact.

The only reason I ask is that the last three BG readings have seemed to stabilize somewhat (using 5 units per injection) but are high. Now I want to keep the stabilization and not change the injection amount too much but increase it a bit to reduce the level at which BG stabilization has occurred. I use the term "stabilized" with a bit of hopefulness perhaps.

[jesse girl]

Re: Levemir?

i am curious how you got to 20 units and what was regulation like before the hypo event

do you have any past curves during the regulation process at different doses leading up to the 20 units

some of that history could help to determine a dose that maybe adequate

[amydunn19]

Re: Levemir?

I understand what you are proposing - all of the specific terminology is a bit over my head, but in theory it would make sense. But, our dogs don’t exist in theory and you have to be careful with making assumptions based on the way things should go according to all we know about diabetes. For example, the dog had a higher reading in the morning so you said you assumed that things stabilized overnight but without testing, you do not know this. My dog was the ultimate rebel when it came to her blood sugar doing what it was “supposed” to do. It is almost like she knew it and decided to drop like a rock randomly just to keep me guessing.

Also, the bladder infection is in play and blood sugar can drop drastically as it goes away.

Our motto around here is you can’t really go by “the book” when our dogs can’t read any of the books. They just don’t always respond the way they are supposed to.

[stylynjm]

Re: Levemir?

Completely agree with others..stay with 5 units for example, same time,same food and give pup some time to get adjusted...time is your friend...you can not hurry this process, as many of us learned over years of experience! !!

[moccasgrampa]

Re: Levemir?

Jesse Girl : We don't have any background data as the dog is our daughters and she went out of town for a week or so and left us instructions re the 20 units. After the hypo crash and overnight stay at emergency vet, and my rush to research things, we quickly discarded that level of injection and started measuring BG. The only thing we can think is that the dog gets too much inappropriate treats at home necessitating the higher dose then she comes here and gets nothing but her food so the dose crashed her but until we talk to our daughter it is just conjecture on our part

I did the 5 before dinner and 5 after dinner last night. BG was 27.2 / 489 yesterday afternoon. This morning BG is 16.4 / 295, not too bad but still a tad high so I gave her 7 units. I'll check her again early afternoon. We seem to be narrowing down to the 5 - 7 unit range.

We hope to hand the dog back tomorrow night or Wednesday morning at the latest and take a valium, lol.

[Judi]

Re: Levemir?

lol, lucky dog to have you guys for grandparents! hang in there!