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Should I switch from Novolin N to Levemir

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  • Should I switch from Novolin N to Levemir

    Hi Dr. Joi-

    Max is a 12 year old Westie who was diagnosed with diabetes this past April. To make a long story semi-short I have been through 4 vets trying to regulate him. My current vet wants to change to Levemir, 3 units twice a day. Max is at 7 units of Novolin N at this time. In researching Levemir, before starting, it is my understanding that it is 4 times as potent as Novolin N. Wouldn't this mean it would be equal to 12 units of Novolin? He also said I should be around at the 6 hour mark to make sure he is not going into hypoglycemia. I am unable to come home from work during the week to check this. Another vet at the same office wanted to change him to Humulin, another vet at the office said to just start the Levemir but did not know what size syringes (the Levemir prescription was filled with the pen at only 1,2,3 unit increments - no 1/2 units). I continue to hesitate starting without someone home to keep an eye on his glucose. If this is the route to go I have a 12 day vacation coming up I can start and be home with him 24/7.

    He refuses to eat Hill's w/d but is on a current diet of Purina DCO, Blue Buffalo HW and LID with added fiber. Yes, 3 foods weighed to the exact ounce. I have been tweaking this food combination for the past 3 months and this is the closest I can get to keeping him under 300 (most of the time). I do curves every weekend and cannot get a flat curve he rises post meal, sometimes 150+ points and the between the 6 and 10 hour mark he can drop up to 200 points. Plus during the week when he is home alone and inactive I have had some very low numbers post meal (lowest was 48). As you can see he is all over the place, mornings being much higher than evenings.

    In the end, should I switch to Levemir, what dosage, syringes (U-100 if I need 1/2 unit measures) and can I count on the numbers settling after 12 days?

    Any advice is greatly appreciated.

    Debra

  • #2
    Hi, Debra! First of all, how does Max feel? Is he showing signs of his diabetes (excessive thirst and urination, weight loss, voracious appetite)?

    You say that most of his numbers are below 300. My big picture goals are keeping most of the glucose numbers under 300 and having the curve bottom out somewhere around 100 but it could could be a smidge higher or a smidge lower and still have good control.

    Levemir is a great insulin for dogs. And as you say, it is much more potent than NPH. When I start a pet on insulin I like to start at the lower end of the dose range and sneak up on the dose to prevent hypoglycemia and to avoid overshooting the right dose for that pet. So, changing insulin can take weeks to find the right dose. I don't know that you need to do such a change while on vacation but maybe do it on one of your regular days off. Start the insulin on a days you will be home. About a week (5-7 days) later, curve again. Since you have several vets, choose the one that makes most sense to you. And maybe choose the one who is most accessible to you. A chatty accessible vet is a good thing.

    If you choose to change, I'd get the 3/10 cc insulin syringes. Yes, Levemir is u-100. You can take the pen apart and use it like it were a vial of insulin and stick the pen right into the rubber bit.

    Hope the transition goes smoothly! Happy holidays!
    Joi

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    • #3
      Max

      Hi Dr. Joi-

      Thank you so much for getting back to me, it is greatly appreciated.

      Max does not show any signs of diabetes as before he was diagnosed, he is not drinking excessively or urinating in his cage or at night in bed, as he had before. He still has a voracious appetite though, even licking the floor and I caught him outside eating cat feces out of the flower bed!

      I have had him on 7 units of the Novolin N for close to 2 months now and I will give you a sample of his last 3 curves, now that you mention good numbers are under 300, he is most of the time. With the following would you still suggest a change to Levemir? The numbers run every 2 hours starting at 6am ending at 10pm, with meals (always exactly the same) and 7 units at 6am and 6pm.
      246, 346, 280, 297, 177, 124, 89, 246, 401
      265, 287, 229, 349, 294, 151, 153, 282, 409
      153, 311, 174, 253, 264, 283, 233, 243, 201

      However during the week pre meal 6pm numbers could be as low as 80, my husband took care of him Friday and said his bg was 58 although he showed no signs of hypoglycemia and I did check my meter (AlphaTrak2) and it is reading fine. When I graph the numbers it looks as though he's bouncing all over the place. Sometimes I think I am a stress that causes his numbers to be high during curve days as he is always running on the higher side.

      If I do change would starting at 1.5 units of Levemir be a safe starting point? I am just not comfortable with the 3 units as the last vet stated.

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      • #4
        Hmmmm... His pre-insulin numbers being low and his post injection increases in blood glucose makes me wonder if he isn't dosed higher than he needs. He may be doing the somogyi swing. That's when the blood glucose gets too low and the liver reacts by making glucose and the blood glucose then spikes. What dose did you start him when he was diagnosed?

        Now, since I've never examined your pet I won't be telling you if you should change insulins nor what dose to give. That's the job of a doctor who HAS examined your sweetie. However, it may just be a matter of lowering the dose of his current insulin. Chat with your vet!

        Joi

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        • #5
          Max

          I've had Max at 6 units for approximately 2 months then 6.5 units for approximately 1.5 months. At both units his numbers were over 400 at times and sometimes reaching over 500, hence the switch to 7 units at the advice of my 2nd to last vet (not the Levemir vet). One vet did suggest Somogyi, however she told me to up the dosage and only give him a morning shot. Needless to say that was the last visit to his first vet.

          I'll be doing more vet research on my vacation!

          Thank you for your help, it is greatly appreciated.

          Happy Holidays!

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