should we switch insulins? - problem solved!

I am at the bottom of my PZI Vet vial, so it's time to put on the thinking cap I guess!!! Bix was almost looking like he was going OTJ, he was going about a week between shots for a while, now he is running higher (upper 100s) and I can't seem to get him back in the greens very often. Some of that is my bad but it also seems like he is not responding as well to the insulin right now. He doesn't zoom at all anymore, yet doses that used to bring him down before are like shooting water lately.

He seems a bit "off" at times, but there is nothing obviously wrong with him that I can tell. The "off" sense (low energy I guess, first noticed it around 3/10) seems to improve when I am giving him more insulin. Money is non-existent right now, so while I'll take him to the vet if it's needed (will probably need to go this week regardless to get insulin), I can't spend any more than I have to on tests.

Higher # thoughts - do any of these seem likely/unlikely?

• 1. PZI could be bad...? It's the dregs at the bottom of the vial right now.
  2. Unidentified infection or other illness/pain going on.
  3. I've had him out of good #s for long enough now that his pancreas has shut back down, and if we could get some sustained good #s he would get back on track nicely.
  4. He has developed some sort of PZI resistance and needs a different insulin.

Next insulin thoughts:

• 1. Go with ProZinc. He seems to get excellent duration on PZI Vet & did really well on BID back in July/August+.
  2. Try something like N or Vetsulin. Worried about short duration on these, but maybe it's what he needs to kick him back into good #s?
  3. Try Lantus or Levemir.

If anyone has suggestions on what my next steps should be I would appreciate the perspective. The "I'm broke!" half of me wants to go out and just get a vial of N and try it out and see if it helps. The "I want to be thorough & rule out everything that could be a possible issue" part of me wants to go to the vet, get a bunch of tests run to see if something else is going on with him, go with ProZinc first and see if that helps, and if not, go to Levemir. Can't really afford that route, but at the same time there's not much point in going a cheaper route if it's not going to solve anything, we will just end up at the vets sooner or later, probably with a bigger bill. ohmygod_smile

thanks in advance for any input!

 

Re: should we switch insulins?

I am biased, but I would vote for ProZinc. The 10ml vial should be around $100 and will last til it is gone, like PZI Vet. If you think he is close to going OTJ, I would be warry about spending $250 on 5-6 months worth of Lantus or Levemir.

 

Re: should we switch insulins?

That is only if you buy the pack of 5 pens or cartridges.

A 10ml bottle of Lantus or Levemir costs about $100. But the bottle doesn't last long, maybe a month before it starts to "poop out". Some people have been able to get a few months out of a bottle of Lantus or Levemir but that does't happen too often.

A pack of five 3ml Lantus pen cartridges or pre-filled SoloStar pens or a pack of five 3ml Levemir FlexPens dose cost about $150 or so but the entire pack is a 5 month supply because you use one new pen or cartridge each month. So it comes out to about $30 per pen or cartridge. Many people find this much more cost effective: $30/month for a cartridge or pen vs $100+/month for a 10ml bottle.

You can read the sticky on the Lantus board to understand how it works, how to handle it (ie no rolling or shaking) and how to use a cartridge or pen with an insulin syringe. The info also applies to Levemir.

Do shop around for the best price on Lantus and Levemir. You can also use a free prescription drug card to get the insulin at a lower price: http://www.felinediabetes.com/phorum5/r ... ?8,1946184 (or, viewtopic.php?f=3&t=8482)

Have you asked on the PZI board for recommendations? Some PZI users have switched to Lantus or Levemir and are having good results. Others have switched to ProZinc. I guess it partly depends on your cat's situation.

There is a FDA warning on using Vetsulin so do not use this.

Humulin N is too short acting for most cats.

 

Re: should we switch insulins?

If you are using the dregs of the bottle, it's my bet that the insulin has lost its punch. I would start with that assumption. All of the other possibilities are indeed possibilities, but I would start with #1.

Have you asked on the PZI Board whether anyone who has made the switch has an unneeded (maybe partially used) vial the would gift you? If there just isn't any out there, I think I would give the ProZinc a try. He's done well on PZI. No no no to N or Vetsulin.

Squeem3's pricing information is a bit old, or it's based on prices in a brick and mortar Canadian pharmacy. The 5 packs of Lantus and Levemir are now running about $200 in the states, slightly less (but not much) from the Canadian mail order pharmacies. And when a person with a DCIN-sponsored cat tried to use the discount card at a Costco, it didn't change the price.

 

Re: should we switch insulins?

Thanks everyone, that is all great info!!! I woke up thinking "what the h*ck is N and why am I even considering something I know absolutely nothing about?" so it's nice to have confirmation to drop that idea. Saves me some time reading up on it. ;-)

I got a PM from someone who might be able to send me an Idexx vial, so I'm thinking I'll pursue that route first, and if that doesn't come together, probably go to the vets for Prozinc, and just try to keep myself from requesting excessive blood tests, etc.

Feeling much better about things this morning. Happy Easter everyone! :mrgreen:

 

Re: should we switch insulins?

Woah! That is erroneous information as to the cost of Lantus or Levemir. Recent posts regarding care and stability of Lantus have changed the previous held belief that a 3ml cartridge only lasts as manufacturer recommends, something like 1 month. Please see the stickies in Lantus ISG for more complete information on care of cartridges or vials.

And I can tell you from personal experience that a 3ml Levemir cartridge will last 3 months. I get 15 months use out of a $200 (cost has since increased in US and now need a script to order from Canada, but may be cheaper there) 5 pack of flexpens.

Unfortunately yes the upfront cost is higher, but the breakdown depending on dose is more cost effective than $250 for 6 months! I would hate for someone to be steered away from Lantus or Levemir because of cost.

 

Re: should we switch insulins?

Hey Joanna,

I think a big consideration is the fact that Bix uses very little insulin [when he does need insulin]. Thus expiry is an issue.

So my thinking is that BCP of course *might* me less money if you wanted to stick with the PZI route. Whoever presouzkitty is wouldn't respond to my PM and other questions about the size of the bottle she got and the strength. But she did say something along the lines of $60 delivered to her doorstep [not sure if that was 5ml or what]. But assuming this was 10ml of U40 then it would be an attractive price EXCEPT the expiry is only lasts 6 months AFIK. Supposedly the way to get the good price is to have your vet send a script to BCP [or maybe call it in] and not buy from your vet. But the less communication between the vet and BCP is best since you do not want the vet marking it up. The scenario would have to be carefully managed. I bet 10ml of U40 lasts you about 10 months - maybe longer now that Bix likes to take some days off??? So it's a tough decision, potentially pay less now and deal with any expiry issues down the line [perhaps it will last longer than the expiry???].

You've been able to follow how we did on our switch from PZI Vet to ProZinc. Currently, I pretty use it like the old PZI Vet. I have no complaints at this point.

If you really check the coupon sites you may be able to find a coupon better than $5 to 800petmeds that would bring the price below $90-95 for ProZinc. I found an old 800petmeds coupon for $20... Or you may be able to find a local pharmacy willing to price match. VCA will price match - I think even online prices. You could have your vet call in the prescription to a VCA in your area then have VCA price match the $80 one I found.

One thing I would want to know is how does Lantus and Levimir deal with sputtering P? Is is more difficult [or perhaps easier] with those than with PZI?

Thought I would also mention that I kind of had similar happen [seeming like maybe he wanted more insulin] with H at the end of this PZI Vet bottle [but we had many things happening at that point including a little dry food]. Then we switched to ProZinc and as it turned out he needed a higher dose of ProZinc. So I'm still unsure if he just needed a higher dose before or what was going on.

BTW I think there might be law in CA about vets not being able to prescribe if they haven't seen you kitty in the last year??? At least this is what one of our vets claim. Thank the very active vet lobby in CA for this.

 

Re: should we switch insulins?

I was wondering that too. I like the idea of being able to shoot on low PSs, which has been an issue for him at times on PZI when he hovers in the mid-100s, below 150, but never zooms. I've taken to shooting on lower PSs, but haven't gotten particularly great results with that, but still better I guess than having him go for hours/days in slightly high #s but still technically too low to shoot. So it seems like the Ls might solve that problem. But then if he doesn't need a shot 12/12 (he often gets longer than 12 hrs off a PZI shot, so who knows what he might get off something even longer acting), I don't know how the L's handle that.

Well it looks like I may have an Idexx vial lined up so if that comes together, I will shelve the thinking cap for now anyhow.

 

Re: should we switch insulins?

I may have gotten the price a little off, but from my reading on the Lantus board is that the pens in general last a little more than a month each if you go by the maufacturer's suggestions. Some people do not, and stretch out the vials until they see numbers go high again, and that is up to them. But my main point was that the up front cost was much more. If Bix is soon to be OTJ possibly, then there will be much left over. I have heard of some pharmacies selling lantus/levimir 1 cartridge at a time though. You could also become buddy buddy with a human diabetic or doctor. My mother-in-law gets her insulin for free as "samples" from the doctor's office. (She uses Lantus and Humlin). I know that lantus/levimir have had a good success rate, but we, unfortunately, are bound by cost sometimes.

 

Joanna, sorry I don't have advice to give you about the different insulin's. I've only used ProZinc. If you do decide to go back to TID... ProZinc was great for Pru, as far as being able to shoot at a low PS.