Insulin Advice - currently using Caninsulin (Vetsulin)

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Kiara

Kiara

Member Since 2015
Hey everyone,

First of all, THANK YOU all for just being here. This forum is such a lifesaver.

Billy is 10 and was diagnosed in September. Like most cats in Canada (from what I've seen with friends and here in the forums), he was given Caninsulin. He responds well to it, and at 2.5 units, I have him in the green and blue consistently. The problem is, with 12 hour dosing, he shoots back up to the 300s for AMPS and PMPS.

Caninsulin gets a bad rap on these forums, but from what I can see in my own cat, it works. It just might not be long-lasting enough...? It seems to me (and I really don't know for sure) that he would benefit from 3x per day shots on Caninsulin but that wouldn't work for my schedule.

So here's my question .... is it too soon to jump ship to Lantus? I'd rather save the money and use what we have, but his health is my ultimate priority. We have more than half a vial of Caninsulin left. Should I give it another month or two?

Any and all suggestions welcome. So much love to this group!!! :bighug:
 
Hi Kiara. I use Vetsulin (the U.S. name for Caninsulin) as well, so I'm pretty familiar with it. I looked over your spreadsheet, and I see what you're talking about, but I don't really see anything unusual in it, except that Billy certainly seems to be getting a lot of "bang for the buck" out of the Caninsulin! When I first joined FDMB someone explained to me that you want your AM to PM and PM to AM to resemble a smile, higher at the outside edges and sloping down lower in between, and I've always thought it was a great analogy! In Billy's "smile" he is dropping significantly lower before rising again at the end of the cycle. There may be a bit of a bounce going on there, in which case, believe it or not, you would want to lower your dose a bit (bounces can go on for days, sometimes, Squallie bounces a lot and I dread it because in his case it goes on for a long time till he flattens out again). Have you shown your spreadsheet to your vet, or spoken to him/her about it? If so, what do they say about it?

If it was me, I would probably continue on with the Caninsulin and see if some dose adjustments might bring his BG down and level it out a bit, but that's just my personal opinion. I'm sure there are a lot of people who would suggest you make the switch to another insulin! Either way, I would discuss his test results with your vet, preferably with spreadsheet in hand, and see what they suggest.

Please keep us posted, I'd really like to know what your vet says and what you decide to do! :):)

Lucy
 
@Squalliesmom Thanks for the advice... interesting about trying a slightly lower dose. Maybe I will try him at 2 for awhile. Vet tolerates my treatment but isn't a champion of our methods, lol. He wanted to dose based on Billy's weight and thought human glucometer testing was a bit crazy. He also is somewhat skeptical about remission. He is cheaper than other vets so I guess you get what you pay for, haha.
I'll pop in to the vet soon and let you know, it's just a couple hundred metres from my office.

@Larry and Kitties Dosing every 8 hours is not possible... I am at work 10 hours a day. That's why I'm curious about a longer-acting insulin...hmmm
 
Kiara, my former vet tried having me dose Squallie every 8 hours, and it was a disaster. It became immediately apparent, too, that that was too much insulin in that time frame for him. Not to mention it's a very difficult schedule for someone who works 8 hours a day.
 
I have never had a problem with Vetsulin/Caninsulin lasting a full twelve hours, once the appropriate dose is determined.
 
Do you know you can get Lantus without a script in Canada? You just ask for it at any human pharmacy

I saw someone buy a 5 pack of pens for around $100 not long ago....that's enough to last most cats about 2 years, so it works out to be pretty affordable.

I think the Caninsulin is not lasting long enough, and it's also dropping Billy quite a lot (and pretty quickly) which could be setting him up to constantly bounce high by the next shot time

That's one of the things about using Caninsulin...it hits hard, drives them down and then it's gone so there's nothing left to help keep the BG more stable.

My personal opinion is if you can swing the Lantus, I'd give it a try....it's a depot insulin, so it works totally differently. It's generally more gentle and instead of having giant "smiles" for cycles, you have more of a "grin"....but of course ECID, so it's a decision you'll have to make in the end.

There's lots of information about Lantus in the Lantus/Levemir Forum . I encourage you to read up on it and maybe it'll help with your decision
 
Squalliesmom said:
I have never had a problem with Vetsulin/Caninsulin lasting a full twelve hours, once the appropriate dose is determined.
Click to expand...
Lucy, I think you have one of the only cats who lasts a full 12 hours on Vetsulin. Most people find it wears off after 8 hours. But as we know, Squallie likes to dance to his own tune. :woot: (Hope he's feeling better, btw!)
 
I'm open to anything that could keep him out of the pink and red ranges! How long should I give Caninsulin, I wonder? Is a couple months fair?
 
Squalliesmom said:
I was probably told "grin" (and actually, I think it might have been you who first told me this, lol!) and my mind remembers "smile," instead!
Click to expand...

Yeah, that sounds like me!! But both are really correct...it's not unusual to see "smiles" more especially at first...it takes awhile to get them to be flatter and change to a "grin"

With Caninsulin though, you're going to see those higher Pre-shots, then the lows and the steep jumps back up...that's just how it generally works in most cats...so you get more of a
smiley-163510_640.jpg



With Lantus, the goal is to get more of a
historyofthesmileyface1.png
 
I found, with Squallie, that it became really a matter of getting the dose fine-tuned, then he started to flatten out more. Of course, lately he's been all over the place due to a UTI. :( So I get to start the whole process over again, yay...
 
Kiara my girl Genghis was started on Caninsulin as well. Like you, I wanted to give it the good old college try before I abandoned it.

I think the best insulin is the one that works best for your cat. I was getting decent results but I just had the feeling it wasn't the right insulin for Genghis.

I think if you take a look at Genghis' sheet you will see she is the poster child for "smile to a grin". It takes some mental adjusting to using Lantus (the toughest for me was learning how to "shoot low to stay low" so having used Caninsulin with its rather steep effect the first time I shot a green number I was given a very useful set of "balls of steel" to help me through it, lol), the other being that shot times need to be a tad more precise but I have been delighted with the results.

It's definitely up to you but if you can find a pharmacy that will split up a box of pens -- I have heard that Walmart often will -- it's actually quite affordable. I like that the syringes can be purchased at any pharmacy - you will need to change to U100 syringes. Oh, and if you do decide to change, be prepared for the smell. Lantus has a very ... odd odour. Someone said it smelled like a Bandaid factory and I thought that was on the money. It isn't a horrible smell but it sure is strong. The plus side is you can easily detect a fur shot!

Good luck whatever you decide.
 
@Brashworks Walmart in Canada will split a box of pens? I was just going to go to the mom and pop pharmacy across the street but if Walmart might split the box I would definitely go there.
How much was a box of pens for you, if you don't mind me asking? The whole box might be what i end up getting.
I'm so grateful you gave me all of this info :)

One more question, I've been told to buy vials and told to buy pens, and then I was told to buy a refill for the pen but not the pen... ?? What does it all mean?
 
I'm just at work but promise I will respond to this properly shortly. I can tell you quickly that unless you have a high dose cat the vials are a waste because they are so large. Pens are the way to go!
 
I've never heard of anyone in Canada buying just one pen because it's cheaper in the long run to just buy the box of 5, but you can always ask if they will! Most places won't split a box up....worth a few phone calls I guess to find out!

You don't want to buy a vial if you're buying Lantus....a vial contains 10mL which is 1000 units...with most cats getting less than 4 units per day(2U every 12) you'll end up throwing away a lot of insulin since at best, you're only going to get about 6 months before the insulin starts to go bad---Also, if you drop a vial, you're going to lose whatever insulin is left...they're VERY breakable

The pens each hold 3mL...so 300 units...even at low doses, usually you'll be able to use every last drop in a pen without worrying about the insulin going bad and they hold up to being dropped pretty well since they're designed for people to throw into a pocket and carry around all day. A box of 5 is 1500 total units, but will remain good until the expiration date on the box...usually at least 2 years away

Before they invented the newer Solostar pens, they had something called the "Opti-click pen" that took cartridges....they come in boxes of 5 and are 3mL each. These are no longer available in the US, but some places in Canada still have them

The top picture is a Solostar pen and how you use it...the bottom picture is a cartridge...basically the same thing only without the extra plastic that makes up the pen

solostar pen picture for FDMB.jpg
syringe in pen1.jpg
 
@Chris & China That is so so helpful. Makes a lot more sense. Still cruising along with Caninsulin with the same numbers... pre-shot in the 300s, but once in awhile 400. Lowest points always in the green. It doesn't feel like that will change so I might try Lantus. Definitely over the weekend so I can be there 24/7. If not this weekend then next.
 
Kiara, here is the pricing I found - it may not be the cheapest but you get the idea.

lantus.PNG
lantus pen.PNG




I actually was lucky - my Dad was visiting and he's a senior with Type II and he just gave me a pen. With the price difference between 10mL versus 5x3mL pens - the pens are a much better deal. Keep in mind they say they are only good for 28 days once you start using them but that is under the assumption that a person is carrying the pen, unrefrigerated, all the time. Kept in the fridge, they can keep for up to 6 months I think. Sorry, I'm now repeating what Chris has basically already said. AND she has given you way better instructions than I ever could on how to use one!

Unopened, most Lantus you buy right now would have an expiry into 2017 or 18, so tons of time.

Here are the syringes I use. They are 100u, 3/10 mL with half unit markings. I've been happy enough with them but I also use a dose ruler for precision because I do find some of the line markings to be inconsistent. No biggie for a 150 lb human on 8 units; a much bigger deal on a nine pound cat! If you are interested, I can send you the pdf or send you to the posting here where I found it. I was ordering from diabetesexpress.ca but heck, they are cheaper at the pharmacy. And don't let them try to tell you that you need a prescription for them. A few folks at Shoppers have tried to tell me that a few times. Maybe I look like a heroin addict?? LOL.

BD.PNG


Lastly, I would absolutely recommend you head over to Lantus/Levemir forum for suggestions on starting dose. You will find those folks so warm and supportive and helpful (like so many other folks here!).
 
Thank you... I wonder if there are Lantus users in the Toronto area who would split a box with me? Billy's dose is pretty low so far. It's a bit steep for something that will sit in the fridge for the most of two years. :P There is probably some concern about that but it would be cool to arrange such a thing. Or maybe, I can phone around to see if Walmart will split up the box of pens as suggested.

I've been lurking in the Lantus forums since I joined, taking in everything I can. Everyone does seem great.

Sooo.... I was cartridges vs pens, right? Pen has a superfluous component?
I've seen that these syringes are cheap at Costco. Going to take a look...so glad to have you all around
 
Yeah if you can get the cartridges, you'll save a plastic tree from being killed....LOL

But then again, I like having the extra "covering" for when I drop the silly things

Price looks to be the same, so it's really up to you which kind you get
 
Brashworks said:
Kiara, here is the pricing I found - it may not be the cheapest but you get the idea.

View attachment 17093 View attachment 17094



I actually was lucky - my Dad was visiting and he's a senior with Type II and he just gave me a pen. With the price difference between 10mL versus 5x3mL pens - the pens are a much better deal. Keep in mind they say they are only good for 28 days once you start using them but that is under the assumption that a person is carrying the pen, unrefrigerated, all the time. Kept in the fridge, they can keep for up to 6 months I think. Sorry, I'm now repeating what Chris has basically already said. AND she has given you way better instructions than I ever could on how to use one!

Unopened, most Lantus you buy right now would have an expiry into 2017 or 18, so tons of time.

Here are the syringes I use. They are 100u, 3/10 mL with half unit markings. I've been happy enough with them but I also use a dose ruler for precision because I do find some of the line markings to be inconsistent. No biggie for a 150 lb human on 8 units; a much bigger deal on a nine pound cat! If you are interested, I can send you the pdf or send you to the posting here where I found it. I was ordering from diabetesexpress.ca but heck, they are cheaper at the pharmacy. And don't let them try to tell you that you need a prescription for them. A few folks at Shoppers have tried to tell me that a few times. Maybe I look like a heroin addict?? LOL.

View attachment 17095

Lastly, I would absolutely recommend you head over to Lantus/Levemir forum for suggestions on starting dose. You will find those folks so warm and supportive and helpful (like so many other folks here!).
Click to expand...
Brashworks said:
Kiara, here is the pricing I found - it may not be the cheapest but you get the idea.

View attachment 17093 View attachment 17094



I actually was lucky - my Dad was visiting and he's a senior with Type II and he just gave me a pen. With the price difference between 10mL versus 5x3mL pens - the pens are a much better deal. Keep in mind they say they are only good for 28 days once you start using them but that is under the assumption that a person is carrying the pen, unrefrigerated, all the time. Kept in the fridge, they can keep for up to 6 months I think. Sorry, I'm now repeating what Chris has basically already said. AND she has given you way better instructions than I ever could on how to use one!

Unopened, most Lantus you buy right now would have an expiry into 2017 or 18, so tons of time.

Here are the syringes I use. They are 100u, 3/10 mL with half unit markings. I've been happy enough with them but I also use a dose ruler for precision because I do find some of the line markings to be inconsistent. No biggie for a 150 lb human on 8 units; a much bigger deal on a nine pound cat! If you are interested, I can send you the pdf or send you to the posting here where I found it. I was ordering from diabetesexpress.ca but heck, they are cheaper at the pharmacy. And don't let them try to tell you that you need a prescription for them. A few folks at Shoppers have tried to tell me that a few times. Maybe I look like a heroin addict?? LOL.

View attachment 17095

Lastly, I would absolutely recommend you head over to Lantus/Levemir forum for suggestions on starting dose. You will find those folks so warm and supportive and helpful (like so many other folks here!).
Click to expand...
Hi Melanie - can you tell me what you mean by a dose ruler?
 
Last question! I promise... do animal rescues take opened insulin or should I just pitch the Caninsulin? Seems wasteful but I suppose there is no way to verify my opened insulin has been handled properly
 
@Carol C there is a dose ruler you can print out on the A4 setting of any printer (but still use 8 ½ x 10 paper in the actual printer) that shows how to measure small doses consistently. It ONLY works with 3/10 mL, 8mm needle BD syringes with half unit markings. You can access it at the German Katzen site HERE

It looks like this:

Screen Shot 2015-10-30 at 6.35.17 PM.png




Here is a pic of me measuring out a .2 dose - with the middle of the plunger on the .2 line (sorta - dang it's hard to do one-handed!)

Screen Shot 2015-10-30 at 6.45.18 PM.png


Basically I just carefully folded over the top edge, then line up the top of the barrel - this is not perfect here because I'm trying to take a pic and do it at the same time. I would "hug" the paper with the wide plastic part of the syringe to see how the plunger lines up - it should be in the centre of the plunger for the dose, but you can make it "fat" or "skinny" depending on if you took the plunger to the top, middle, or centre of the line.

Screen Shot 2015-10-30 at 6.44.58 PM.png


Here is a view a little further away -- see how the "0" line on the syringe is all wonky and who can tell how much insulin is in there? But the dose ruler takes the guesswork out. If nothing else, it at least helps immensely in keeping the dose consistent.

Screen Shot 2015-10-30 at 6.44.42 PM.png


This is pretty low tech (like me!) -- Lots of people also use digital callipers. Marje (as in Marje & Gracie) has an excellent post on how to use them HERE.

Hope that helps!
 
@Kiara - never stop asking questions, especially good ones! That is an excellent one. I would think a shelter might take one - FD people are nice people. Would probably be worth a few phone calls. I gave mine to a cat rescue here (despite looking like a heroin addict -- see self-deprecating post above ;)) but the people have known me a long time.
 
Kiara said:
I wonder if there are Lantus users in the Toronto area who would split a box with me? Billy's dose is pretty low so far. It's a bit steep for something that will sit in the fridge for the most of two years. :p There is probably some concern about that but it would be cool to arrange such a thing. Or maybe, I can phone around to see if Walmart will split up the box of pens as suggested.
Click to expand...

@MrWorfMen's Mom you're in the GTA - I know you switched to Lev but do you know any Lantus folks in the area who would go sharesies, or perhaps a tame Wal-Mart or other pharmacy that would break up a box of pens for Kiara?
 
@Brashworks I did a sketchy thing. Met a guy from Kijiji at Shoppers Drug Mart and watched him fill a script for Lantus pens. Paid $40... he said he has lots of "customers" with cats and even a snake. If anyone knows Scarborough, this is very #Scarborough

I watched the pharmacist do this, so I feel fine about the whole thing. Saved a lot of money. The things we do for our cats!! Doing some mega reading now preparing for his first dose.

I could only get 6mm BD UltraFine 3/10 cc ml with half units... :( Walmart AND shoppers were out of the 8 mm
 
First update ... omg.... 6mm!! How am I ever going to shoot with these... :'( And now i can't return the open box. We use a loooong needle right now.
 
@Kiara, my sister used to live in Scarberia but left in 1992 long before it got so dodgy. Can I just say HOLY CRAP WOMAN, Billy is a lucky cat you would risk life and limb for him like that!!!!

Have you decided on a dose? I really suggest a quick post in Lantus - make sure you put a ? in the title - they are magical there and have a ton of experience. Make sure you include his weight, whether he is at, below or above ideal weight, and they will take a gander at Billy's SS and have a super safe dose really quickly for you.

ETA - you might want to put some thought into whether you want to go TRP or SLGS.

I fell into TRP just by getting great results. There is a great sticky there on being able to do TRP with a full time job.
 
Brashworks said:
you're in the GTA - I know you switched to Lev but do you know any Lantus folks in the area who would go sharesies, or perhaps a tame Wal-Mart or other pharmacy that would break up a box of pens for Kiara
Click to expand...

I do know one other person in Toronto using Lantus but I'd have to check to see if she'd want to go sharsies. I never bothered to ask about getting a box of vials split up given Menace's higher dosage so I don't know if any Walmarts or Shoppers would do so or not. I can ask at my Walmart the next time I run over there. Mind you I am in the west end of the city so it would be a bit of a trip for you Kiara.

As for the syringes, I have a Walmart that pretty much always has the 8mm needles (still shorter than you are used to though!) so if you can't find them closer to home and want me to pick some up for you, we can just meet someplace midway for a handoff. Went to a different Walmart one day and ended up with the 6mm too and I agree...they ARE too short!
 
@MrWorfMen's Mom Thanks for getting back so quick. I bought a 5 pack so I am okay. More worried now about having to buy more syringes :P

I am in the west end all the time for work, but I think if I call the pharmacy and tell them which syringes I need, they should be able to order them (fingers crossed). Thank you :)
 
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