? Assessing Lantus versus ProZinc Experiences

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Here are my thoughts having checked out Teasel's spreadsheet and reviewing your notes re: your experience with Lantus.

I agree with Bobbie that getting some earlier and later cycle tests might shed some light on what's going on with Teasel. Teasel looks much like Citrus, the cat I assisted with on ProZinc...bouncing wildly and oh how I feel for you! :banghead: It's royally frustrating and worrisome.

When you were using Lantus, your dose adjustments were by 0.5u rather than by 0.25u (a little eyestrain required but doable) so I can't help but wonder if some of what you were seeing was too high a dose rather than too little and if you might have skipped over the ideal dose for Teasel.

I have a high dose cat with IAA and can truly relate to the frustration you are feeling. I used Lantus previously and now Levemir. At my girl's doses, (she got up to 16u BID) I could have made adjustments by up to 1 or more units at a time but I found all that did was cause her to have major bounces and we went up and down.. repeat... repeat. Taught me you can't rush anything with these sugar kids.

It may be that Teasel is one of those cats that craves consistency but he also is very sensitive to dose changes. While you are able to adjust doses a little more finely with ProZinc and you have held doses at times, there are other times when doses have changed quite a bit over a few cycles and I think his body may be finding that confusing. I can see why you changed the dose in many instances but in some cases, I admit I was a bit puzzled.

The other thing I would suggest you think about, given the difficulty you are having regulating him and his wild swings, is having him checked for Acromegaly. This likely is a long shot because it's generally considered to be a high dose condition designated by requiring over 6u BID by vets but that isn't always the case. Acromegaly is a pulsative condition meaning things change depending on how much growth hormone is being pumped into the system on any given day. Acromegaly is a co-morbid condition in up to 25% of diabetic cats.

How is Teasel's weight? If he's gaining despite the lack of regulation, that could be another sign that acromegaly may be in the picture.

The test for Acromegaly is relatively inexpensive and most of the cost is the blood draw and the transport of the sample because it can only be done at the University of Michigan. The caveat to this test is that if you take blood on a day when the pulsative activity is low, the test may be erroneously negative.

If he were my cat, I'd give Lantus or Levemir another go finessing doses by 0.25u at a time and get the acro testing done because if he does have acro, at least you'll know why he is so erratic and believe me, just knowing what you are dealing with can relieve a lot of the stress and worry we go through with our hard to regulate furkids. . :)
 
Hi Kris,

Had a quick parse of the relevant posts but I need to give it a more thorough going over before I have a hope of offering any feedback. It's 4am here and I'm about to take my sleep meds but will get back to you some time tomorrow - hopefully with a suggestion or two but can't guarantee I'll find something others have not flagged already.

For now regarding the Lantus dosing and swinging BGs I would also raise a flag about the dose adjustments not being done in 0.25IU increments.

Another question mark in my mind is whether there might be any possibility of the starting dose being too high.

Some questions:

If you still have a record of Teasel's weight/body condition (overweight/normal/underweight) when he first started Lantus treatment could you post details here, please?

Also, what is Teasel's body condition at the moment (overweight/normal/underweight)? Is he currently losing or gaining weight? How is his appetite?


Mogs
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Thank you, Mogs. I'll give you a bit of info for your perusal tomorrow:

Critter Mom said:
dose adjustments not being done in 0.25IU increments.
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I was following my vet's instructions and she told me that any fractions less than 0.5 u were impossible with U100 syringes that have half unit markings. I was so blindsided by the diagnosis I followed instructions to the letter even after a couple of weeks when I sensed that he might need an "in between" dose.
Critter Mom said:
any possibility of the starting dose being too high.
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This could well have been the case because by the end of week 2 on Lantus he was swinging wildly. At that time I was clueless about bouncing.
Critter Mom said:
Teasel's weight/body condition
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Teasel has always been slim and trim. He was about 6.5 kg at diagnosis, which is good for his size. He was lean but in good flesh with a sleek, healthy coat. His appetite has always been good. He and his sibs (especially his sister) share allergic reactivity. She has a propensity to develop eosinophilic plaques on her face and thighs but her hypoallergenic prescription diet helps a lot. Teasel has reacted to certain varieties of litter by having itchy feet. He's also prone to bouts of cystitis often with no evidence of infection. My vet calls him a "Pandora" cat, as in Pandora syndrome, an umbrella term for a variety of inflammatory conditions. FD is not that surprising then and I've read that this can also create problems in regulating the cat.
Critter Mom said:
Teasel's body condition at the moment
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Currently, he's about 0.5 kg less than at diagnosis but stable. He's lean but not bony and his coat is in excellent condition. His appetite is very good, maybe heightened still by FD but he's always been a very good eater. He's not drinking water excessively or peeing more often. His urine clumps are still the largest though.

He is impacted by the insulin and fluctuating BG levels. He sleeps a lot in the first half of the cycle and is generally more active in the second half. When his BG is in the 8 to 10 range he seems happiest and most energetic but he can fool me. I've seen him chasing his siblings and jumping up onto his cat tree and then tested his BG to find it's 20+.
 
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Kris I am so sorry it took me so long to respond - I've taken a little break from the board (sometimes it's all just too much)
I switched to Levemir after 10 months on Prozinc - some are thinking that Lev might actually be insulin of choice - don't know but I choose it predominately because another member of the Prozinc family (@Cara and Wynken) went to a feline diabetes specialist who recommended Levemir
I am glad I switched - Murphy had huge drops with Prozinc - he has them less with Lev but I am also using a human meter now which I continue to hate but it does cloud the issue. Be that as it may, I truly believe it's more an issue with the cat than the insulin - Murphy continues to be unregulated and erratic so it hasn't solved the problem. But I do like the idea of a depot. It seems like alot of cats are started out on Prozinc, do well and either go into remission or become regulated. Some don't become regulated, and after a period of time, end up on the L insulins - some lucky cats do great with the switch - some - like Murphy - remain unregulated.
I agree with Jayla above - I'd consider a switch to Levemir - with no promises that it will the answer but ................
 
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Thanks very much for your input, Carol. I flagged you because we'd "talked" previously about our unregulated kitties, AT meters, etc. I keep coming back to your comment, "it's more an issue with the cat than the insulin". I've taken all the kind responders' advice on board and am letting it lie fallow, so to speak, for now. It needs to percolate in my brain for a bit ...:)
 
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