Hi again. Is it OK to call you Ruby?
Have you seen cases of remission in cats on Lantis?
Absolutely! We've seen hundreds of cats here achieve remission when treated with Lantus (possibly more), one of whom was my own Saoirse. It should be noted that some cats can do well on other insulins and achieve remission on them, Vetsulin included, but the better choices are Lantus, Levemir and Prozinc because they have greater duration in cats, thus can keep them in better numbers for a greater part of the day. The longer a cat can be kept close to or within the normal feline BG reference range, the greater the chance of becoming a diet-controlled feline diabetic (not on insulin), hence the significantly greater statistical chance of achieving remission in cats treated with longer-acting insulins. I've attached the peer-reviewed study that provides the foundation for the Lantus dosing methods used at FDMB below for your information. (It also addresses use of human glucometers to monitor cats' blood glucose levels in case your vet may have any queries in this respect.)
Vetsulin (also branded Caninsulin in some countries) is an 'in-out' insulin: the dose goes in, does its work during a single 12-hour cycle, and is then gone from the system. Typically it hits quite hard and fast early in the cycle and peters out several hours before the next dose is due. Here's an 'ideal' example of a glucose curve for a cat on Vetsulin:
Because there's typically quite a significant drop from preshot to nadir BG on Vetsulin, it often results in getting to the point where preshot BGs may still be fairly high but any increase in the dose is likely to take the cat too low at nadir.
Conversely, Lantus is a 'depot' insulin: some of each dose gets used during the cycle in which it was administered but part of the dose goes towards building up a little 'tank' of insulin under the skin - the depot - which releases gradually over time. As each successive dose builds on the previous ones, duration of effect of this insulin is enhanced, thus helping the cat to stay in better numbers for longer on each cycle. Also, Lantus typically has a gentler mode of action and when an effective dose is arrived at (through small, gradual increments) Lantus curves can be more like wide, shallow smiles compared to the 'bucket-shaped' curves so typical of Vetsulin, and it is this characteristic that, with adequate testing, creates greater opportunity to give insulin safely at lower preshot levels and therefore more tightly regulate a cat's blood sugars.
Although not a depot insulin, Prozinc also has good duration in cats but, to the best of my knowledge, as BG levels get into tighter numbers, the preshots may not get down into quite as good a range as might be possible with Lantus in some cats.
Saoirse was treated initially with Vetsulin (a legal requirement at the time in the UK) but it became impossible to improve her numbers enough to get her into remission (dose could not be increased for safety reasons, poor duration). After switching to Lantus, Saoirse's overall blood glucose range improved greatly within a few weeks and she achieved remission in under 3 months.
If today I was looking to treat a newly diagnosed feline diabetic and could choose any of the available insulins I would go straight for Lantus without any hesitation.
The vet mentioned if we wanted to do that and wait for the shipment she could start us on Vetsilin (sp?) then switch but we'd have to recheck those glucose curves all over again if we switch.
That's a very good suggestion from your vet. It would let Jack get started on insulin ASAP, reducing risk of any complications from ketones (see
FDMB ketone primer for more info) and buy you the time to get the Lantus Rx from Canada. WRT running curves again, that's no real biggie if you're testing at home because you'll be able to get real-time readings on how Jack is doing every day, regardless of the insulin he's being treated with, provide feedback to your vet, run any required curves at home. Data from daily readings and home-run curves can be used to safely and effectively manage his dosing. We can give you guidance on the difference in mode of action of the two insulins, particularly the best times to test to catch the lowest (nadir) BG level and make sure the dose is safe. Also, you don't need to take a step backwards when switching insulins because you'll be able to take into account his response to Vetsulin when setting the starting dose for Lantus.
On starting dose, for safety we very much recommend starting low and going slow with the dose adjustments. The latest
manufacturer's dosing guidelines for Vetsulin base the starting dose on a snapshot BG level at start of treatment. From their website:
The trouble with this is that the baseline reading may be taken at the vets and may be temporarily elevated by stress, so if it's borderline the 2.0IU dose may be too high as a starting dose. The
FDMB Vetsulin/Caninsulin guide generally recommends a starting dose of 1.0IU.
(Note: An older iteration of the Merck Vetsulin protocol took both the cat's weight and baseline BG into account when setting starting dose but, as noted above, the recommended starting dose is now per cat based solely on baseline BG.)
Lantus starting dose is based on the cat's weight (0.25IU per kg of actual weight OR per kg of ideal weight if the cat is overweight at time of diagnosis - an average 10lb cat would start on 1.0IU Lantus). Also, if a kitty has been on another insulin prior to starting Lantus treatment, the dose of the previous insulin is also taken into consideration.
NB: If you do decide to go with your vet's plan to treat briefly with Vetsulin and then move quickly onto Lantus, bear in mind that they have different concentrations and you need to use the insulin syringe type appropriate to the insulin you're using. Vetsulin is a U40 insulin (40 international units (IU) per ml) and is administered with U40 syringes, Lantus is a U100 insulin (100 international units per ml) and is administered with U100 syringes. If you know that you won't be treating with Vetsulin for long, then perhaps just buy enough syringes to cover you till the Lantus arrives.
As Diane notes above, you can use the Lantus pen as a 'mini vial' of insulin and draw up each dose using a U100 syringe. Walmart do carry the 0.3ml U100 syringes with 1/2 unit markings but, according to some members' reports, their staff sometimes don't actually realise they stock them so it's worth asking them to double-check if you have problems at your local store.
There are lots of information 'sticky' posts at the top of our Lantus support group's board to help you learn more about this insulin. I'd suggest starting with the following:
What is the insulin depot?
[Lantus] Dosing methods: 'start low, go slow' and 'tight regulation'
It is a bit of a steep learning curve at first, but so much of this will become second nature, and a lot sooner than you might think right now. We'll do all we can to support you as you learn. Ask away with any questions you have, we're only too happy to answer them.
Mogs
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it was about $60 I when I bought it.