4/22 Dimi - AMPS 380, +2 402, +3 348, +8 334, PMPS 312

Bobbi Kraham

Bobbi Kraham

Member Since 2022
Thank you for your input yesterday, @Wendy&Neko @FrostD and @Diane Tyler's Mom. I heard from our vet today and she clarified her thinking for me. She feels that changing him to a different type of insulin may allow for tighter control, and ideally, remission. She said there is a bit of trial and error to determine the best insulin fit for each diabetic cat. Lantus is generally her first choice, but shared the following about the other options:

1) more potent long lasting insulins like Levemir (this is a "cousin" to lantus and a bit more potent), I would not recommend Levemir for Dimi.

2) A more concentrated form of lantus called Toujeo. This may allow once/day insulin injections but is also very potent. A new study was just released showing this was very safe for cats

3) a slightly less potent type of insulin made for cats called Prozinc. This may allow a higher dose of insulin to be given which is more accurate to draw up into a syringe rather than the 1/4 unit increments that you are currently drawing into the syringe and in reality, very small dose adjustments in the 1/2 unit range are often imprecise when under 4 units of insulin.

If we were to change Dimi , I would opt for either option 2 or 3 listed above , there are pros and cons to each option and we will have to see what his response is once we make the change. Close monitoring is always our best guide to his treatment (along with your TLC at home and high protein low carb diet).

I do have trouble with the .25 unit dosing (my eyes aren't great), and even with a magnifying glass, I can never be sure I'm giving him a consistent does. Sometimes it might be closer to 1 unit and other times to 1.5 units. This is why I think she proposed option 3. I also got the sense that she likes to reserve Levemir for high dose kittys.

So what do you think about Toujeo once per day? Really appreciate your insight! Many thanks.


Previous post: https://felinediabetes.com/FDMB/threads/4-21-dimi-amps-172-7-337-9-366-pmps-392.262318/#post-2940569
 
We have had people try Toujeo but have not found it to work better. This is a forum where people have posted about it. Most find once a day doesn’t work.

If Dimi were my cat I would stick with lantus. It’s just been 2 months. My next choice after 6 months would be Levemir. I disagree with your vet. We had one person recently switch to Levemir and her cat is not diving as much as on lantus.
Looking at your ss I think your cat needs an increase.
 
I was just thinking of Cali too

So I disagree with ProZinc. Based on experience, more often that not ProZinc prevents you from raising the dose enough to bring overall numbers down (the steeper dives). I can dig for some example spreadsheets if you like to see some.

"more or less potent" is misleading - it's just a different concentration, and many times we find the doses when you switch insulin are nearly the same. ProZinc is U40 - 40 units of insulin per mL; Lantus/Lev are U100 - 100 units per mL. Then toujeo is U300. So when you draw up a 1U dose for example, it's the volume that is different (0.025mL, 0.01mL, and 0.003 mL respectively). Remember the majority of syringes are labeled in units, it's the internal volume that is different. A unit of insulin is a unit of insulin; the only difference is some cats tend to have a stronger initial reaction to Levemir...but that is addressed simply by lowering the dose.

I've also heard the same about toujeo not working as a once a day, I will try to find the study your vet mentioned later.
 
7 cats in this study...not exactly statistically significant to me. Also found no difference in duration of action. It does say flatter time action curve.

https://www.sciencedirect.com/science/article/abs/pii/S0739724020301624

I am having a hard time finding U300 syringes for some reason, perhaps they don't really make them. Which leaves you with Toujeo pens, there's 2 different kinds. Minimum dose adjustment is 1U, and as I understand pen needles are exoensive. Some reading says they don't really make syringes due to overdose concerns. In humans anyway, it says a 14% higher dose of U300 is needed to maintain the same glycemic control as U100.

So my two cents: I would be uncomfortable using Toujeo on my cat due to overdose risk, added cost and issues with pens. I would not move to ProZinc as it has a less-flat action. Levemir would be my first choice if you're really itching to change, but that's apparently in conflict with the vet ha
 
Penny is a recent example of a switch from ProZinc to Lantus - you can see ProZinc took her from 600+ to 100 in a single cycle. Caused a bounce, repeat.

Cleo - doing ok on ProZinc but you can see the swings.

Ace - pretty big swings, 400 down to 66

Spike - one of the flatter cats but you can still see 100+ pt drops


In my experience, most of the cats that are flat on ProZinc were relatively flat to begin with, or fell into flatter cycles relatively quickly after starting insulin (within 2-4 weeks).
 
FrostD said:
Penny is a recent example of a switch from ProZinc to Lantus - you can see ProZinc took her from 600+ to 100 in a single cycle. Caused a bounce, repeat.

Cleo - doing ok on ProZinc but you can see the swings.

Ace - pretty big swings, 400 down to 66

Spike - one of the flatter cats but you can still see 100+ pt drops


In my experience, most of the cats that are flat on ProZinc were relatively flat to begin with, or fell into flatter cycles relatively quickly after starting insulin (within 2-4 weeks).
Click to expand...
Thank you for these examples. My guy's already a swinger, so nope, ProZinc is not for us.
 
FrostD said:
I stumbled across this spreadsheet, very fascinating. Was on Toujeo less than a week, then back to Lantus, then eventually Levemir. The Levemir currently looks pretty promising but a little soon to tell.
https://docs.google.com/spreadsheets/d/1I6JegKess9S4-56n-dwCd5I6vYYFTkDcHuG445d9Ac4/edit?usp=sharing

(Post here so you can see her signature)

This cat does have underlying conditions though.
Click to expand...
Yes, she and I communicated in the facebook group. I was admiring all of Nico's blues and greens. She's a more obsessive scanner than I am. I don't know when she sleeps!
 
Ok, so Lantus it is, and maybe Levemir later if necessary. @tiffmaxee, I'll increase his dose tomorrow am, as you suggest. He does seem droopy tonight, and I live in constant fear of another DKA. After $10,000 in ER bills for his two DKAs, my husband said no more. I wasn't around today to test for ketones, so will try to test tomorrow, and praying that's not the issue.
 
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Bobbi Kraham said:
Ok, so Lantus it is, and maybe Levemir later if necessary. @tiffmaxee, I'll increase his dose tomorrow am, as you suggest. He does seem droopy tonight, and I live in constant fear of another DKA. After $10,000 in ER bills for his two DKAs, my husband said no more. I wasn't around today to test for ketones, so will try to test tomorrow, and praying that's not the issue.
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Sorry if it's been mentioned before but just doing due diligence for post DKA cats
- water water water. Soupy food, sometimes an actual fountain gets them to drink more often.
- I would see if your vet will give you Cerenia, ondansetron (zofran) and an appetite stimulant just to have on hand. Possibly subQ fluids. That way if he starts to get inappetent on you, you have the med cocktail to hopefully get him eating, and fluids if he starts to get dehydrated
- syringes for syringe feeding. In a post DKA cat I would not waste any time assist feeding if he won't eat on his own. Small amounts at a time, watered down. The Hills AD and Royal Canin Recovery foods are popular because consistency is nice and cats usually like them, but more often than not I just use the plain Gerber meat baby food (turkey, chicken, etc purees in a jar - nothing added that could potentially be toxic to cats so check labels).
 
FrostD said:
Sorry if it's been mentioned before but just doing due diligence for post DKA cats
- water water water. Soupy food, sometimes an actual fountain gets them to drink more often.
- I would see if your vet will give you Cerenia, ondansetron (zofran) and an appetite stimulant just to have on hand. Possibly subQ fluids. That way if he starts to get inappetent on you, you have the med cocktail to hopefully get him eating, and fluids if he starts to get dehydrated
- syringes for syringe feeding. In a post DKA cat I would not waste any time assist feeding if he won't eat on his own. Small amounts at a time, watered down. The Hills AD and Royal Canin Recovery foods are popular because consistency is nice and cats usually like them, but more often than not I just use the plain Gerber meat baby food (turkey, chicken, etc purees in a jar - nothing added that could potentially be toxic to cats so check labels).
Click to expand...
I do have some cerenia and I have mirataz to stimulate appetite. I have some of the Tiki cat mouse that I watered down and spoon fed him when he was reluctant to eat last time around. I'll grab some baby food when I go to the store this weekend. Hopefully he's just having an off day and he'll feel better tomorrow. Thanks so much for all your support.
 
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