Changing insulins - need advice

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Willie

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Willie was diagnosed on 2/18/2010. I have not posted but once but have read here as much as I have time to. Comparisons of insulin cost have cropped up here and there in the postings but that wasn't my focus at the time and I cannot remember every thing I read. So please excuse me for asking for a summary but I will be talking to my vet soon and need to be prepared.

Willie started on Lantus but was not making progress toward regulation. He then went on PZI vet (I am aware this is discontinued but this is what the vet put him on with the intention of switching to PZI zinc -- I know , I know doesn't make sense but I didn't know enough to request at the time that he be switched to PZI zinc). Willie initially seemed to be moving toward regulation but that is no longer the case despite changing the dosage. (Yes, he is on the right diet based on this website so that is not an issue).

Now for the question: if Willie's insulin is again changed, my vet is open minded about my input. So, from a cost stand point would I be better off to request an insulin I can buy at the drugstore as opposed to PZI zinc which I understand is only sold by vets. I know this is a detail controlled question as some insulin must be discarded after a month and there is waste, so the dosage for Willie is an issue, etc. But I am just asking if there are any general guidelines I should consider if we assume any of the insulins would work, are any easier on the pocketbook? (I am spent $800 in two months even with doing most testing at home and not much to show for it ) Thanks so much. Susan and Willie
 
Levemir acts similar to Lantus but lasts longer - I have not needed to throw away any - one 3ml cartridge lasts ~4 months at Tiggy's low dose.

I would personally recommend getting a prescription written for a 5-pack of 3ml Levemir pen cartridges (don't need to use the pen).

Just bought a 5=pack from Canada and the cost at Walmart was $119. It does cost more in the US.
 
Lantus is a good insulin and is cost effective if you use the 5 pack of 3 ml cartridges. However, the upfront cost is high, about $180 or so. Why did you switch from Lantus? IF it rally was not working then changing back to it is not a good idea. Going to the Levemir disposable pens is another choice and the cost is about the same as Lantus for the five pack.

You can buy ProZinc over the internet, with script, from places like 1-800PetMeds but I do not know if it any less expensive than buying it from you vet considering that special shipping is required.

Is the PZI Vet working? If so the ProZinc may be your best choice.

An alternate is BCP PZI. It is 100% bovine insulin somewhat like the PZI Vet which is 90% bovine and 10% porcine. It is less expensive than ProZinc and you can order it from them with script. Also, you can get your vet to obtain a free 5 ml sample. See:
http://www.bcpvetpharm.com/pdf/sample.pdf
 
i'm a little curious too as to the lantus. you were on it a little over a month if my math is correct? honestly, that wasn't really long enough to see if it was gonna work. if you flip thru some of the spreadsheets for those using Lantus, you'll see that alot of them took more than a month for the lantus to really start working

if the pzi vet is working then prozinc would be a good choice although you can't just go get it at a local pharmacy and know going in that you have to give it time to work and from what i'm seeing with other kitties on the board here on it, it seems like the doses are a bit higher than those on the pzi vet.
 
I didn't see where you mention it so forgive me if it's been asked and answered, but have you switched or tried to switch to canned food? I'm just wondering if you didn't see the Lantus working because you were still feeding dry food? Tugger was on Lantus for months before I noticed a real change, and it didn't happen till I changed his food to canned, at which point his numbers hit the floor. I'd seen a little bit of improvement before, but only when I increased his dosage (which I went about the wrong way do don't do what I did!)

So that's why I asked about food, if you haven't changed his diet that could be why the numbers are still high.
 
Thanks for all the responses. Very helpful advice. I just wrote a long explanation of Willie's situation but it seems to have gotten lost in cyberspace. Don't have time now to redo it. But need to ask a few questions.

First, Marvie - sorry I was unclear. Did state that Willie was on the right diet based on this website -- which is no dry food and high protein, low carb wet food. So yes, we can eliminate diet as the problem it seems.

Cindy - I agree with you that Willie was not on Lantus long enough to tell. This is why I wrote the long, now lost explanation about why he was switched. This is also why I want the vet to consider putting him back on Lantus. (see below).

Phoebe - thanks so much for Levemir suggestion. Sounds like a good one to consider. Not close to Canada unfortunately but still .. . ...

Larry - why is it not a good idea to go back to Lantus if we suspect he was not on it long enough to judge?

Thanks and I will try to post a reconstruction of the explanatory post as soon as I can. Things are at sixes and sevens here rigth now. Susan
 
If you didn't give lantus a fair trial, then there is no reason why you cannot try it or levimer again. Honestly, both these insulins work in similar fashion and can choose either one and be happy.

If you try one of the L's again, are you able to follow the protocols outlined in the lantus ISG? It's important that you are home testing and able to get spot checks in and dose on a 12/12 schedule.
 
Not trying to hijack- but what would make you choose levemir over lantus or vice versa?
 
If you hit post the sme time as someone else, your post can get lost in cyber space....so copy your post first just in case!
 
Amanda,

Sometimes price can be a factor as Levimer supposedly is less expensive than Lantus. I don't know, as I only priced Lantus. But the way to find out is call the pharmacies and do a cost comparison.

Some people believe that Levimer is less fragile an insulin than Lantus. Still needs to be treated gently, no shaking, rolling, etc.

Also, sometimes a vet may not have heard of one, but is familiar with the other and when wanting to work with the vet, you go with the one they know.

Last year, Lantus had a free offer - 5 pens for free! Many, many people took advantage of that offer and stocked up on Lantus. Even Levimer users - with the thought when they run out of Lev, they will switch to Lantus.
 
This is a recap of the lost posting with explanation of why Willie was switched to PZI vet from Lantus.

Willie was diagnosed by my regular vet (Vet #1). I have 7 cats and 1 dog and have been satisfied generally with this vet. Vet #1 does not however seem to be up to date on FD if the following is any indication: First recommended an insulin that is no longer used for cats before proscribing Lantus. Told me to roll it when this is not good for Lantus according to the manufacturer. Told me diet did not matter. Did not talk to me about signs and treatment for hypoglycemia, and did not think home testing was important or to be encouraged. After about one month on Lantus with increases of dosage, no real progress was made seemingly. He was put on a broad spectrum antibiotic for 10 days to eliminate the possibility he had an infection that was making him insulin intolerant if that is the right term. He was diagnosed at 400 at 2 p.m. After that the vet always tested at 7 am pre injection and Willie never tested lower than 419 which was on 2/22. By 3/16 he was at 428 at 7 am. That is going in the wrong direction.

I did put Willie on a wet high protein low carb diet on my own from the start based on this website.He was a 13 1/2 pound cat who was not overweight. Very large boned cat, huge feet, etc. He lost 2 pounds before he was diagnosed. Got very bony along the spine and ribcage. Despite the lack of progress on gc numbers, he has regained 1 pound, coat is no longer greasy and dry, and he has regained some perkiness. So I do know he feels better.

Although now I believe it is possible that he was not on Lantus long enough to tell, I did not know this at the time and was discouraged by what seemed to be lack of focus by the vet -- test one day not call back for 2 days, etc. Interviewed other vets and found Vet No 2 who encouraged home testing, thought diet was key, etc. She put Willie on PZI vet. So that is why he was changed. This morning at +12 (7 am) , he was 431, just now at +6 he was 385. Vet will call shortly and my guess she will increase the dose. This is the last time she will increase this insulin. So that is why I am trying to figure out what input I want to give on another insulin. Thanks for all the comments. It is very helpful to hear from others dealing with FD.

Susan and Willie
 
Sorry you guys got started out wrong, as it really does waste a lot of time and money and can cause a lot of confusion.

Testing is your answer. Test preshots, test spotchecks and get the occassional curve.

What kind of numbers do you have with the PZI?

Jen
 
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