confused newbie - Which insulin? Who do I trust?

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Elson and five tails

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So far, in a nutshell:
Darth was diagnosed with diabetes on Tuesday (495 when the vet tested him). Vet put him on a twice a day regimen of 2 units of Vetsulin and changed his diet to Purina DM (we are currently giving him 1/2 can of wet mixed with 1/3 cup of dry twice a day - both are Purina DM).

OK, so then I read on the board here about Vetsulin problems. I talked to my vet, I've looked on the web and I'm confused as h*ll. Here is what I know (believe) to be true...
1. Vetsulin has had manufacturing issues, causing consistency issues. They have suspended production, but not recalled the product. FDA issued a warning. Lots of people are angry.
2. There are only two FDA approved insulins for cats - Vetsulin and Prozinc.
3. Prozinc is very new to market, with only 6 months or so of being in use. It may or may not be identical to a product that used to be on the market under the name PZI.
4. Some people use Lantus or Levemir with good results, but neither of these are FDA approved for use on cats. Also, the FDA has a microscope on Lantus use in humans because 3 studies have linked Lantus use with increased risk of cancer in humans.
5. Prozinc is 3 times more expensive than Vetsulin

I explained my concerns about the consistency of Vetsulin, and the suspension in production. My vet explained that there are only two (approved) products for use with cats. One (Prozinc) has only been on the market a short time.
Among other questions, I asked my vet the following specific questions (the answers are not quotes, but rather the understanding I have come away with):
Q Have you seen any consistency issues with Vetsulin?
A. No.

Q. What about using products like Lantus or Levemir off-label?
A. That is a possiblity. Some vets are using Lantus with good results, but my vet suggested that we don't cross that bridge unless we come to it (the impression I got was that using medicines off label is something that should only be tried after approved options are exhausted).

A word about my vet...
I am inclined to trust her. She was the one who figured out what was wrong with Yoda after another vet clinic in the area couldn't figure it out and told us we'd just have to live with it. She is the only Diplomate of the American Board of Veterinary Practioners in my town (but I'm not exactly sure what that means..). In the surrounding towns, there are a total of 8 Diplomates (including my vet). There are two in the state capital, and the other 5 are all at a well-respecting veterinary teaching and research program at a nearby university. She has served as a consultant to the state Veterinary Board, and sat on the board's exam committee. These are not things she has told me, but things I have found out just from my own research.

It's hard for me to go against my vet's recommendation...

What would you do?
 
I would be inclined to stay away from a product that has been recalled. Simply because your vet hasn't seen issues, doesn't mean the issues aren't out there. I guess to qualify that first question you would need to know how many diabetic patients your vet treats and how many are closely monitoring their pets. Lots of pets are blindly injected and hope that they aren't going to hypo. The manager at the shelter I volunteer for had a diabetic cat who she blindly shot (despite my talks about testing) who hypo'd many times... and only occasionally bad enough that she went to the vet so her vet wouldn't necessarily know if the hypo was because of the insulin or the cat's general health.

and what is going to happen when you "cross that bridge" is your vet going to wait until there are problems? if so what kind of problems would prompt a change? are those problems life (or even just health) threatening?

It is fully possible to trust your vet and not like one or two aspects of the treatment. remember they are only human, and they do work for you. If you would feel more comfortable going to Lantus or Levemir just let your vet know that. She should be willing to work with you.

Connie
 
And to muddy up the waters for you even more...LOL...there's BCP PZI a compounded bovine insulin. http://bcpvetpharm.com/news_bovineinsulin.html
Some people don't like compounded things, but BCP has had studies done showing no inconsistencies with their product. I've trusted them for about 8 years and haven't had a problem. I personally would not use Vetsulin. FWIW.
 
also just want to add that vetsulin is not much off from humulin n as far as it's poor use in cats. despite whether or not there's been consistency issues and the fda getting involved and all that. it's a rough ride for a cat on either of those two insulins, to be blunt about that :) .

as far as prozinc goes, well, to be honest, i don't much care for what i'm seeing with it as far as what i read here and other places and all but it is new so maybe after it's been out for a bit and people figure out how to use it and it's intricacies and such it will get better.

as far as lantus not being fda approved for use in cats, well, neither are probably about 50% of the medications used in veterinary care but they get used. not being fda approved in cats doesn't mean they don't work. it just means the very expensive research studies necessary for that approval aren't bothered with by the companies who make the product and in all honesty, why would they? they make enough money off selling their products to us for our own use. LOL!

what i would do if i were in your shoes right now is i'd probably try catching your vet up a bit in the world of feline diabetes, tactfully of course, by perhaps gathering some of the info that's out there on lantus and levemir and such, learning yourself, and then having a nice sit down discussion with her. you might just find that you enlighten her too.
 
As Cindy said, there are lots of meds not approved for cats being used off label, I believe Metacam is one and I'm sure your vet uses that for pain management.

I've used PZI, BCP PZI (which is great like Dale said), but I prefer the Levemir we switched to because it is so much more gentle for my cats. I don't know ProZinc but it seems to be a little harsh from what I've seen on the Board.

Show your vet this document on Lantus (Glargine)
http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf

If you can, take a look at the information on the Lantus support group where I got that link from.
viewtopic.php?f=9&t=157

The information may be very helpful for you to make a decision or even show to your vet. I don't know the number of cats that have been on Lantus/Levemir from this board, but others may and I'm sure the numbers would be staggering. They are both excellent insulins and if it were me just starting, I'd go with Lantus. Because my cats were FD for so long, I chose Levemir and absolutely love it. My cats felt better almost immediately.

Misty and Tucker both didn't scrunch their heads, they used to get these head aches from the ups and downs of other insulins. The BGs were high, they'd get a shot, then go lower during the day, not too low, but then they'd go up. It was like being on a constant roller coaster, I'd imagine.

Today I have only Tucker on insulin, but the gentle numbers he gets on Lev make him a less grouchy and happpier kitty.
 
Vetsulin - the product warning is because it can be irratic and dangerous. To me, that's nuf said, I wouldn't risk swinging from not treating the disease to overdosing the cat when there are products that don't have that problem..

Sorry, but your vet sounds like she is practicing old school medicine and needs to do some reading and research to catch up with the treatment of diabetes in cats. Lantus is showing one of the best reconvert rates in newly diagnosed cats (up to 85% in some studies); your vet shouldn't miss that just because the FDA testing hasn't been done.
 
Melanie and Smokey said:
Sorry, but your vet sounds like she is practicing old school medicine and needs to do some reading and research to catch up with the treatment of diabetes in cats. Lantus is showing one of the best reconvert rates in newly diagnosed cats (up to 85% in some studies); your vet shouldn't miss that just because the FDA testing hasn't been done.
Click to expand...

Agreed. My vet gave me the same line about BCP PZI not being recognized by the FDA. However, I did not go that route as the ProZinc finally did it's magic. One must remember that YOU are the best advocate for your cat - and if your vet is too set in their ways - there are plenty of vets that are willing to learn and work with you.
 
Elson and five tails said:
Q. What about using products like Lantus or Levemir off-label?
A. That is a possiblity. Some vets are using Lantus with good results, but my vet suggested that we don't cross that bridge unless we come to it (the impression I got was that using medicines off label is something that should only be tried after approved options are exhausted).

It's hard for me to go against my vet's recommendation...

What would you do?
Click to expand...
I'll tell you what I did. I really like my vet. She runs a small and large animal practice. She's been there for me many times. She tries to keep the costs down.

When Maggie had to go back onto insulin after many years off, we were in a bind. Maggie had been on Humulin U which was no longer made. Vet Vicki didn't really like the veterinary insulins because they didn't give the nice gentle curve Humulin U did. I told her about Lantus and Levemir. She had never heard of them. I printed off the info from here and from the petdiabetes.wiki for her. She read up, called around to other vets, called OSU and decided on Levemir. We worked together on it this, and it worked very well.

I complimented her on being open to my internet research. She said, "I'm only human and I don't know everything. I'm always happy to learn." (Love her!!)

So, I'd print some information out for your vet. Tell her you are looking for something with a gentle curve and 12 hour duration. And remember, you can start on one insulin and change to another if you aren't getting the desired results.
 
tuckers mom said:
I don't know ProZinc but it seems to be a little harsh from what I've seen on the Board.
Click to expand...
Personally, I haven't noticed ProZinc being any more "harsh" than PZI Vet and I haven't noticed anyone else say that ProZinc was more harsh than any other PZI insulin [but I haven't read everything on this board so... what do I know?]. Anyway, I've used ProZinc and the old PZI Vet with success and have been very happy with both. My transition to ProZinc from PZI Vet was not absolutely perfect in the beginning but that was because I was lazy/stupid and did not treat it like a change to a new insulin.

EDIT: L&L are great insulin and the PZIs are excellent too and have been great for us. PZI has certain advantages in it's flexibility time wise. Also in our case PZI is great because it does not build up a "shed" so when H stops eating I do not have to worry about a shed built up or building up again one he stars eating again. Also, if I'm out late and I am a couple hours late [I've actually been up to three hours late a few times] it does not mess anything up. So PZI is more convenient in that way than the Ls. So it depends on your cat, if you kitty is normal excpet for the DM then the Ls would be a great choice [and even PZI would be great too]. And if your kitty has some things going ons [or you want flexibility] then I've found PZI to be particularly beneficial in that regard. The Ls may have a smoother curve for uncomplicated cats - though for cats with some things going on this may not be as true. Vet comfort level can be another consideration too - some vets might be more comfortable with ProZinc since it is FDA approved for cats. Irritating a vet you depend on care for should be minimized. Conversely, there are studies with Lantus using specific protocols with cats that have had excellent results so you could share those with your vet to help them become more comfortable with Lantus. In the end, as long as you go with a PZI or L your are in good territory and the each have their advantages. Lantus seems to have the biggest userbase here...
 
Hi,

The fact that the company that makes vetsulin is actually telling vets to transition cats to other insulins is all there is to know! They obviously don't want a law suit (though someone was starting one. Somone posted it on here a while back)

We used aninsulin (european name for vetsulin) in the beginning. Total ups and downs. Finaly got a script for Levemir and Lucky was beautifully regulated in no time.

Lantus and Levemir studies that have been undertaken in USA? (Rand, I think it's American),German feline diabetes forum and Queensland have all had similar results. If Lantus/Levemir used within 6 months of diagnosis, excellent chance (not guaranteed) of remission (diet controlled)

As someone else has suggested, would print off 'convert a vet' and the studies from the stickies in the Lantus isg (go to insulin groups and click Lantus)

Also, you don't need prescription food. Plenty of commercially available foods that are better.See the Frequently asked questions post by Cindy at top of page. Part way through gives link to canned food table. Dry food is one of the big reasons kitties become diabetic as it's loaded with carbs.

If you swap to wet, also whatever insulin you use, start with 1u.
I'm sorry, I know you like your vet, just hope despite all her 'bodies' she's part of she's still willing to learn from a lay person (that seems to be half the battle most of the time)
Good luck :-D
 
Elson,

You've gotten great feedback on the medical issues, so I'll comment on trust.

I had to walk away from our first vet, who gave me the wrong advice when my kitty was first diagnosed. That was very hard to do. Here's what I learned: I had to take responsibility for my kitty's health, and make my own decisions in consultation with my vet. I ended up getting another opinion, which is what led me to this wonderful website. My kitty just went off insulin - remission after 15 months on insulin. We were on Lantus, BTW.

I had to learn to be as assertive as you're being. If you get an answer that doesn't make sense -- like starting on an insulin that is being phased out -- trust your gut, and keep asking questions until you're satisfied that you have a sensible answer.
 
I tried pretty much every insulin available in the 7+ years that Angel was diabetic. Nothing ever worked great for her, but in the last few weeks of her life, ProZinc with an R booster finally worked pretty well, definitely better than anything else had. I agree with the advice from others. I wouldn't use Vetsulin except as a last resort. I did use it with Angel for a while, but it had changed in its behavior before the FDA warning came out last year, so I stopped trusting it. It also is not a long-acting insulin in most cats, and only lasted 4-5 hours for Angel.

Most regular vets that I've encountered aren't keeping up with new treatment protocols, unless a sales rep from a company marketing to vets shows up at their door peddling a new product. I would never have known about Lantus or Levemir if I hadn't seen it on this board, because the vet I was taking Angel to for most of her life knew nothing about them. If I were you, I'd probably try to start with Lantus, if you can convince the vet to give you a Rx for it. Is this vet someone you think will be open to learning about new things? You can get copies of articles published in veterinary journals about studies of Lantus in cats, which have shown good results for losing the need for insulin if used early enough after diagnosis. Maybe that would help make your case.

And if not, do you live in a place with other vets you could try instead, if your current one isn't open to new ideas?
 
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