Considering a switch to another insulin

[donnahc]

Hi everyone!
Thanks for taking the time to read my post. I am cross posting this on both Lantus and Levimir just fyi.

Currently I am a ProZync user. It has been brought to my attention a few times that I may want to switch insulins. I guess I am a bit scared to make a switch but bottom line is I have to do what is best for my cat Asher.

I am wondering if some of you might have time to look over my spreadsheet and offer your opinions if Asher might be a good candidate for Lantus or Levimir .

Asher is 7 years old (will be 8 next month) and in good health other than diabetes. He takes no other medicines besides insulin. His dx was January 3 of this year. He has had a dental and regular checkup this past spring. He is currently on 3.1 units of ProZync bid. We use a Freestyle Lite meter and U100 syringes (with the conversion chart) for smaller dose changes. We feed home baked chicken treats and canned Blue Buffalo Wilderness cat food. He gets about 3/4 can mixed with some water twice a day plus his chicken treats.
He usually has a mid day snack and a 3 am snack. (seemed to help his numbers a bit) He has a brother Alby who eats exactly the same thing as Asher, so there is no naughty food around for them to get into.

I am also concerned about flexibility. My partner and I are self employed photographers. And I have an elderly Mother that we help out. We can usually test mid day, sometimes we can’t due to work out of town. We can always test at night if need be. You can see by our spreadsheet we don’t only test before shooting insulin. Do you think we could be Lantus or Lev people? I have heard one has to be more rigid about using insulins other than PZ, but that could just be a nasty rumor

So far the “worst" we have had to do is move his evening shot back an hour unexpectedly due to getting home late from work, and over a period of days moving him up 15 mins per day to a time we could shoot early so we could leave early for a job. We have also moved him up a half hour if his numbers were high in the pm, to avoid him going even higher. Are any of these things Lantus or Lev no nos?

I think some sort of protocol or set of rules would be good for us. Sometimes I just flounder around with PZ and am not sure what to do. I think due to all the great help from the experts in PZI land, we have come a long way, but it is possible with another insulin we could do better. It is possible that Asher is on the “difficult kitties list”

Lastly I am concerned about talking my vet into this. I switched vets once in the beginning of this journey. Our first vet was mean and was insistent we start with a higher dose. She said we should only test bg if the cat was “sick” and we shouldn’t use a human meter. She also withheld insulin from me and it made me mad enough to switch vets. I now go to my Mom’s vet 40 minutes away. He is a kind man and very good vet. He has helped my Mom’s cat so much and was very receptive to us coming to him. He is very into testing at home. He will email me with answers to my questions and is impressed by the spreadsheet He uses ProZync. I asked him about a switch once before and he kind of brushed it off.
Have any of you had to talk your vet into a switch? Is there anything I need to know about getting a script and buying Lantus or Lev? Does it come in a vial like PZ and dosed the same way?

So there is our story. Any insight you all may have is much appreciated. Thanks so much!

 

[Sienne and Gabby (GA)]

Welcome, Donna!

Asking here about Lantus or Lev is a bit like preaching to the choir! I've not used Prozinc so I can't comment from my own experience. What I can tell you is that there are quite a few people here who have switch from Prozinc to Lantus. There's no way to predict how a cat will respond to Lantus or Lev. If you think Asher isn't doing as well as you'd like on Prozinc, then give Lantus or Lev a try!

Lantus does require a bit more consistency than other insulin. That said, there are people who have successfully used Lantus who work long days or who's schedules are difficult. You do the best you can to keep to a 12-hour cycle. Where some types of insulin will allow you to shoot an hour early or late, you don't have that much flexibility with Lantus -- at least not on a regular basis. It's less of an issue if, like you described, you have to give a late shot and then migrate the time back in small increments. An early shot is more problematic due to the overlap between doses with the long-acting types of insulin.

Looking at Asher's SS, the one difference will be that you will need to get some tests at night. Lantus/Lev dosing is based on the nadir. Getting pre-shot tests is very important but you also need to get at least one spot check per cycle.

I'd suggest reading the starred, sticky notes at the top of the Board. They will give you a good idea of how Lantus/Lev works. Prozinc and Lantus/Lev require a very different mindset reading the notes may generate questions that we can help answer.

As far as convincing your vet, I've attached a research article from a veterinary journal that investigated the outcomes of Lantus (glargine) vs. Prozinc.

 

[Jill & Alex (GA)]

welcome to the group, donna!

i've used both lantus and levemir. i can't say i have a preference for either one. they're both great insulins! alex has done very well on both. about the only difference i've seen from one to the other is *usually* kitties nadir a little bit later on levemir than they do with lantus. however, ECID! since lantus and levemir are so similar and can be used the same we have had many, many levemir users join us on this forum. as you can see from the stickies posted at the top of the forum, we don't differentiate between the two insulins.

sienne linked you to a great article to use for convincing your vet to give you a script for lantus. research has shown using lantus or levemir results in close to the same percentage of cats going OTJ. lantus had only a very, very slight edge over levemir.

both lantus and levemir are more effective when used on a 12/12 schedule. however, life often has a way of getting in the way of that "perfect" 12/12 schedule. not everyone can hit that 12 hour mark daily. many of the lantus and levemir users here have come up with some pretty creative ways to handle schedule changes. i wouldn't let your schedule distract you from using either one of these insulins.

lantus is available in vials and a box of five 3ml SoloStar Pens. levemir is available in vials and a box of five 3ml FlexPens. Some pharmacies will sell you a single pen rather than a whole box. vials are less expensive than lantus or levemir pens, but generally speaking the pens prove to be more cost effective.

last, but not least...
you'll undoubtedly hear some hoopla about the longevity of levemir versus lantus. not everyone is up-to-date on the lantus/glargine research from the two leading experts in the field, Jacquie S. Rand BVS, DVS and Rhett D.Marshall BVS. in their words:

"Glargine should be refrigerated because it has a shelf life of 4 weeks once opened and kept at room temperature. We have found that opened vials kept refrigerated can be used for more than 6 months. If using an insulin pen, the manufacturer recommends that once a vial of insulin is used, the pen be kept at room temperature because temperature changes associated with refrigeration alter the volume administered by the pen."
http://www.uq.edu.au/ccah/index.html?page=43599&pid=0

we use U100 syringes to draw Lantus from cartridges (no longer available in the US) and pens. we do NOT use needle tips which can be attached to the pens to administer insulin. therefore, refrigeration will not alter the volume administered by the pen apparatus. refrigeration combined with the use of syringes to draw insulin (versus using the needle tip made for the pen) from the opened pen has been found to extend it's life well beyond the 28 days suggested by the manufacturer. please see the sticky for more information on lantus and levemir: STICKY: LANTUS & LEVEMIR - INFO, PROPER HANDLING, & STORAGE.

both lantus and levemir users have been able to use their insulin far longer than what the manufacturer recommends by refrigerating both unopened and in use insulin. incidentally, lantus & levemir users on the German Katzen Forum were onto this long before we were! lol!



good luck whichever insulin you choose to use... lantus and levemir are both excellent choices! i think you'll be very happy with the switch.
hope to see you posting often! :mrgreen:

 

[MauiGuppy]

Hi Donna!

I'm not familiar with Prozinc either and have been working with Lantus for 5 months now, 3 of them with FDMB.com.

From what I've seen on this board, there have been folks who have made the switch and the transition has been pretty good.

To me, it seems that the ones who struggle are ones who change doses every day or every couple of days because of what they see at pre-shot and who don't do spot checks. This would be true of any newbie but with former PZI users, they might be struggling b/c they're trying to use what they know about PZI and apply it to Lantus. Fear of the unknown may be holding them back.

Hope this helps.
Bonnie

 

[Angela & Blackie & 3 Others]

Welcome to the group!

My cat, Blackie, was on ProZinc before I switched her to Lantus, and I can honestly say that I'm glad that I made the switch. I'm not sure how Levemir works, however, if you choose Lantus, you start at the losest dose, which is 1u BID every 12 hours. The starred stickies for the protocol will tell you everything you need to know, and if you have any questions at all, there are always someone with experience on here to help you.

Good luck, and again welcome.

 

[mybuddybinks]

Welcome!

our history is not truly helpful, as we began with Vetsulin, but Binks was terribly ill when we switched to lantus, and with the wonderful guidance
from the folks here, Binks went OTJ after 7 months.

Obviously, I'm a huge fan of lantus, but my only other experience was basically a non-viable insulin with no info or guidance.

best of luck with whatever you decide, though!

Celi & Binks

 

[donnahc]

Thank you so much everyone for your informational responses!!!

After talking with my vet, right now I think we have decided to stay with ProZync. Our vet feels we are doing an excellent job managing Asher’s diabetes and is happy with his numbers and feels his clinical signs are excellent. He feels the PZ is working and tries to reserve the use of other insulins for cats who don’t respond to PZ. It is also flexible for our nutty schedule.

He asked about the diet, and mentioned we could tweak Asher’s diet to lower carb too, but he didn’t remember we are already feeding 1-2% carbs, so I don’t think we can go much lower there.

So...we are hanging out with PZ for now. If things change in the future, we’ll be back.

Thank you all again!

Donna and Asher