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 Levemir 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 Levemir .

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!

 

[Vicky & Gandalf (GA) & Murrlin]

Hi Donna,
After looking at Asher's spreadsheet he's all over the place on Prozinc sometimes, but others does OK with steadier numbers. Steadier BGs are better for them than swinging from 300s to double digits to 300s or more again by next shot time.

I'm sure you've read the stickies on both ISGs. Ours does not address Lantus as few of us here have used it.

I have had to develop a split dose regime for using Levemir due to my job and I feel it works fairly well, better than leaving the next shot go to +14, so I can help you understand how to dose on days you might have to give a later shot. It simply involves splitting the dose in half and giving at 2 separate times to extend duration. In my experience Levemir has flexibility if you use its duration to advantage.

One thing that's less flexible on Lev is dosing. There needs to be a plan of increasing which starts with a low dose (1U would probably be OK for Asher to start) and systematically increases as the nadir warrants. The Tilly protocol is the standard to follow although we sometimes see the need for smaller increases rather than .25U. It really depends on how the cycles are going.

Hope that info is helpful.

 

[Sheila & Beau GA & Jeddie GA]

Donna, thanks for the detailed account of Asher's FD history. You might want to copy and paste the food, dosing, testing and health details into a Word doc to use to create a profile at some point. All that info is important background - so why retype it, right?

Anyway, I think most (all?) cats are good candidates for lev or lantus, but I think ProZinc is also a good insulin. What are your reason's for considering a change? What do you hope to get out of a new insulin that you aren't getting now? Those answers would help us in answering you "switching" query.

I do think that lev is more flexible than lantus, but I have very limited knowledge of lantus - just reading what others have posted about it. These insulins work differently than ProZinc so you will have a learning curve. I used another insulin for 2 years before switching to lev and it was a whole different way of thinking about dosing and "reading" the BG numbers, but not impossible to learn by any means.

I wonder if Asher is getting a too much insulin now? With the faster acting insulin (vetsulin - even faster than PZ) I never wanted Beau's nadir to go below 80 - at least in a planned-for way - and he had a lot of sensitivity to lower numbers (below about 120) and fast and/or deep drops. They always set him up for rebound. I noticed that Asher was getting a nadir of 80 with PS's in the mid 200s on a 2u dose back at the end of Feb. That was a nice, gentle curve. Then a few days later, he had a PS of 126 so was probably lower than 80 a few hours earlier. You shot a reduced dose, but he still had a rebound bounce into the 300s. He also had some nice curves on 1.6u a few weeks before that. He might do better on a dose somewhere between 1.5u and 2.0u.

So, if you switched to lev I would actually rather see him started at .5u than 1u because you are looking for the best dose to shoot consistently at every shot time that won't cause BG swings from 50s to 300s. It takes patience and methodical dose raising to find that best dose. Lev works best without dose "hopping" that is pretty standard on the faster-acting insulins. Sure you will have times when you have to reduce the dose on an unusually low PS because you don't have the data to show it will be OK and/or you won't be home to monitor him, but in general you want a consistent dose.

As for talking the vet into it - there is information and studies posted around her somewhere that you could printout and show to him along with your explanation of what you want the new insulin to achieve that you can't get, or can't get easily, with PZ.

 

[Blue]

I have not had any experience with PZI but have given Shadoe Caninsulin, then switched to Lantus, and then to Levemir. She definitely does much better on Lev than on Lantus; she is more tense on Lantus, I don't know why.

Also there's the 28days for Lantus as opposed to the42days for Levemir to consider if you are on a small dose.
I do know that some may say it's important to stick to the 12/12 rule and that an early shot is an increase and a late shot is like a decrease, but you also have the bit of an overlap so you have a bit of a leeway .... If you are 30min late, it won't ruin everything.
The shed could come in handy for the odd shot times.

 

[Vicky & Gandalf (GA) & Murrlin]

I have not had any experience with PZI but have given Shadoe Caninsulin, then switched to Lantus, and then to Levemir. She definitely does much better on Lev than on Lantus; she is more tense on Lantus, I don't know why.

Also there's the 28days for Lantus as opposed to the42days for Levemir to consider if you are on a small dose.
I do know that some may say it's important to stick to the 12/12 rule and that an early shot is an increase and a late shot is like a decrease, but you also have the bit of an overlap so you have a bit of a leeway .... If you are 30min late, it won't ruin everything.
The shed could come in handy for the odd shot times.

Are we really going to hash this one over again? I don't use Lantus so I will not comment on its efficacy life, but Levemir in the experience of every one of us here is that Levemir in the flexpens, if refrigerated, is good to the last drop. No one considering a switch to Levemir should be scared off because of what the insert says regarding its intended use for humans, which is unrefrigerated and carried around in a shirt pocket or purse.

Sorry to be harsh and hijack the thread on it, but this issue should be swept under the rug for good. I have nearly 4 years experience using every single pen down to about 12U over 3 month periods each. And Dian and Wheezer would probably tell me I wasted those 12U!

And for what it's worth, Lantus users have been able to use pens for longer as well.

Here's a comment from a Think Tank thread:

I chose against Lantus because of its fragility and cost (the pens/cartridges were not initially available).

after years of experience with lantus and levemir in felines, members of the German Diabetes-Katzen Forum have concluded:

"members of the German Diabetes-Katzen Forum buy 3 ml Lantus/Levemir cartridges, refrigerate them after opening and routinely use them for 6 months or more - when refrigerated, opened cartridges of these insulins are extraordinarily stable": http://www.tillydiabetes.net/en_6_protocol2.htm

fortunately, this experienced based conclusion now makes lantus an affordable choice for use with felines...

So don't let efficacy be an issue against either Lantus or Levemir.

 

[Darlene & Jack]

Hi Donna,
We are pretty new here, but Jack started on ProZinc when diagnosed in April and we used it for a month, then switched to Levemir in early May. I read a lot about Lantus and Levemir, and got some advice from others here as well. Jack was having so many highs and lows on ProZinc, many days hitting just about every color on his spreadsheet.

Although we still haven't regulated Jack, his numbers have come down for the most part and he is having more of the gentler curves and overall lowering of numbers, instead just hitting a green or blue midcycle then shooting right back up. We still are trying to find the right dose and moving in tiny increments, but I think he is doing better on the Lev. I had switched vets after Jack was diagnosed so when I discussed with her the switch she was open to it, even though she had never used Lev before. She saw my spreadsheet and that I was closely monitoring and has been fine with it. I had emailed her some of the articles from here and she did research on her own as well. It definitely does take a little while to get used to not changing a dose just based on one number in a cycle as you are used to with PZ, as I'm still learning!

Also, i definitely think that it is much more cost effective to use the pens as opposed to the ProZinc vials. As far as the dosing, if you know ahead of time that you need to give a shot early or late, these ladies are great at helping you figure that out. It's not something I need to do often, but did it this week because we had a day trip planned. It just takes some extra planning, but it's not impossible.

Good luck to you and Asher, whatever you decide.

 

[Phoebe_TiggyGA_NortonGA]

Hi Donna,

I switched Tiggy from PZI to Levemir.

I knew I wanted either Lantus or Levemir.

Lantus:
more documented studies on use in cats <== vet will prefer because of this
good for 28 days minimum
in an acidic base (at large doses, it STINGS when injected according to human diabetics)

Levemir:
acts very similar to Lantus -- follow same protocol
good for 42 days minimum
in a neutral base liquid - NO STINGING

So -- Lev lasts longer and doesn't sting when injected. There are not very many published studies proving how effective it is for cats, but I know many here who have had excellent results.

SO.... I bought Levemir from Canada where no prescription is needed.
(to order online from U.S. a prescription is needed as of 1/1/2010)

If you can drive to Canada, you can walk into a pharmacy and buy it and walk out. No prescription. I live about 35 miles away from the border, so my last two packs were purchased there.

phoebe

Edited to add: I started Tiggy on Levemir without my vet's knowledge. After a couple months, I took him in for an exam -- had her do a fructosamine test and showed her our spreadsheet. The fructosamine showed that Tiggy was very well regulated, and of course his exam showed him in great health. She then wrote a prescription for Levemir at my request.

 

[Blue]

A cartridge lasts me 4 to 6 days so I have no experience with testing the length of time the insulin would be good after the guaranteed minimums from the inserts.

 

[Charliemeow]

Hi donna,
I remember you and Asher from when I was a pz user. we switched to Levemir, but that was because I never saw any action out of pz for Charlie. Also, we suspected acromegaly (which turned out to be the case), so levemir is the preferred insulin for acrocats. I didn't know that lev lasts over 45 days. I've thrown out 2 vials with about 1/3 left in them cuz I heard that it only lasts 45 days or so. I don't have the pens, though. Maybe it's just the pens that last longer? I don't know. But I really like levemir for Charlie. I actually see some movement in his numbers, and our dose is lower than our ending pz dose. I think that maybe pz works great for cats with microdoses, but maybe isn't quite as effective for cats who need more insulin? Just a thought, and I could be way off. Levemir costs about $35 more per vial from walmart (pz was $85 from vet, lev is $120 from walmart). Good luck with whatever you decide!

 

[donnahc]

Thank you so much everyone for your informational responses!!! Yes, I do remember Darlene and Jack, and Claudia and Charlie from PZ Land

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 here for now. If things change in the future, we’ll be back. Lev was my first choice if we were going to switch.

Thank you all again!

Donna and Asher