Hi Sue. Long history to follow but I'd appreciate your take:
We began the FD journey at the end of January 2016 using Lantus glargine insulin at a dose of 1.0 u BID. At the end of the first week the BG curve showed his BG dropping gradually from about 18 to a nadir of around 6 at +12 but I didn't continue testing in the evening. I knew very little then! We continued at that dose another week and a half and on the next BG curve day he plummeted from 20 down to 4 then back up to 20 in 12 hours. The dose was lowered to 0.5 u BID but a week later the BG curve showed him to be high at around 20 all day. Next experiment was 1.0 u AM and 0.5 u PM for a week. This gave us a gradual drop on BG curve day (end of February) from around 24 to 11 at +12 but no data after that. I thought that he probably needed somewhere between 0.75 u and 0.8 u per dose BID on Lantus but didn't think I could eyeball that very well on a U100 syringe. My vet agreed that measuring would be hard to do. He went back on 1.0 u BID for the month of March and stayed stuck around 20 (according to BG curve data from then). I thought he was in chronic rebound and the vet thought we should try him off all insulin for 24-48 hours and then restart him. He plunged into a DKA episode, spent 3+ very $$$$$ days in the hospital and we decided to try him on Prozinc. He's her only cat on ProZinc and I'm the one who's amassing all the experience.
I've been using ProZinc since the beginning of April 2016. We started at 1.0 u BID and upped doses to 2.6 u BID. I was beginning to understand bouncing (rebounding) and the insulin resistance that sets in when the rebound becomes chronic. I took a break from dose manipulation for a long time because it was driving me nuts. Teasel seemed to be coping. In early August I decided to go back at it, told my vet I wanted to try 3.0 u BID and then finally 3.6 u BID. This got some action going finally but put Teasel in near hypo territory. The vet I work with wasn't in the clinic on 08/17 when I finally joined FDMB because I needed help. His SS tells the rest of the story.
My issues with Lantus: at the time his dose was low and I couldn't see how to fraction it any smaller and have any dose consistency. Also, Lantus is acidic and he seemed to react to its sting even at this tiny dose. This unnerved me a lot because he'd react to his injections. I already have trouble holding a pinch in his skin because of problems with my hands. I didn't need to deal with a jumpy cat! I know Levemir doesn't to that but my vet has zero experience with it - I asked. The plus is that Lantus is much cheaper than ProZinc for me here in Canada. Another worry for me is that if a dose is too high, I have a very long acting insulin to work its way through his system with prolonged hypo danger. The reverse is also true: if it's too low, it can keep him high and so on. He's a cat that gets stuck in high numbers easily if they persist over time.
My take on ProZinc: the negative - a vial is expensive ($127 CAD from my vet) and with large-ish doses, I'll need a new one every 6 weeks or so. The positive: I LOVE that fractional doses are possible with a U100 syringe; it doesn't sting; it's more flexible in timing of dosing; it can be used on a sliding scale if needed. I haven't explored 13/11 scheduling or sliding scale yet because we don't have a reasonable starting point as a dose.
Overall: I can't rule out (maybe) trying Lantus again but I worry about transitioning him back, finding a dose to do that, risking another DKA, etc. I lack data on how the Lantus was really working day to day during the 2 months he was on it. I was doing a BG curve about once a week but measuring BG only every 4 hours, not every 2. I can't make any really good comparisons with ProZinc because of this.I might have a better experience a second time with it. I'm not ready to go there yet.
Just had a brainstorm! I PDFd his BG curve summary chart for you to look at so maybe what I've said above is clearer for you:
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