general questions about insulins

Status
Not open for further replies.
eliseandpony

eliseandpony

Member
i would like a complete list of current insulins that are available for diabetic cats in the USA. So many seem to go by a variety of names and i am getting confused. For example, Lantus is glargine, but are there other names that are also glargine? I would like to know the general makeup of each, so that i can see what they have in common, like which is porcine, bovine, etc... Of course, i have been reading all around on the message board trying to answer my own question, but a lot of changes are being made as products are introduced and eliminated and i need current info. What insulin is most similar to Vetsulin in terms of how it is derived (not its action)? I am thinking of trying to get vetsulin through the critical needs program even though it is risky because pony responds to vetsulin and she has not responded to lantus or humulin n. it seems the general belief is that one insulin is as good as another, except for one insulins action may suit your pet or schedule better. But has any one else had a pet that seemed to really only get results from one insulin and not another?
 
I am far too inexperienced to tackle your question. Just letting you know someone is here for you! Hope you get answers quickly & your kitty achieves maximum health possibilities ASAP. :)

-Mike 'n' Pixie
 
Okay, I'm not nearly as familiar with the different insulin types as some of the folks here, but I'll make a stab at it. (Am perfectly willing to accept corrections to this post.)


Glargine is the generic name, Lantus is the trade name. Like aspirin is a generic name, and Bayer is a trade name. Most folks here refer to Lantus, because that's what's branded on the side of the bottles and pens that they buy; pretty much all research will be released under the generic name.

Besides Lantus, there's also Levemir (generic name detemir). I don't know much about either Lantus or Levemir, though I know a lot of folks have had good luck with both insulins. You can try reading the FAQs in the forums, or try their Wikipedia or manufacturer's pages. Both Lantus and Levemir are insulin analogues. Wikipedia: "An insulin analog is an altered form of insulin, different from any occurring in nature, but still available to the human body for performing the same action as human insulin in terms of glycemic control."


There's PZI, which comes in various types. The manufactured version, Idexx's PZI-Vet, was a bovine/porcine blend that many cats did well on. It's no longer being manufactured. While some vials can be found, reliably sourcing this insulin is and will become increasingly problematic.

You can also get PZI specially made for you at compounding pharmacies. One such pharmacy is BCP in Texas, which is specifically promoting it's compounded PZI as a replacement for Idexx's PZI-Vet, but you should note that almost any compounding pharmacy should be able to make some form of PZI for you. If there's a compounding pharmacy near you (check your phone book), then you can save a bunch in shipping costs. However, you should be aware that there are a number of different 'recipes' for PZI, so if you're looking for a specific type of PZI, make sure you contact the pharmacy beforehand and see what they can supply you with.

Also note that compounded insulins have a lesser shelf life than manufactured insulins (typically 6 months vs a couple years), and there may be variations in the strength of compounded insulins from vial to vial.

And then there's ProZinc, a synthetic analogue that is being marketed as the 'successor' insulin to PZI-Vet. The company claims that it's similar in action to PZI-Vet, though it has different ingredients.


There's Vetsulin / Caninsulin (same insulin, different names in different countries), which is pork-based. That's been having instability problems with how long it remains effective in the body. Due to those problems, the manufacturer has stopped making the insulin and is recommending that no new animals start on it and has warned that animals currently on it will need to be transitioned to a new insulin. I have absolutely no idea whether Vetsulin can be compounded or not, but it might be worth asking about.


And then there're the N's -- Humulin N, Novolin N, NPH. The base ingredient, Humulin, is produced in a lab by a strain of e. coli that's been genetically altered to produce insulin. The Humulin is then mixed with other ingredients to make different types of Humulins -- R, N, L, U, 50-50, 70-30. I've not heard of 50-50 or 70-30 being used in cats. L and U were moderately popular, but the companies stopped making them back around 2005. N can be used, but it's known for it's quick, sharp drops in BG levels, and it usually doesn't last the full 12 hours. Many cats do better on other insulins. R works even faster and runs out even quicker than N; I'm not aware of any cats that have ever been on it.


There may be other insulins available which are being used in cats; these are the ones I can think of off-hand.


> I am thinking of trying to get vetsulin through the critical needs program even though it is
> risky because pony responds to vetsulin and she has not responded to lantus or humulin n.
> it seems the general belief is that one insulin is as good as another, except for one insulins
> action may suit your pet or schedule better. But has any one else had a pet that seemed to
> really only get results from one insulin and not another?

The problem is that every cat reacts differently to each insulin, and there have been cats that have done fantastically well on each -- and there have been cats that have done incredibly *badly* on each type of insulin as well. I went througb four or five insulins before we finally managed to get Gwyn stablised on PZI-Vet, and I know Susan&Cassidy had a bunch of problems because Cassidy had some sort of allergy to either a protein or an additive. If Pony does well on Vetsulin, then Pony does well on Vetsulin. *shrug*


FWIW, I was unclear from Schering-Plough's statement whether they were simply restricting sales of Vetsulin to critical needs patients (which is what I think they're doing), or whether they're starting limited production of Vetsulin again (which I suspect they're not doing). If they're not re-starting production, then the supply of Vetsulin *will* eventually run out. You might think of trying to hoard some (that's what I did with PZI-Vet), or make another attempt at transitioning Pony to a different insulin. I would think other potentially-viable options might be one of the compounded PZIs, or seeing if your local compounding pharmacy (or a mail-in compounding pharmacy) can make a compounded Vetsulin. Or maybe someone else here has better suggestions??

Good luck to you and to Pony --

Jean and her Gwyn
 
great reply, thanks. i, too, am confused if any new vetsulin is being manufactured for the critical needs program or if they are just distributing what remains that way. there is a compounding pharmacy here in portland. does any one know if vetsulin can be compounded? it sounds like my remaining options are to try levemir, compounded PZI, or prozinc. and, it sounds like compounded PZI and prozinc are the most similar to vetsulin in terms of their make up. thanks for getting all that info together so fast, you really have taken a mighty stab towards answering my question.
 
I can tell you, whereas I was immensely satisfied with the results of ProZinc especially since my vet's initial instructions were to dose WAY TOO HIGH and it didn't kill him (used ProZinc for the first few days while I was still learning about my Pixie's condition), the $120 price tag quickly steered me in a different direction. I am now trying Levemir (as two 10ml vials were acquired for me at no charge by my girlfriend's sister, a nurse). Tonight was the first night. Kitty has slept through a couple hours of it (but does his usual "I'm so comfy sleeping" periodic body-stretches). So far so good!

-=][V][=-
 
> does any one know if vetsulin can be compounded?

No idea, sorry.


> there is a compounding pharmacy here in portland.

No idea if the list is current, but there's a list here in case the one you're thinking of can't help you. ('Cause different pharmacies use different 'recipes' to make PZI and maybe other stuff as well.)


> it sounds like my remaining options are to try levemir, compounded PZI, or prozinc.
> and, it sounds like compounded PZI and prozinc are the most similar to vetsulin in
> terms of their make up.

Assuming that you decide not to continue with Vetsulin (or the supply eventually runs out), there are two sides to your situation: the chance at remission vs. the chance for response.

I know that folks on Levemir have a fairly decent shot at remission, which may be something you want to try for. But of all the insulins out there Levemir is closest to Lantus, which you had no success with. If you do decide to give Levemir a try, you might see whether someone will sell you a single pen cartridge, which will give you a chance to try it without investing in a entire 5-pen set.

A second option that *possibly* falls into this try-for-remission category is ProZinc. I know it's an analogue, so it's less "close" to Vetsulin than, say, PZI, but I've not really looked much at ProZinc beyond that. (I never had to.) So I don't know how many cats have gone into remission on it, nor what the remissions rates are compared to Lantus and Levemir. And while PZI is closer "related" to Vetsulin than, say, Levemir, I have no idea where ProZinc falls in relation to Lantus and Levemir vs. PZI and Vetsulin (ie, is it in some middle ground? Or closer to one side or the other? *How* much closer?)

The alternative to looking for the highest-remission insulins would be to look at insulin(s) that folks have been (to varying degrees) less successful in achieving remission on, but which Pony may have a better chance of responding to. In that case, I suspect your most viable options are compounded Vetsulin (if that can be done) or compounded PZI. I'm thinking this because Vetsulin is pork-based, and PZI can be either beef- or beef-and-pork-based, while both Levemir and ProZinc are insulin analogues.

You might want to talk over your options with your vet and see what his/her opinion is.


> great reply, thanks. [...]
> thanks for getting all that info together so fast, you really have taken a mighty stab towards answering my question.

Like I said, there are folks here who know more than I; hopefully someone with more knowledge can chip in and expand / correct as needed.

-- Jean and her Gwyn
 
so then assuming that she just does not succeed with analogues (which may not even be a valid assumption), then the only other choices seem to be compounded PZI or the vetsulin Critical Needs Program. I am not really aiming at remission as it just doesn't seem possible with her. she is on 8 units vetsulin and an underlying health condition has been suspected for a while now. i am just about to have her tested to see if it might be acromegaly. i only started hometesting recently, when i tried to get her going with the humulin n. i slowly got her to 7 units, but that either wasn't enough, or it just wasn't working. (see my ss) i couldn't let her stay with such high numbers any longer, she was miserable with no energy and just laying on her side getting up stiff legged only to get water or to pee. i scored two bottles of vetsulin, which my vet had to call around and beg for, and i just put her back on that. so now i am thinking about what to next. she used to seem pretty good on vetsulin, and now for the first time i am seeing her home testing numbers on it. way better than the humulin n. and it looks like i might even be able to give her more vetsulin and then she might feel even better. but i do need to start developing a plan in case i can't get more vetsulin soon. so, i guess, if it could be compounded (which i don't actually think is possible, i think i did read that somewhere but will still check into it) i'd do that, but if not i'd try compounded PZI next.
 
If this was my cat and I wasn't trying for remission, then I'd ask whether Vetsulin can be compounded. If it can't, then I'd look into compounded PZI -- first, preferably a beef-pork PZI and, if that didn't work, then a beef-only PZI from a different compounding pharmacy. And after that I'd look into either Levemir or ProZinc -- or maybe someone else can suggest an insulin I've missed.


If you decide to try to hoard Vetsulin, you might try posting to Supply Cabinet. I know that, even in the past six months, there've been vets who've put newly diagnosed cats on Vetsulin, and at least some of those cats have moved to other insulins. If folks still have their old, partially-used vials lying around, maybe they'll donate or sell them to you. If you do post, I'd make sure you mention that Pony is a high-dose kitty who doesn't respond to Lantus or Humulin N.

If you post to Supply Cabinet, you might also consider cross-posting to the Vetsulin group. In the unfortunate event that someone's kitty passes, they may remember your post and offer to pass on their insulin. That happened to me with PZI-Vet, and I am eternally grateful to those folks who helped my beloved Gwyn.

And ... I think that's about it for my brain right now. Good luck to you both!

-- Jean and her Gwyn
 
PZI is genetically the closest to the insulin produced by cats.

Since you haven't had much luck with Lantus or N, I would try PZI before going back to Vetsulin.

For my cats, I've used N, PZI and Levemir. If I had a problem with the 12 hour schedule that Levemir requires, we would probably still be using PZI from BCP Vet Pharmacy in Texas. (it can be dosed on a more flexible time schedule)

My first diabetic cat Norton was on N from 6/2006 to 3/2008, then PZI from 4/2008-5/2008.
Tiggy (adopted last year) was on PZI for 5-6 years before we adopted him. Since then, he has been doing very well on Levemir.
Rusty (adopted in March) was on Lantus for over a year at Claudia's - then we switched him to Levemir in March so we wouldn't have to juggle two different insulins for the two diabetic cats currently in our home.
 
Like aspirin is a generic name, and Bayer is a trade name.
Click to expand...

You have gotten some of the major points to all insulins. So I'm just making a correction (as requested :-D ) Aspirin is actually the brand name, Bayer is the manufacturer (in Germany only the product made and sold by Bayer pharma AG is allowed to be labeled aspirin) the generic (active ingredient) is Acetylsalic Acid.

Just like Tylenol is the brand name of Acetominphen or N-acetyl-para-aminophenol (APAP) which is manufactured by a division of Johnson & Johnson.

Lantus is the brand name of Insulin glargine, marketed by Sanofi-Aventis (Frankfurt-Höchst) it is a recombinant human insulin analog. It is a long lasting basal insulin

Other analog insulins are:
Lispro insulin made by Eli Lilly and Company sold under the name Humalog (it is a fast actung insulin)
Aspart insulin, Novo Nordisk manufactures "aspart" and marketed it as NovoLog/NovoRapid also a rapid acting insulin analogue.
Glulisine is a newer rapid acting insulin analog from Sanofi-Aventis sold under the name Apidra (rapid acting)
Detemir insulin from Novo Nordisk markets it under the trade name Levemir as a long-lasting basal insulin

An alternative to Vetsulin would be "N" insulin sold as Humulin N, Novolin N,Novolin NPH, NPH Lletin II, and isophane insulin. It is also a recombinant human insulin (synthetic) combined with a synthetic protamine. It has a simular working profile to that of Vetsulin, it is considered an intermediate-acting insulin. Disadvantage is like all other huan insulins it only comes in U-100 concentration.
 
Elise,
You will have a very important missing piece of information when you get the acromegaly and IAA test results. It very well may be that Lantus didn't work for you because you never got close to the needed dose. Some acrocats require HUGE doses.

I used vetsulin for years, got up to 13-14units and never really got Cody regulated under 250. Then one day out of the blue he started getting random low 100's and next thing I know its being recalled. So we switched to Prozinc and it was so much more gentle and long lasting. and Cody started feeling better

One BIG issue with an acrocat is the $$ you spend on insulin. Both vetsulin and Prozinc are u40 insulins, which means that each vial has 400units in it. At 13 u BID, you go through a U40 vial in about 2 weeks. I get it for $84 but $120 is not uncommon, so at 14u that would be ~$200 /month.

Lantus and Levemir (and some compounded PZI insulins) are u100 insulins, so there are 1000 units in a vial. I just purchased lev for $101 from Walgreens using a county discount card. (look up caremark and see if your county participates) Assuming we work back up to 13/14 units, that vial of Lev will last 5 weeks (2 1/2 x longer). I am hoping that because it has a longer duration even than Prozinc, that the preshots I shoot will stay lower and require possibly less units/dose, but we'll see.

My other thought about inheriting used vetsulin is in my experience it went bad really fast. Sometimes I don't think it held up the 2 weeks it took me to drain it.

There are other good options out there. Wait and see if you have an acrocat. And yes, a lot of non acro cats ARE going OTJ on Prozinc. Ask around in PZI
 
Elise,
Once you have tested Pony and have the results, you will want to consider what insulin you want to use. If the results are positive for acro, that condition is permanent, so you don't want to be trying to continue on an insulin that may no longer be available soon.

You can't really tell from a positive result if Pony will be a high dose or lower dose acro kitty.
For me, I seem to have one of each; Shadoe is currently under 7uLev but Oliver is now at 19uLev.

As was mentioned before, Lantus and Levemir would be very good choices.

Please look at Oliver and Shadoe ss; you will see that Lantus 'seemed' to be not working, but that was due to the fact that acro kitties need LARGE doses, and you just had not reached Pony's good dose.

Once you have Pony tested and get the results, you will know better what should be done.
 
Status
Not open for further replies.
Back
Top