Guidance - Want to switch Insulin

[For Jack]

Tomorrow, Jack has an appointment to get a check up and to get prescribed more insulin. Right now he is on 3 units of Vetsulin twice a day. His BG usually enters the normal range at +4 but by the time he is due for his next shot it has gone back to being high (sometimes even over 600). I do test his ketones and luckily that has not been an issue. Also, sorry but I have not been maintaining his spreadsheet very well so I don't have one to share right now. :x.

Reading up on Vetsulin I read about a study they did themselves. The average dose was 3.3 units and went as high as 8 units! Plus, only 5% of the cats in the study went into remission.

When he was diagnosed last February I was very ignorant when it came to diabetes management in cats. I accepted things that the vet told me. He was diagnosed at the emergency clinic. When he went in his BG was over 600 and they gave him 1 unit of Glargine/Lantus. This brought his BG down to 75. Well, like I said, I was ignorant so when the vet told me they were concerned that Lantus worked "too well" and that 75 was too low a number I believed them.

Here is my main question in regards to Lantus - is it possible to accurately dose less than 1 unit? Another claim of the e-vet was that it wasn't possible to dose less than a unit.

What about ProZinc? I have read quite a few good things about it and it seems that many of the people who use it have good results.

I really don't think my actual vet is very knowledgeable when it comes to diabetes treatment so I feel I need to go in to the visit with as much info as possible. My main thing really is that I don't want Jack on Vetsulin anymore. Fortunately, he seems to not freak out on me (unlike another vet at the practice) when I empower myself in regards to Jack's treatment.

I am doing a curve today so that I can have that to show him as well.

Thanks for any insight. At the end of the day I just want to do what is best for Jack and I don't think Vetsulin is the right treatment for him. He is turning 15 this year and I have had him since he was a kitten.

 

[dirtybirdsoaps]

My thought is, research prozinc, lantus, and levemir and pick what you think is right. Every cat is different, so results may be different but definitely get off the vetsulin if theres been n improvement.

After my research I went with prozinc, and Hidey responded very well to it. Within a month with diet change, a dental & 2 extractions, and prozinc he went into remission. He has now been in remission for 10 months. I liked that prozinc was a little more flexible for dosage, unlike a depot insulin that builds up in the system.

 

[BJM]

ProZinc is an in and insulin (no overlap between doses) which may help your vet understand how to use it properly. I use it with Gracie as my schedule can be erratic, so giving the exact same dose, exactly every 12 hours, can be difficult for me.

Both Lantus and Levemir, depot insulins with carry over effects, need that consistency to work optimally. And when the vet is unfamiliar with using depot insulins, they can really mess up the glucose control.

Cost wise, you need to look at cost per unit of insulin, not the total upfront cost.
Lantus and Levemir have 100 units per mL (U-100).
ProZinc has 40 units per mL (U-40).
BCP PZI comes in 40, 50, or 100 units per mL (U-40, U-50, and U-100 respectively) and a 5 ml sample vial can be obtained by the vet.

One trick with the U-40 is to use a conversion chart and U-100 syringes, to enable dosing in 0.2 unit increments, which is nice on a low dose kitty (Gracie seems to run on about 0.8 units)

 

[Elizabeth and Bertie]

Here is my main question - is it possible to accurately dose less than 1 unit?

Absolutely!
There are cats here on very small doses of insulin (.25 of a unit or less.....)

 

[Larry and Kitties]

The U100 syringes used for human insulins like Lantus can be obtained with 1/2 unit markings. Yu can estimate to the 1/4 unit with those

 

[Deb & Wink]

And some people even measure those tiny doses with calipers.

Generally, you are trying to be as consistent as possible with the dose you are giving. What you draw up as 0.5U may be a bit different than someone else. I have read a number of studies that say you can not measure insulin accurately in doses under 2U. Well, that may be correct but again, our kitties are small and need those smaller doses so we get as close as we can, from shot to shot, of the amount of insulin we are giving. Eyeballing those tiny 0.25U increments and then learning how to measure "drop doses".

Some of this is made way easier by having the smallest syringes available, 3/10 cc with half unit markings on the syringe barrel. These pictures were made with those type of syringes, the marks with the shorter line is the 0.5U increment mark.

 

[For Jack]

Thank you everyone for all your responses .