How to change from Caninsulin?

[Vyktors Mum]

Vyktor's blood levels were averaging 11/200 on a freestyle lite meter. Two vets had said not to treat at this level and neither took their own blood test. Turns out the freestyle lite meter is way out at higher blood levels and he was probably averaging closer to 20/360 (comparison done with vet's accuchek they got 17.3 freestyle got 12.9).

I had been finding ketone in his urine but again both vets said not to worry the dipsticks weren't accurate, his BG wasn't too high and he wasn't showing any symptoms.

End result was an emergency rush to the vet and four days in hospital on death's doorstep - diagnosed with ketoacidosis and, following an ultra sound, triaditis.

The emergency vet he saw put him on caninsulin as that is the only insulin they have in stock there. I had already decided that if he needed insulin that lantus or levemir should be the one so now I want to change him over. Especially having seen what's the caninsulin is doing to him (on a new meter!).

Hi preshot BG is now higher than it had ever been prior to his hospitalisation (this morning 25.3/455 on the new meter - the freestyle reading was 15.6/280). The insulin peaks at 4 hrs and then his BG is rising for another 8 hours before he is due for a shot.

Any advice as to how to go about changing over his insulin? I will be back at the vet with him on Friday and would prefer to have the views of the board in mind before I go. The views of the board have thus far been much more accurate than those of the vets!

Because caninsulin is the short acting one and should be completely out of his system by the time he is due for a shot can I just change to lantus at any time?

 

[Vicky & Gandalf (GA) & Murrlin]

Hi,
I can't do any better than send you to the University of Queensland website for veterinarians. Print out the info they have there on managing with Lantus or Levemir and take those articles with you. I hope your vet would be open to the switch, especially since that info comes from the U of Q.

http://www.uq.edu.au/ccah/index.html?page=41544&pid=41544

Here is a dissertation that was done at the University of Illinois, U.S., on Levemir & Lantus use in cats:

https://www.ideals.illinois.edu/bitstream/handle/2142/16049/1_Gilor_Chen.pdf?sequence=3 That is a pdf file, so hope you can open it.

Either Lantus or Levemir is better than Caninsulin. The US version, Vetsulin, is in fact no longer available.

When you make the switch, you simply give a shot of the new insulin at the time you would have given the Caninsulin. I suggest making it a time you can test over the next 12 hours, every 2 hours if possible. You also want to start with no more than 1U of Lantus or Levemir. What dose of Caninsulin are you using fro him now?

 

[Vyktors Mum]

Hi,
What dose of Caninsulin are you using fro him now?

He's only on three units but I imagine the vet would want to increase based on his results but I don't see how an inrease in caninsulin will help. It will still peak in 4 hrs and finish working completely by 8 hrs.

 

[Vicky & Gandalf (GA) & Murrlin]

Hi,
What dose of Caninsulin are you using for him now?

He's only on three units but I imagine the vet would want to increase based on his results but I don't see how an inrease in caninsulin will help. It will still peak in 4 hrs and finish working completely by 8 hrs.

That's the problem with faster acting insulins and often the response from vets - give more. I was giving Gandalf 6U of PZI before I found FDMB and learned that less is often more.

How is your kitty doing now? Is he eating well? It's very important that he is eating well, receiving insulin (even if it is performing poorly) and does not have any infection so the ketones do not return.

 

[Vyktors Mum]

[quote="Vicky & Gandalf

How is your kitty doing now? Is he eating well? It's very important that he is eating well, receiving insulin (even if it is performing poorly) and does not have any infection so the ketones do not return.

He's eating well since he came home from hospital and I'm not tring to feed him MD anymore. Some would say too well but he has always had a good appetite and isn't overweight so I'm not keen to reduce his food. He is still on antibiotics from the vet and tested negative for ketone yesterday. If I wasn't home testing I would think the caninsulin was working quite well. Not so sure the vets will want to increase now though we just got a 4/72 which is the first time I have tested him anywhere near the normal range and is down from 19/340 this morning.

 

[Anyname]

I am not going to discuss whether or not you should change to Lantus. I don't really know enough about Caninsulin. Ask on the Lantus forum what they think IMHO.

Just want you to know that you can buy Lantus across the counter at the chemist. You don't need a script. You should be able to find a chemist who will supply you 5 vials for $90. I have just been incredibly ripped off by my vet. This is the explanation I just received via email:

"With regards to an itemised breakdown of cost for Little Boy’s last consultation (20/12/11):
The consultation was $58.00
There was a Private Script Fee of $18.00 – for the Neoral medication
The 5 vials of Lantus Insulin Glargine $197.20 ($37.04 per vial + $12 dispensing fee).

Unfortunately as a veterinary practice we do need to place a higher mark up human drugs stocked, this is in-part due to out billing structure, and we must also order in much smaller quantities than human pharmacies making it a more expensive exercise."

All they needed to say was that it's much more expensive to buy it thru us and leave it for me to decide. They charged me over twice as much to buy Lantus when I could have saved $110 by buying it locally. This is one of the most disappointing things I've seen in a very long time.
As if having a diabetic, allergic kitty isn't enough work and worry!!!

At least if you change over you won't be totally ripped off by your vet. :sad:

 

[Amy&Max]

Hi there Vyktors Mum,

I don't get on here much any more as Max is OTJ but logged on today to see if anyone else's cat eats slugs. I have caught Max slurping them up a couple of times eeww! I think he's been doing it a while and that may have been part of the problem getting him regulated while he was on insulin. Extra "food" every time it rained...

Anyway, back to the topic at hand Max also started out on caninsulin and we experienced the same thing as you. Got up to a dose of 3u 2xday with preshot BG around 25 and nadir BG of 10-11 around +4.5. By +6 he would be zooming back up. Harsh and fast drop and then gone before you know it :roll:

When switching to lantus from another insulin you can factor in your dose on the old insulin in working out the starting dose. Usually you'd start on 1u 2xday, but can go a little higher with the starting dose as you know Vyktor can handle 3u of a harsher insulin without crashing. I started Max on 1.5u of lantus and we didn't get a lot of movement from high numbers until the lantus dose was around 3 - 3.5u, then had a couple of dose reductions close together.

You'll probably find that you'll go backwards a little for the first week or 2 when changing over. I upped Max from 1.5u to 2u after 4 days as he was looking miserable and back to peeing and drinking lots. From there I held doses around 5 days. Lantus works differently to caninsulin and takes a few days to build up in the system before you see the full effect of a dose - you need to wait at least 3 days to see how each dose is doing. As lantus is such a gentle insulin you sometimes need to go a bit higher to breakthrough the high numbers and then do a dose reduction within a few days back down to to a maintenance dose. ie the maintenance dose doesn't have the oomph to break the high numbers initially but its the right dose for when the preshot BG's are not sky high.

I'm not sure if anyone else mentioned it, but you'll need to use different syringes for lantus. Lantus is U100 (concentration) and caninsulin is U40 insulin and you're probably using U40 syringes (with red caps). Lantus has 2.5 times greater concentration than caninisulin. If you use your old U40 syringes with lantus you'll be giving 2.5 times the dose you want. You can get U100 syringes from a chemist - the one I go to weren't able to get the 0.3ml syringes and only had 0.5ml ones. You really need the 0.3ml ones so you can measure half units. I ordered mine online through medshop - these were the ones http://www.medshop.com.au/bd-ultra-...ml-29-g-0.33-mm-x-12.7-mm-syringe-326103.html They don't have half unit markings but its easy enough to eyeball it.

Also, I opted to get my lantus from the chemist - about $90 for a 5 pack of 3ml vials (Marilyn $197 - ouch!!!). The vet I was using wrote Max a prescription for it and I took it to the chemist. Anyway, if you have any other questions about the switch over PM me and I'll jump on and see if I can help.

Cheers,

Amy

 

[Larry and Kitties]

In the USA, the average cost of a 10 ml vial of Lantus is about $120.

In the USA

I am not going to discuss whether or not you should change to Lantus. I don't really know enough about Caninsulin. Ask on the Lantus forum what they think IMHO.

Just want you to know that you can buy Lantus across the counter at the chemist. You don't need a script. You should be able to find a chemist who will supply you 5 vials for $90. I have just been incredibly ripped off by my vet. This is the explanation I just received via email:

"With regards to an itemised breakdown of cost for Little Boy’s last consultation (20/12/11):
The consultation was $58.00
There was a Private Script Fee of $18.00 – for the Neoral medication
The 5 vials of Lantus Insulin Glargine $197.20 ($37.04 per vial + $12 dispensing fee).

Unfortunately as a veterinary practice we do need to place a higher mark up human drugs stocked, this is in-part due to out billing structure, and we must also order in much smaller quantities than human pharmacies making it a more expensive exercise."

All they needed to say was that it's much more expensive to buy it thru us and leave it for me to decide. They charged me over twice as much to buy Lantus when I could have saved $110 by buying it locally. This is one of the most disappointing things I've seen in a very long time.
As if having a diabetic, allergic kitty isn't enough work and worry!!!

At least if you change over you won't be totally ripped off by your vet. :sad:

 

[Anyname]

Amy, It was Richard who charged me the $197.50 - plus $12 for giving it to me - it was over $200. I'm really upset about it. It feels like a betrayal of trust. I wouldn't have it in me to do that to someone. :roll: I like money as much as the next person but to screw my fellow man to get it? Forget it. I rather feel good about myself!

Marilyn