Insuvet PZI discontinued in UK!

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mrswoodwoose

mrswoodwoose

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Help, I have just received notice from my vet that this product has been discontinued :cry:

Any ideas? Have looked online but can't check for sure if they have stock till tomorrow morning - I so don't want to use the Caninsulin as Cattro is very sensitive to insulin and even on PZI she throws the off low reading before injection (can be as low as 2.9)

Thanks,
Kay
 
Sorry to hear that.

I just called Boehringer Ingelheim Vetmedica to find out if ProZinc was available in the UK or not. I figure their 800 number may not take calls from the UK so thought I would just call myself for you. I got vmail - so I'll let you know on that.

I do not know the other options in the UK. I would say worst case [if you wanted to continue some sort of PZI] you might be able to find a compounding pharmacy to compound humulin with protamine zinc like is done by some pharmacies here.

If you had to switch to a different type of insulin then you might look at Levimir or Lantus over Caninsulin. Levimir supposedly captures some [but likely not all] of the flexibility of PZI but is longer lasting and generally has more gentle curves.
 
[ do not know the other options in the UK. I would say worst case [if you wanted to continue some sort of PZI] you might be able to find a compounding pharmacy to compound humulin with protamine zinc like is done by some pharmacies here.]

Thanks but we don't have the same sort of access to compounding pharmacies here - most are attached to a hospital and you can't get things made up as you guys can.

I have had a look on the net and it does appear that the product is no longer available in the UK, ditto their Lente.

I have posted on the Lantus group as my vet was not interested in using it and I am hoping to persuade him if it is available here, does anyone know?

Thanks,
Kay
 
There is a company called MastersDirect in the UK - they might have Insuvet still. They sell another kind of beef based PZI called Hypurin too. The wiki PZI link talks about it I think.
 
[ They sell another kind of beef based PZI called Hypurin too. The wiki PZI link talks about it I think.[/quote]

Many thanks, I have now managed to speak to my vet who will consider this when the time comes as they say they aren't allowed to let me "stockpile" insulin.
 
I was using Caninsulin for my cat and it was horrible! I switched to Lantus and then to Levemir, and my Shadoe does the best, much better on Levemir.
I would also suggest you switch to Levemir because both my cats are doing extremely well on this insulin, which is much longer lasting and very gentle.
 
[I would also suggest you switch to Levemir because both my cats are doing extremely well on this insulin, which is much longer lasting and very gentle]

Hi, are you in the UK and was your vet happy to prescribe this? Not sure what the protocol is for Levemir?

Thanks,
Kay
 
You can read in the Levimir support group here about it. I think the basic protocol is the Tilly's Tight Regulation protocol which might be more hassle than you are used to with PZI. But it does not have to be used in that way. You would just have to go over to the Levimir group and explain to them what your expectations are about testing and regulation wise and see if it could work out for you and your kitty. Some folks also need to use an insulin with some flexibility time wise [cannot always give the cat a shot right the the 12/12 cycle] and need to be able to have the flexibility to give a shot an hour or two late which PZI is great for. But I've heard that Levimir *might* be able to be used with *some* flexibility. You would just have to ask the Levimir folks.
 
Levemir is a depot insulin and dose changes are based on the nadir. Both the Tight Regulation protocol, or the Start Low, Go Slow protocol work with Levemir.
 
2 vets that i had been using for years refused to give anything other than Caninsulin, so I went to a 3rd practice who would only prescribe Lantus as it's the only other insulin they have used. The Cascade system has made it more difficult for vets to prescribe anything not licensed for animal use :(

If it wasn't for her great age and other medical conditions I would be thrilled with Lantus, but I really wanted a like for like at this stage.
 
Hi,

Some of us in the UK use Hypurin Bovine PZI which can be prescribed under the cascade system if Caninsulin is not effective. It has similarities to Insuvet PZI in that it is also a protamine zinc insulin, but usually has a longer duration than Insuvet PZI.

Eliz
 
Elizabeth and Bertie said:
Hi,

Some of us in the UK use Hypurin Bovine PZI which can be prescribed under the cascade system if Caninsulin is not effective. It has similarities to Insuvet PZI in that it is also a protamine zinc insulin, but usually has a longer duration than Insuvet PZI.

Eliz
Click to expand...

I asked 3 vets for this but all refused. :(
 
mrswoodwoose said:
Elizabeth and Bertie said:
Hi,

Some of us in the UK use Hypurin Bovine PZI which can be prescribed under the cascade system if Caninsulin is not effective. It has similarities to Insuvet PZI in that it is also a protamine zinc insulin, but usually has a longer duration than Insuvet PZI.

Eliz
Click to expand...

I asked 3 vets for this but all refused. :(
Click to expand...

Hi, on what grounds did they refuse? What justification was given? Some vets in the UK certainly are prescribing it... If you're in London maybe it's worth phoning around to see if other vets near you will prescribe it...?

Edited to add: Just had a look at your cat's chart. Do you have any current/recent mid-cycle numbers? Just wondering how she's dropping on the Insuvet at the moment.
 
Elizabeth and Bertie said:
Hi, on what grounds did they refuse? What justification was given? Some vets in the UK certainly are prescribing it... If you're in London maybe it's worth phoning around to see if other vets near you will prescribe it...?

Edited to add: Just had a look at your cat's chart. Do you have any current/recent mid-cycle numbers? Just wondering how she's dropping on the Insuvet at the moment.
Click to expand...

Cascade. Saying that they did not have sufficient reason to believe she wd not do well on Caninsulin despite her severe hypo on it 4 years ago and never having good numbers on it. The 3rd vet practise has only used Lantus in addition to Caninsulin so said they cannot prescribe one they don't know about. I don't have car so I also need to take into account travel time and cost especially after hours, so I need a local vet. These days vets seem to not like you to be registered at more than one practise.

I haven't done mid cycle numbers for ages but we did find that she would drop (at times) from 22Bg preshot to 2.6 nadir on 1in Insuvet, so decided after a number of mid cycle tests not to dose more than 1iu. Hence my fear of switching to Lantus ( sitting in the fridge!) and also the starting dose of 1iu which vet assures me is correct. She has just started meds for hyperthyroid and was not eating, taken one appetite stimulator and is eating at the moment. So feeling very nervous, but my Insuvet is waaay past use by date.
 
Oh, I really do feel for you. That puts you in a very difficult situation... (((Hugs)))

How vets interpret what they can and can't do under the cascade system seems to vary enormously from vet to vet!

My own vet had never used Hypurin before prescribing it for us. But after Insuvet was discontinued I told him that I wasn't going to put Bert back onto Caninsulin (I think some words along the lines of 'hell having to freeze over first...' came out of my mouth...) so, that meant opting for Hypurin as the closest available insulin.

It may be then that Lantus could be your best - or indeed only - option in the circumstances. It is much gentler insulin then Caninsulin and has a much longer duration. (I know that one of your fears about Caninsulin is hypo) And it sounds like one of the vets you've spoken with does have some experience of it. Further, there are a LOT of very experienced Lantus users on this forum who could help you with dosage advice.

When will your supply of Insuvet run out?
 
Aha... Just noticed that your vet is recommending that you start Lantus at 1 unit. Given your fears over hypo (entirely justified!) and the fact that your cat has been on a really low dose of Insuvet, then I think you'd be wise to start with a much smaller dose than that...
 
Elizabeth and Bertie said:
How vets interpret what they can and can't do under the cascade system seems to vary enormously from vet to vet!
Click to expand...
Tell me about it! And it's not like every script is going to be checked up on and she has more than enough reason to go with Hypurin B

Elizabeth and Bertie said:
My own vet had never used Hypurin before prescribing it for us. But after Insuvet was discontinued I told him that I wasn't going to put Bert back onto Caninsulin (I think some words along the lines of 'hell having to freeze over first...' came out of my mouth...) so, that meant opting for Hypurin as the closest available insulin.
Click to expand...
I had said the same and they led me to believe they would make a plan when the time came! I feel totally let down by my vets.

Elizabeth and Bertie said:
When will your supply of Insuvet run out?
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It expired Feb 2012. I know, I know....my cat is old and vomits if she east more than abt a teaspoon at a time so keeping food down and getting enough into her is a full time job. Ijust feel for her to be getting high numbers on a new insulin while we hope it will work. Not with hyperthyroid etc in the background.

Thanks for your kind words. How is your cat on Hypurin B?
 
Bertie is doing really well on Hypurin. His numbers were quite erratic prior to that and they've levelled out a lot. But it's not a straight substitute for Insuvet PZI; it's long duration brings a lot of benefits, but some challenges also.

There has been talk of Hypurin being discontinued at some point in the future too. If that happens during Bertie's lifetime we'll have no choice but to switch to Lantus... :roll:
 
Elizabeth asked me to pop over as an experienced lantus and levemir user. Both are lovely insulins and cats do well on them. We do suggest that you always get a preshot test and, depending on whether you work outside your home, either a midcycle or out the door and in the door tests. At night, a PS test and before bed test is good.

Lantus and levemir work differently than PZI in that they are depot insulins. So the first shots you give go towards the depot and then the kitty starts using what you inject. We make very small dose adjustments at a time and let the dose have several cycles to settle in as you are increasing it. Think of the doses for these insulins as a cruise ship...you can turn the wheel but it takes time to change course. Also, also unlike PZI, we dose primarily on the nadir with only some consideration given to the PS. That's why midcycle tests are important.

It's amazing that your little beauty is so old and has done so well as a FD for so long. When switching insulins, we typically recommend the starting dose of lantus be about 70% of what you are shooting with PZI. I'd like to look more at her SS to recommend a good starting dose.

So to be clear....she has chronic kidney disease and is hyperthyroid? Can you please give me an idea of how she's doing with both of those? Do you give daily subcutaneous fluids for her CKD?

If you decide to switch to lantus, you do not have to follow the tight regulation protocol and we would be more than happy to help you in the lantus ISG forum.

I'll let you think about that info and will be back shortly to address any questions.
 
Marje and Gracie said:
Elizabeth asked me to pop over as an experienced lantus and levemir user.
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Many thankls, I have been reading up and have a friend in Europe who uses Lantus

Marje and Gracie said:
We do suggest that you always get a preshot test and, depending on whether you work outside your home, either a midcycle or out the door and in the door tests. At night, a PS test and before bed test is good.
Click to expand...
I have always done preshots so that's not a problem, I won't be able to do many mid cycles: I can initially but not every day as I am able to with preshot.

Marje and Gracie said:
When switching insulins, we typically recommend the starting dose of lantus be about 70% of what you are shooting with PZI. I'd like to look more at her SS to recommend a good starting dose.
Click to expand...
I was thinking of 0.5iu Lantus as a starting dose?

Marje and Gracie said:
So to be clear....she has chronic kidney disease and is hyperthyroid? Can you please give me an idea of how she's doing with both of those? Do you give daily subcutaneous fluids for her CKD?
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Her bloods are good: they were good last year when she was not hyperthyroid so vet doesn't think they are being masked, She is on Fortekor and no sub-q fluids, it's not something the vets seem to do here. Bearing in mind my objective is not to keep her alive longer (as such) but to make her comfortable in whatever time she has left. She has only been on thyroid meds for 10 days or so:L initially did not want to eat but that has improved, whether due to appetite stimulator or the fact that I adjusted dose to be given every 30 hours instead of every 24 hours, She needs bloods at the end of this week to see how the dose it doing.

Thanks again.
 
Only when I am happy in my mind re the starting dose and I have 3 clear days: so end of the week Fri or Sat morning would be best
 
Good. Here is what would actually be best for determining a realistic starting dose for lantus....if you could p,ease get some midcycle tests while she is on PZI. She could be going lower than you realize and then bouncing back up. The midcycle test will help us with that.

Also....a/d is a higher carb food which can contribute to her BGs and it's also not the best choice for a CKD kitty. And are you aware that in the US, there is a black box warning against using metacam in cats? It has been linked to renal failure and one of our members was very prominent in getting that black box warning when her kitty went I to renal failure after she used metacam as prescribed by her vet.

I do understand that at Cattro's age, your intent is to keep her comfy and if the metacam helps with that, so be it. But just wanted to be sure you are aware. My philosophy in dealing with my elderly kitty issues is quite different than dealing with the same issues if they are young.
 
Marje and Gracie said:
Good. Here is what would actually be best for determining a realistic starting dose for lantus....if you could p,ease get some midcycle tests while she is on PZI. She could be going lower than you realize and then bouncing back up. The midcycle test will help us with that.

Also....a/d is a higher carb food which can contribute to her BGs and it's also not the best choice for a CKD kitty. And are you aware that in the US, there is a black box warning against using metacam in cats? It has been linked to renal failure and one of our members was very prominent in getting that black box warning when her kitty went I to renal failure after she used metacam as prescribed by her vet.

I do understand that at Cattro's age, your intent is to keep her comfy and if the metacam helps with that, so be it. But just wanted to be sure you are aware. My philosophy in dealing with my elderly kitty issues is quite different than dealing with the same issues if they are young.
Click to expand...

She is having a few days A/D as she lost weight and had so little appetite that she needs a bit of building up: normally she is on Natures Menu which I have found the best food for her Bg, but needs be when she won't eat etc. It is also a reason why I don't want to start the Lantus until she is back to her normal food.

At the moment I am home a lot and don't see any inkling of hypo altho I realise that they can be low
and not show it. Generally when she hits the 2's she gets very hungry.

I have seen and read all the arguments for and against metacam and after discussion with my vets am happy to use it as and when: it has saved us a few times when her cystitis kicks in and I cannot get a the vet soonest.
 
Thank you for clarifying. Obviously you and your vet are doing it right if she's 23! Fantastic.

By the way....are you able to get U100 insulin syringes preferably with 1/2u markings? That is the syringe we use for lantus.
 
Marje and Gracie said:
Thank you for clarifying. Obviously you and your vet are doing it right if she's 23! Fantastic.

By the way....are you able to get U100 insulin syringes preferably with 1/2u markings? That is the syringe we use for lantus.
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Thank you, it is a lot of work to keep her as healthy as possible. I already use these same syringes for Insuvet.
 
Hi,
Elizabeth asked me to take a peek and offer my thoughts, so here I am :-)

If they won't let you have hypurin, and the choice comes down to caninsulin or Lantus, it's a no-brainer to me.
As Marje pointed out, Lantus works differently than what you're used to, but it's a great insulin for cats. You will need to adjust your testing routine somewhat, and know that "nadir" is the key to dosing. But there are lots of experienced L users that will share how they manage the treatment around their schedules.
What I find encouraging is the numbers that you've been seeing on what is a very small dose of PZI.

One question - is your current insulin a U40 or a U100?

Carl
 
Re: starting dose..

I used compounded pzi, and not Lantus. If you can do what Marje suggested, and get a few mid-cycle tests to try and see what sort of nadirs she getting, you'll have a better idea. If she's NOT going really low and bouncing back up because of that, then I think your idea of starting at .5 u on Lantus is logical.
Carl
 
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