is Lente a good insulin? vet wants to prescribe it

Status
Not open for further replies.
My cat, Terra, has been on Lantus since beginning of the year. She hadn't been responding to it recently and so the vet did some tests, found evidence of pancreatitis. He recommends trying Lente since Terra's BGs have been very high for the past week even while continuing on the Lantus at 1.5 u/bid. Seeing how unfamiliar vets seem to be with good fd practices , I thought I'd ask here what the experts' opinions are of Lente, and would there be another insulin I could ask for?

The vet put her on Zeniquin antibiotic when we went in for the testing, and he recommends continuing it for the pancreatitis.

thanks for any feedback...
 
I'm pretty sure Humulin Lente and Ultra-lente have been out of production for
several years.

The only Humulins now are "N" also known as NPH, and "R".

Both of those are hard-hitting, fast-acting, and do not have much
duration.

Two human insulins which are effective in cats are Lantus (Glargine) and
Levimir (Detemir). We have many users of Lantus here.

I would pose your questions, and get help with Lantus dosing on the Lantus
Insulin Support Group, here on FDMB.

A couple of cat-specific insulins are Pro Zinc, and BCP PZI. Both of
these are for cats, specifically. They are U-40 insulins (40 units of
insulin per ml of liquid. Human insulins are U-100 (100 units of insulin
per ml of liquid). U-40 insulins require a different syringe

It worries me greatly that your vet does not know that Lente ("L) and
Ultra-lente "U" are not available. I would suspect he has little
current knowledge about treating diabetic cats. Very worrisome, indeed.

Where are you (city, state).
 
Baxter & I use ProZinc which is a slow, long lasting insulin. We are on a 12/12 schedule.

The insulin will cost around $130 (my vet). Check SAMs or Costco pricing it might be cheaper. The bottle should last about 3 months. I have had my bottle since Nov. & still have almost a 1/2 bottle. It could be different for you depending on how much you need to use.

Everyone in the ProZinc or PZI FDMB board are wonderful & will help you with dosing.
If you decide to go with ProZinc come on over & let them help you.

Jenn & Baxter cat_pet_icon
 
What your vet is suggesting is to use a faster acting insulin with the Lantus. It is what humans do to control their after-meals blood glucose. That is not a very good idea in cats, especially with someone new to feline diabetes and often becomes counter-productive against the action of Lantus.

After looking at your spreadsheet, I would like to suggest considering a dose increase instead. She was responding well to 2U and although yes there's a possibly that 2U may have been a bit too much, 1U and now 1.5U are not enough apparently, although it's a little hard to tell with all the skipped tests.

Why all the skipped preshots? I read this
taking a break on testing b/c of new dose, giving it time to settle
and just cringed. Sorry to break out the wet noodle, but there really is never a time to take a break from testing, and especially not preshots and especially not after changing doses.

If she is not eating or having spells of vomiting, yes that could be pancreatitis. Right now would be a very good time to test more frequently for ketones however, especially if she's feeling under the weather and especially since you lowered the dose. The excessive thirst and hunger is a sign that her blood glucose is way out of control, but you can see that from the BGs you have gotten.

I'm sorry to be blunt about the testing, I know it is hard sometimes and they get tired of it. But it's shooting in the dark with Lantus if you don't test, as it is with any insulin. When you've done such a good job, can you see that now things are going array and one of the causes may be lack of testing to truly know what's going on with those BGs?
 
It looks like you were seeing some great numbers and then suddenly dropped the dose from 2u to 1u when a decrease should have been to 1.75. I wholeheartedly agree with Vicki that without those preshots, it's really hard to see what's going on, and it's dangerous to shoot insulin blindly. A cat can drop low for whatever reason, even if they've been consistently high. One day I came home from work after Bandit had been having consistently high numbers (300s-400s), and his preshot that night for whatever reason was 46. If I had skipped that test because I thought it was safe to assume he would be high at his preshot if he was high at his nadir, we could have had a very serious hypo incident on our hands. It was the only time in the entire year he was insulin that something like that happened, but I think almost everyone here could tell you a story like that.
 
The reason I stopped testing was the vet told me to stop testing. I just went ahead and did some spot tests anyway. Clearly Terra is having problems: she was doing well for a week and then suddenly , on the same dose, her BG skyrocketed and it wasn't a bounce. It sounds like there is pancreatitis that may be causing this. From observatin over the past two months I can tell pretty well when Terra isn't feeling well and what behaviors tend to correlate with higher BGs. So I was reasonably sure that her BG was staying high even when I wasn't testing. I wasn't sure what to do; one vet refused to work with me , when I went in asking for an fpl test, because of the home testing and the protocol suggested here. And then I just didn't know what vet to turn to. I tried out this next vet and he at least communicates way better than my first vet but he's kind of a control freak and sounds like people here have better advice.

I will ask him about another kind of insulin but I'm not sure what to ask for.
 
Karen -

If your vet is not working with you, you may wish to consider seeking alternatives. If you'll post your location in your signature or profile, there may be others with recommendations for helpful, experienced FD vets in your area. Also, Nudderbaby 2/27 on the PZI board recently had a major issue w/ her vet, as did Charley: "Vet visit :( " on 2/24. and "Great Vet Phone Call" yesterday 2/29. You may want to look at these threads , what they did, and how one vet has educated himself and come to the table to work with her.

Remember, the vet works FOR the client. And it's not always a bad thing to question something if you're not comfortable with it. I think everyone on the board will agree that home-testing is key to your ability to be an effective care-giver. The vet should not feel threatened by your staying on top of your cats BG.

Good luck!
 
Alarm bells go off with a vet that says you cannot home test your cat (absolutely NO reason why a vet would insist you not test) and then want to prescribe an outdated (off the market eve?) harsh insulin instead of trying to use the gentle current insulin you are on correctly. Lantus is an insulin of consistancy. It needs a consistant dose, and when you are adjusting a dose it needs to be based on nadir numbers. Frequently reacting to reshot number with Lantus will not allow Lantus to work properly. It would be better to give the Lantus a chance to work. Dose consistantly for 6 cycles, testing at nadir or at least catching some mid-cycle to see how the insulin is acting. Adjust after 6 cycles accordingly and hold the new dose steady again. Step up the scale until you find the right dose.

If you do use the short acting insulin in conjunction with the Lantus as he wants, please home test. You really run the risk of sending your cat into a hypo situation with that kind of insulin and mixing it with a long lasting; and for a vet to recommend it while saying you can't test to monitor BGs is kind of crazy, I'd say malpractice.
 
I would give the Lantus a fair shot by testing and following the protocol consistently before switching to a different insulin. Terra was showing a lot of improvement when you were doing that the first three weeks of February. Just understand that it's a slow process that takes patience, but it does pay off in the end.
 
KarenAmelia said:
The reason I stopped testing was the vet told me to stop testing. I just went ahead and did some spot tests anyway. Clearly Terra is having problems: she was doing well for a week and then suddenly , on the same dose, her BG skyrocketed and it wasn't a bounce. It sounds like there is pancreatitis that may be causing this. From observatin over the past two months I can tell pretty well when Terra isn't feeling well and what behaviors tend to correlate with higher BGs. So I was reasonably sure that her BG was staying high even when I wasn't testing. I wasn't sure what to do; one vet refused to work with me , when I went in asking for an fpl test, because of the home testing and the protocol suggested here. And then I just didn't know what vet to turn to. I tried out this next vet and he at least communicates way better than my first vet but he's kind of a control freak and sounds like people here have better advice.

I will ask him about another kind of insulin but I'm not sure what to ask for.
\

Can you find out what test was done to determine a pancreatitis diagnosis, what was the test result and finally what treatment was given to treat it?

Pancreatitis is not treated with Zenniquin or any other AB; you should have been given pain meds if the test was positive for p-titis as it is extremely painful, and you should be giving SubQ fluids at home daily. One of my cats who had frequent issues with p-titis has been better since giving her weekly B12 shots at home, but before the B12, I was givin her pepcid AC twice a day, and fluids as needed, plus pain meds buprenex. When you are next at the vet office, pick up copies of the results from any testing and bloodwork done.

Ask any human diabetic: Do you just give yourself an insulin shot and not bother to test your BG first?
The human will look at you like you are crazy. You are playing Russian roulette with your cat by shooting insulin and not knowing if it's safe. If your cat's BG was low, but you did not test, and you just gave the insulin shot, you could force your cat so low that you will have a hypo situation on your hands and may need to rush your cat to vet ER to save the cat.
Test before any shot. Be safe.

Suggesting you to use an insulin like Lente - I have heard of it, but thought it was some kind of ancient insulin not even available anymore, or not used by any animal owners as there are many much better insulins. Even if the vet wanted you to use this Lente as a bolus to help the Lantus, I would think the vet would suggest something faster acting like Humulin R.


http://en.wikipedia.org/wiki/Diabetes_in_cats
below is found in the above wiki site.
Insulin injections
Humans with Type-1 diabetes are often treated with a "basal plus bolus" method, where a long-acting insulin is injected once or twice daily to provide a "basal" insulin level, then shorter-acting insulin is used just before mealtimes.

For cats, a "basal" method is usually employed instead—a single slow-acting dose, twice daily, along with a very low carbohydrate diet, attempts to keep the blood sugar within a recommended range for the entire day. In this case it's important for the pet to avoid large meals or high-carbohydrate food, since they can seriously affect the blood sugar (meals may also be timed to coincide with peak insulin activity). Once-daily doses are not recommended,[16] since insulin usually metabolizes faster in cats than in humans or dogs.[17] For example, an insulin brand that lasts 24 hours in people may only be effective for about 12 in a cat.[18]

Cats and dogs may be treated with animal insulins (pork-based is most similar to a dog's natural insulin, beef-based for a cat), or with human synthetic insulins. The best choice of insulin brand and type varies between pets and may require some experimentation. One of the popular human synthetic insulins, Humulin N /Novolin N/ NPH, is reasonable for dogs, but is usually a poor choice for cats,[18] since cats' metabolize (most) insulin about twice as fast. The Lente and Ultralente versions were therefore very popular for feline use until summer 2005, when Eli Lilly and Novo Nordisk both discontinued them.

Until the early 1990s, the most recommended type for pets was beef/pork-derived PZI, but that type was phased out over the 1990s and is now difficult to find in many countries. There are sources in the US and UK, and many vets are now starting to recommend them again for pets, but they have been discontinued by most manufacturers as of 2007-2008. A new synthetic PZI analogue called ProZinc is now available.

Caninsulin, known in the USA as Vetsulin, made by Intervet is a brand of pork-based insulin, which is approved for dogs and cats, and is available both through veterinarians and pharmacies with a veterinarian's prescription, depending on the country. Note, though, that Vetsulin was recently recalled due to inconsistent strength and is no longer used in the USA. According to the manufacturer's website, this insulin's action profile is long and flat in dogs, but in cats very similar to that of NPH insulins, and lowers blood sugar quickly, but for only about 6–8 hours.

Two new ultra-slow time-release synthetic human insulins became available in 2004 and 2005 for improving basal stability, generically known as Insulin Detemir (Levemir) and Insulin Glargine (Lantus). Studies at the University of Queensland, Brisbane, Australia have had remarkable results with Insulin Glargine in cats. Followup research Roomp and Rand, Vet Intern Med 2008, 22 (3):791 shows that Levemir can be used with a similar protocol and that either insulin, on this protocol, leads in most uncomplicated feline cases to remission, with the most success being in cats who start on these protocols as soon as possible after diagnosis.

I would say to stick with the Lantus and follow the protocol to increase the dose to what is needed, and forget about a 2nd insulin in the mix.
 
I'm doing what I should have done a week or more ago: taking Terra to a fantastic internal specialist whom I worked with on a dog issue several years ago. He will be excellent. I held off because he's also very pricey and Terra's a 15 year old cat. But now I see that I don't have other good alternatives. I would pay more trying one vet and then another. It's such a crapshoot, finding a good vet. This most recent one did not want to admit that he's out of date on FD. When I asked him about Lente no longer being manufactured, he said that's the problem - they keep coming changing the insulins. I didn't want to ask him how long since his last FD patient. This is a vet hospital that's part of the VCA chain, that owns over 500 vet clinics nationwide. I was leery of that from the start.

Perhaps the internist will help with the pancreåtitis and will suggest continuing with the Lantus. I feel confident that he knows what he's doing. Too bad - he's trying to retire but can't! When there's a good vet, people know it and demand his/her services. There need to be more.
 
Melanie and Smokey said:
Alarm bells go off with a vet that says you cannot home test your cat (absolutely NO reason why a vet would insist you not test) and then want to prescribe an outdated (off the market eve?) harsh insulin instead of trying to use the gentle current insulin you are on correctly.

Where did you get the information that Lente was a harsh insulin? It worked quite well for a lot of cats in the past. The only downfall was that some cats didn't get quite enough duration from it and those were the cats that did better in Ultralente or PZI.

The "gentle" insulins don't necessarily work well for every cat. People need to work out which insulin works best for their individual cat, not what someone tells them is the best insulin.

FYI, i think there may still be a beef Lente available from the UK. If Boo had still been around when Humulin L disappeared, that probably would have been my next choice. The slower acting insulins did nothing for him.
 
That's a good move, Karen. Every cat is different and some do better on one insulin than another but lantus, levemir and prozinc are the insulins of choice for cats. I would just stay on lantus and increase slowly by .25 or .5 unit until you find the right dose. It is imperative that you test bg at least 3x daily though when changing doses, at preshots (before shots) and at his nadir (low point) usually at about +6 hours after the shot. It could be 5-7 hours though and you won't know what it is without testing. The protocol for changing dose is in the Lantus tight regulation section. It would really be good for you to look at it and maybe bring some info with you to the vet from the different info in that section. http://www.felinediabetes.com/FDMB/viewtopic.php?f=9&t=1581

Good luck with the new vet and I hope your baby feels better.

Melanie & Racci
 
Deanie and Boo (GA) said:
Melanie and Smokey said:
Alarm bells go off with a vet that says you cannot home test your cat (absolutely NO reason why a vet would insist you not test) and then want to prescribe an outdated (off the market eve?) harsh insulin instead of trying to use the gentle current insulin you are on correctly.

Where did you get the information that Lente was a harsh insulin? It worked quite well for a lot of cats in the past. The only downfall was that some cats didn't get quite enough duration from it and those were the cats that did better in Ultralente or PZI.

The "gentle" insulins don't necessarily work well for every cat. People need to work out which insulin works best for their individual cat, not what someone tells them is the best insulin.

FYI, i think there may still be a beef Lente available from the UK. If Boo had still been around when Humulin L disappeared, that probably would have been my next choice. The slower acting insulins did nothing for him.

The slower acting insulins do work well for the large majority of cats, however, and in this specific case the Lantus not been given a fair shot on the correct dosing protocol. I would not recommend switching insulins until it's really been shown the Lantus isn't working. Switching to a different insulin without correcting the dosing/testing issues will merely give the same results. Especially Lente, which has only about a 25% remission rate in cats.

Lente (otherwise known as Vetsulin/Caninsulin) often causes steep drops within the first few hours, with a much more dramatic curve than Lantus/Levemir. That's why people call it "harsh", and why it's no longer a recommended insulin for cats. The duration of action is only about 6-8 hrs (vs. 12 hrs for Lantus), and presents a greater risk of hypoglycemia in cats than the slower-acting insulins.

Karen, I know that the VCA Hospitals in my area are all incredibly up to date with diabetes treatment, so good luck to you! I think you'll at least find they're more receptive and able to offer better advice, even if a treatment recommendation or two might be off. They may try to tell you that you need to buy an alphatrak meter from them--just say your human meter is fine and you don't need the pet one. I would also print and bring them in a copy of the dosing protocol so that you're on the same page: http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf
 
Well, the internal medicine specialist I went to spent about an hour and a half talking with me! He thinks outside the box, and while no one else has suggested hyperthyroidism, he thinks Terra has that, as he noted an extremely rapid heartbeat that stayed that way over the several hours she spent there and enlarged thyroid nodes. The primary noticeable symptoms of hyperthyroidism are same as with FD: extreme eating and drinking and peeing, along with weight loss; lots of vocalizing is a symptom as well - and Terra has recently started meowing vociferously in the middle of the night, which she's never done in the past 15 years. He thought the pancreatitis would not be got under control without dealing with the FD and the thyroid issue. So we're going to do a trial on a med. called methimazole .
 
KarenAmelia said:
Well, the internal medicine specialist I went to spent about an hour and a half talking with me! He thinks outside the box, and while no one else has suggested hyperthyroidism, he thinks Terra has that, as he noted an extremely rapid heartbeat that stayed that way over the several hours she spent there and enlarged thyroid nodes. The primary noticeable symptoms of hyperthyroidism are same as with FD: extreme eating and drinking and peeing, along with weight loss; lots of vocalizing is a symptom as well - and Terra has recently started meowing vociferously in the middle of the night, which she's never done in the past 15 years. He thought the pancreatitis would not be got under control without dealing with the FD and the thyroid issue. So we're going to do a trial on a med. called methimazole .

For the pancreatitis diagnosis, what test was done and what was the result value? The blood test would be the fPLI test.
For pancreatitis, you treat with SQ fluids, and pain meds, with likely some pepcid for any upset stomach.

My vet had me start giving Shadoe weekly B12 shots at home and she has had her pancreas inflammation issues clear right up. If Terra has frequent problems with pancreas inflammation, ask about trying the B12 shots (the pink stuff).

I hope you get positive results from the tapazole for the thyroid issues.
 
Thanks Gayle. It was fpl, and I didn't see the actual test result. I'll ask about B12. The vet thought Terra wasn't in pain because she didn't complain when he palpated her abdomen. I asked about pain meds but he didn't think necessary. I will trust that for now.

It didn't hit me till today, on thinking about all this and rereading the info on TR that the standard line I've heard from the past two vets (not including the internal med guy), which is to keep blood sugars in the 250-300 range to be safely away from hypoglemia, will never allow the cat the possibility of remission. The internal med guy also spelled this out, and he's very in favor of TR and suggested I look up Jacqui Rand. So that's all good.

Rand states in one article I read that sometimes a cat's nadir occurs at the preshot time. It was good to hear that this might be normal for a cat, since Terra's nadirs sometimes show up at that time, and the first vet didn't know how to deal with that other than suggesting going to one shot per day.
 
KarenAmelia said:
Thanks Gayle. It was fpl, and I didn't see the actual test result. I'll ask about B12. The vet thought Terra wasn't in pain because she didn't complain when he palpated her abdomen. I asked about pain meds but he didn't think necessary. I will trust that for now.

It didn't hit me till today, on thinking about all this and rereading the info on TR that the standard line I've heard from the past two vets (not including the internal med guy), which is to keep blood sugars in the 250-300 range to be safely away from hypoglemia, will never allow the cat the possibility of remission. The internal med guy also spelled this out, and he's very in favor of TR and suggested I look up Jacqui Rand. So that's all good.

Rand states in one article I read that sometimes a cat's nadir occurs at the preshot time. It was good to hear that this might be normal for a cat, since Terra's nadirs sometimes show up at that time, and the first vet didn't know how to deal with that other than suggesting going to one shot per day.

Right away, I want to say that cats don't stand up and say 'excuse me, I am in pain here.' Cats are very secretive.
If Terra has pancreatitis, she IS in pain. Just ask any human who has had experienced pancreatitis and you will be told that it is excruciatingly painful. Get buprenex. You don't need to see the fpli test as it's just a number; ask what the number was and you will know what to get. Positive result means get a fluids kit and pain meds.

That BG range is over renal threshold; you want to have Terra's numbers UNDER 250 at all times, to prevent organ damage.

A link to the TR they suggested:
http://petdiabetes.wikia.com/wiki/Tight_regulation
 
Status
Not open for further replies.
Back
Top