Lantus vs PZI vs Caninsulin

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Kim & Twice

Kim & Twice

Member Since 2013
Hello all,

I have a newly diagnosed kitty that was put on Caninsulin. His numbers seem very jumpy and in another post it was suggested that I may want to think about using Lantus. I have been reading about this insulin for hours now, as well as PZI, and I am left with a spinning head.
A couple questions regarding Lantus: Do I need to be able to test quite often day to day, or will +2 and +4 in the evening be alright? How quickly does one typically see the results of the dose given? ie. Do you need to stick to one dose for a couple weeks to give their body time to adjust to it?
It is exciting to read about remission and such successful control, but is this a program someone like me could be successful at? I work full time and usually 7 days a week, away from the house for approx. 11hrs each day. I have switched my brood from Hill's W/D dry to fancy feast pates only and feed twice daily as opposed to the free feeding they were familiar with (so far this has actually worked quite well).
Not sure what else to include here, but if there are 'cliff notes' somewhere regarding the use of Lantus I would be grateful for a point in the right direction. Otherwise, should I be considering a different insulin like PZI or sticking it out with the Caninsulin....although I think I am not going to see great success with the latter.

Thanks in advance,

Kim & Twice
 
Kim & Twice said:
Hello all,

I have a newly diagnosed kitty that was put on Caninsulin. His numbers seem very jumpy and in another post it was suggested that I may want to think about using Lantus. I have been reading about this insulin for hours now, as well as PZI, and I am left with a spinning head.
A couple questions regarding Lantus: Do I need to be able to test quite often day to day, or will +2 and +4 in the evening be alright? How quickly does one typically see the results of the dose given? ie. Do you need to stick to one dose for a couple weeks to give their body time to adjust to it?
It is exciting to read about remission and such successful control, but is this a program someone like me could be successful at? I work full time and usually 7 days a week, away from the house for approx. 11hrs each day. I have switched my brood from Hill's W/D dry to fancy feast pates only and feed twice daily as opposed to the free feeding they were familiar with (so far this has actually worked quite well).
Not sure what else to include here, but if there are 'cliff notes' somewhere regarding the use of Lantus I would be grateful for a point in the right direction. Otherwise, should I be considering a different insulin like PZI or sticking it out with the Caninsulin....although I think I am not going to see great success with the latter.

Thanks in advance,

Kim & Twice
Click to expand...

Kim,
You are in Canada so you are extremely fortunate. Caninsulin is crap, pure crap. Do NOT waste any time using it. You can go to any pharmacy, I suggest Shopper's DrugMart, get their loyalty card Optimum, and start your cat on Levemir.

Lantus is OK but some cats have issues with Lantus and are just fine on Levemir.

I would suggest that you go to the Levemir forum on FDMB and read the stickys.... please do not think that you can get away with little or no testing on some insulins because the testing is to keep your cat safe.

Most people work or go to school, and are not home during the week, so they can't do lots of tests, but that's fine.... when you have a day off or over the weekend, you can do a curve once a week, and the other tests that are daily.... before the am shot, before the pm shot, and then just before you go to bed. I don't think it's alot, and you would do the same for your child, so no big deal.

Lantus and Levemir dosing is based on the low points in the cycle, so that's why you need to do the odd test here and there, and some curves.

There are some general guidelines that apply for depot insulins like Lantus and Levemir:

"General" Guidelines:
--- Hold the initial starting dose for 5 - 7 days (10 - 14 cycles) unless the numbers tell you otherwise. Kitties experiencing high flat curves or prone to ketones may want to increase the starting dose after 3 days (6 cycles).
--- Each subsequent dose is held for a minimum of 3 days (6 cycles) unless kitty earns a reduction (See: Reducing the dose...).
--- Adjustments to dose are based on nadirs with only some consideration given to preshot numbers.

Increasing the dose...
--- Hold the dose for 3 - 5 days (6 - 10 cycles) if nadirs are less than 200 before increasing the dose.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 200, but less than 300 increase the dose by 0.25 unit.
--- After 3 consecutive days (6 cycles)... if nadirs are greater than 300 increase the dose by 0.5 unit.

Reducing the dose...
--- If kitty drops below 40 (long term diabetic) or 50 (newly diagnosed diabetic) reduce the dose by 0.25 unit. If kitty has a history of not holding reductions well or if reductions are close together... sneak the dose down by shaving the dose rather than reducing by a full quarter unit. Alternatively, at each newly reduced dose... try to make sure kitty maintains numbers in the normal range for seven days before reducing the dose further.

--- If an attempted reduction fails, go right back up to the last good dose.
--- Try to go from 0.25u to 0.1u before stopping insulin completely.

Random Notes...
Because of the cumulative nature of Lantus and Levemir:
An early shot = a dose increase.
A late shot = a dose reduction.

A "cycle" refers to the period of time between shots. There are 2 cycles in one day when shooting twice a day.

Sometimes a dose will need to be "fine tuned" by adding some "fat" or "skinny-ing up" the dose.

So, back to testing amounts....
I had 2 cats to test so what I did was this...
When I got up in the am to get ready for work around 5am, I'd test both and then get ready for work. Their shots were an hour later, so I'd test at shot time, give the shots, then go to work.
I'd get home a couple hrs before shot time so I sometimes tested when I got home, then made dinner and stuff, and then at the pm shot time, I'd test and give shots.
Depending how their numbers were in the pm, I may test at +3 or so, but most times, I'd just test before I went to bed.
On the weekends, I was like most others.... errands and shopping to get done, so my morn would start the same and then I'd just test here and there, whenever I was around.... just gathering data.

The numbers you get will tell you the story on how your cat is doing on the insulin, if more or less is needed, or the dose is just fine. You don't need to test like crazy as some people imply.... just get the 3 tests a day, then a curve when you can and you are good to go.

Forget about PZI; it's not as long lasting as the human insulins, so go with Levemir.

Gayle
 
Thank you Gayle for the great information. So much to learn and so grateful for the FDMB people out there helping us newbies and our furbabies.
 
Welcome to the FDMB Kim and extra sweet Twice! What an interesting name!!

Lantus, Levemir and Pro Zinc are all good insulins. Pro Zinc is an "in and out" insulin that doses are more based on pre-shot numbers, where Lantus and Levemir are "depot" insulins that take a little time to "Fill the depot". Some is released quickly, while the rest goes into the depot and is released more slowly. With Lantus and Levemir, the doses are based mostly on the "nadir" (the point where the insulin is working it's best).

Lantus is the only insulin that has a proven, published protocol that's been proven to get up to 84% of diabetics OTJ (off the juice) within 6 months of treatment, but any of those 3 insulins is a good choice.

Caninsulin is (unfortunately) what a lot of vets use because they have more experience using it...In dogs. It doesn't work well for cats since their metabolism is faster.

No matter which insulin you use, you'll need to learn to home test, as it's the only way to safely give it. The "protocol" called "tight regulation" requires a little more testing to "dial in" the perfect dose, but there's also a protocol called "Start Low, Go Slow" that you can look into.

Luckily, in Canada, you can get these insulins without a prescription. The sticker price might scare you a bit, but if you take care of your insulin by keeping it in the main part of your refrigerator (not the door), it can last up to 6 months, so don't worry about it if you hear it's only good for 28 days.

You ALWAYS want to get a pre-shot test before giving insulin. This is for safety. You wouldn't give a child insulin without knowing where his blood glucose is first, and it's the same for our furkids.

If possible, you want to get a test in somewhere between +5 and +7 (number of hours after shot is given)...this is to try to catch that "Nadir". The 4th test we recommend is a "before bed" test. Many cats go lower at night, so getting a test before bed lets you know if you should set an alarm to get up later to get another test. First and foremost, we want Twice to be safe!

If it's impossible to get those tests during the day, you should still always get those pre-shot tests, and then maybe on weekends you can get more tests through the cycles to help fill in those spots. The more data you have, the better you'll be able to see how Twice responds to both insulin and food.

Glad to see you've switched over to wet foods. If you keep food to under 10% carbs, it will greatly increase the chances of getting Twice under control. Here's a list we use...the carb percentage numbers are in Column C Dr. Pierson's Food Chart

Good luck to you and Twice, and let us know what else we can help you with!
 
On looking at your ss, you have a couple comments about giving kibble at +2 and +3 ... I am guessing to bring up the BG - please know that dry food can take HOURS to bring up a low number, so if you are trying to raise a low number, go with gravy from food or karo or honey.... the more that the body has to do to process what you feed, the longer it takes to get to a sugar state.... and karo / honey are already in that state so you should see a rise in about 15min with honey, but an hour with dry food.

Also, you see how you have such fast and low numbers after only a couple hours of the shots? That's how Caninsulin works; it drops the cat's numbers low and fast and early in the cycle, then bounce high, and is right out of the cat's body after about 10hrs max.

I would say to start with a 0.5u dose on Levemir, just by looking at your cat's numbers.

Good luck with your switch.

Gayle
 
Hi Kim,

As you've seen, different folks favour different insulins, and it can indeed 'make your head spin' when trying to work out which insulin to use! (That's assuming that there is a choice, of course. In some parts of the world folks have very little choice about insulin, and so just have to work with what they can get. For example, quite a few folks in the UK have to use Caninsulin because they can't find a vet who will prescribe anything else. (And, for the benefit of anyone else on Caninsulin who reads this thread, please know that it IS possible to work with Caninsulin. Your cat is not doomed! And quite a few UK cats on this forum have gone into remission while using it.))

For those who do have a choice of insulins there are some things to weigh up when making the decision of what to use.
For cats, the longer lasting insulins (PZI, Lantus and Levemir) tend to work better than shorter-acting insulins (Caninsulin/Vetsulin etc) because they are generally 'gentler' (less inclined to cause steep/sudden drops in blood glucose) and last longer in the cat's system thereby keeping the blood glucose lower for longer.

I've used 3 insulins for my cat. I started out on Caninsulin. Then I switched to a PZI that had a longer duration. And finally I switched to very long lasting insulin (called 'Hypurin Bovine PZI', not available in the US). So I've tried insulins that have all kinds of durations.

I found that Caninsulin and the standard PZI were very 'in and out'. I injected them, they did their stuff, and then left the system (in our case it was around 8 hours for Caninsulin and 12 hours for PZI). With the longer lasting insulins the doses can essentially 'overlap'; this can either be a true overlap, or it can be that some insulin remains 'stored' in the body ('depot'). So, when giving a shot of a very long lasting insulin the shot/s given before that one will also form part of the picture (if that makes sense?). (It is for this reason that most Lantus users here on the forum try to keep shots to exactly 12 hours apart (or as near a possible)).

I did consider trying Lantus at one point because it has a track record of being a very good insulin for cats. But I was unable to regularly give insulin shots exactly 12 hours apart and so the flexibility of a PZI insulin (which is much more forgiving in this regard) seemed to be the better choice for us. If you are also unable to regularly give shots 12 hours apart then this may also influence your decision about which insulin to use.

None of us knows, in advance, which insulin is going to work best for our cats. It's very much a 'suck it and see' thing. And I do hope I haven't confused you further....

Eliz
 
"The probability of remission was greater for cats treated with glargine than cats treated with PZI or lente insulin. In newly diagnosed diabetic cats, twice daily treatment with glargine provides better glycaemic control and higher probability of remission compared to twice daily treatment with PZI or lente insulin. Good glycaemic control soon after diagnosis is associated with increased probability of remission and should be the goal of insulin therapy."
2009, ESFM and A AFP. Published by Elsevier Ltd.

Hope this help You decide.
 
Note that the Lantus/glargine studies used small numbers of cats - like 24 or so. Doesn't mean its wrong.

Any insulin will be better than not treating the diabetes at all, but some may be risky for use as maintenance (don't use just R to manage diabetes! It may be used, in special cases, as a supplement)

Longer acting insulins will fit more folks schedules better than shorter acting ones (NPH, Caninsulin/Vetsulin).

Folks with erratic schedules may prefer an in and out insulin (ProZinc, PZI).
Folks with very stable, schedules that allow shooting on 12 hours almost exactly may prefer depot insulins (Levemir, Lantus).
 
As others have mentioned, the generally recommended insulins for cats are PZI/ProZinc, Lantus (glargine), or Levemir (determir) because these insulins work best with a cat's faster metabolism than the other insulins, which can work hard and fast on a cat and can require a lot more monitoring and time and make it much more difficult to get a cat regulated and even into remission.

I wrote up this Insulin Cheat Sheet a while back that might help explain the differences between the insulins a little better. It can get pretty confusing!
 
What wonderful information. I am convinced that the Caninsulin just isn't turning out to be the right insulin for Twice. As many of you have noted, it drops him fast (alarmingly at times) and really isn't lasting as long as I would like to see for him. Most days I have been able to get at least a few readings from him, and enough to see a trend in the quick drop and rise. After sorting through all the great replies, I think the 12 hour schedule (Lantus or Levemir) will be the option for us. The work schedule I have is pretty solid but does require me to be away for approx 11hrs/day and usually 7 days a week. I will continue testing pre-shots and throughout the evening to ensure proper monitoring of Twice. I want what is best for this little family of mine, and I am blessed that so many of you stay dedicated to a forum like this. Thank you for letting us be a part of your unbelievable community!
 
We're all just paying it forward Kim. We all found this wonderful board, scared, confused and not knowing what to do, or if we could. Others helped us, and now we help the new people.

In time, you'll be able to relate some of your experiences with someone else new, telling them "If we can do it, you can too!"....just like we're doing with you.

You must tell us where you got the name "Twice"...There has to be a good story :lol:
 
Twice actually got his name during an almost tragic end. When I was working at the vet clinic I got a call one day from the SPCA asking if I would come and assess one of the new cats they had gotten in. They were concerned about a "wound" on the back of his neck and as he was a young adult intact male, they were worried he might have something contagious. Upon checking him over I had concluded that he most likely had an allergic reaction to something and suggested isolating him for several days while treating the "wound" appropriately. He was an absolutely beautiful cat. Lion wide nose, silk fur, and overall just a beauty. Hard to believe he was a stray as his body condition was so good. Well, long story short, this particular SPCA (like many), is extremely overburdened and always short on space. The unfortunate inflow of kitties compared to the outflow is not a balanced situation. One week after my visit to them, I was cleaning up after a horse colic surgery the vets had performed and wandered into the small animal clinic side. There, on the table, was Twice. They had sent him for euthanasia and the techs had already given him the sedation. I took one look at him and was horrified. I told the tech who he was and how adoptable I know he would have been. We vented our frustration at the situation and she asked me what I wanted to do. I knew I didn't "need" another kitty, as my gang was already quite extended. I thought though that I would be able to find a great "forever" home for him. Meanwhile, we had a call up front and when we got back, the other tech had noticed he was waking up and "topped" him off. This poor cat was experiencing the worst luck that day...twice.... so I told the girls to neuter and tattoo him since he was out for the count again anyways. The name hit me and it stuck. Then he came home with me and we lived happily ever after for the past 10 years. He is truly one of the sweetest things that has ever happened to me!
 
Wow Kim! What an awesome story!!

Both you and Twice were more than "twice blessed"!

I've been a foster home as well as a transporter for many, many animals. I absolutely know that the ones that get that "second chance", know it, and are forever grateful. I've helped transport many animals that were (in the shelter environment) said to be skittish, fearful and/or downright mean or dangerous. Not one of them ever bit a transporter and the vast majority of them seemed to really know that their lives had just taken a big turn for the better. I did a lot of transport coordinations too and I can't remember one where I didn't hear "Oh he was so great!", or "I would take her home with me if she wasn't already spoken for" at least several times.

Let us know which insulin you decide to use so we can get you started on this journey. Already home testing will make it a lot easier.

Good luck to you...and to Twice too!
 
What an awesome story!

Couple things -
Note that the Lantus/glargine studies used small numbers of cats - like 24 or so. Doesn't mean its wrong.
Click to expand...
Lantus is the only insulin that has a proven, published protocol that's been proven to get up to 84% of diabetics OTJ (off the juice) within 6 months of treatment, but any of those 3 insulins is a good choice.
Click to expand...

Nitpicking maybe, but it was actually 55 cats on Lantus, 18 on Levemir.
This protocol was tested in 55 diabetic cats for glargine and 18 diabetic cats for detemir. Owners
measured blood glucose an average of 5 times daily and adjusted insulin dose based on the protocol.
Click to expand...
Fifty-five cats diagnosed with diabetes mellitus, whose owners joined the online German Diabetes-Katzen Forum, were included. An overall remission rate of 64% was achieved in the cohort. Significantly higher remission rates were observed if good glycaemic control was achieved soon after diagnosis: 84% for cats started on the protocol within 6 months of diagnosis went into remission, and only 35% for cats that began more than 6 months after diagnosis
Click to expand...

Another study, testing Lantus against a discontinued version of PZI and Caninsulin showed these results (unfortunately a very small sample size, eight cats on each type of insulin. Just wanted to point out that 2 kitties did go OTJ with the insulin you are currently using.

In a head-to-head comparison between Lantus, PZI and Caninsulin®/Vetsulin® (also called porcine lente insulin) in newly diagnosed diabetic cats

• 8 of 8 cats treated with Lantus went into remission (100%)
• 3 of 8 cats treated with PZI went into remission (38%) and
• 2 of 8 cats treated with Caninsulin/Vetsulin went into remission (25%).

The authors came to the conclusion that remissions occur more frequently with Lantus in newly diagnosed cats than with the other two insulins.
Click to expand...

I also wanted to say that I agreed with everything that Elizabeth said above. Especially this:
None of us knows, in advance, which insulin is going to work best for our cats.
Click to expand...

The best way I have read it here is:
There is NO SUCH THING as a "best insulin". The best insulin is the one that works best for YOUR cat.

Unfortunately, there's no way of knowing which one that is going into it.
I think bovine PZI was the bee's knees, because my cat went OTJ in just 10 weeks using it. He might have gone OTJ no matter what type of insulin he was given, but I'll never know that for sure.

The important thing is exactly what you are doing.... asking questions, doing research, and making an informed decision. No matter which type of insulin you choose, you'll get plenty of help from people with first-hand experience.
 
You mentioned that your cats were/are grazers and now you are feeding them two meals a day.

My cats are also grazers - I think that happens because when feeding dry food, it's usually left out all the time and cats can come and go at their leisure.

While I try to have meal time for my cats, they don't eat what I serve at one time. Rather they continue to graze with the wet food. So my trick (learned here) is to add water to the food, keep it moist and let them eat when they want. It works well for mine.

If you find that the meals aren't not working in your house, you may want to try leaving it out and letting them graze on the wet food.
 
My only comment to add is that you will likely find more support here, and more users with experience to advise you, if you choose Lantus.

Wendy
 
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