Martin switching from PZI to Lantus - what should we know?

[jakes]

Hi everyone,

Our diabetic cat Martin has been on PZI for about 2 months now and it's pretty much been a continuous rollercoaster. Sometimes he'll seem to be regulated for a couple of days, but then his BG will go crazy again. In a given cycle his BG can decrease and then increase again by 400+, and this seems to be happening even with low doses of PZI. We took him to a specialist vet who's knowledgeable about feline diabetes, familiar with somogyi (bounces/rebound), etc. She spent a lot of time looking through his whole spreadsheet and told us that she thinks the PZI is just too potent for him, so she's suggested that we switch him over to Lantus.

I've read a bit about Lantus and it seems promising, so I'm excited that we might actually be able to get him regulated on it. The vet asked us to start at 0.5u, which seems reasonable to me since 0.5u of PZI seems to be a bit too much for him and I've read that Lantus is a less powerful insulin than PZI. I've also read through Tilly's Lantus protocol and am planning to follow it as closely as possible while continuing to work with our vet.

I'm looking for general advice on the switch from PZI to Lantus - I'm wondering if there's anything specific we should know ahead of time. Any suggestions or advice would be greatly appreciated :smile:

Thanks!

 

[Blue]

Re: Martin switching from PZI to Lantus - what should we kno

If you haven't already, you can post in the PZI forum as many who have made this same switch in the past surely keep in touch with their friends in that forum.

Just curious about your comment on the ss ... your vet saying you should switch insulin because PZI is too potent? From the looks of the ss numbers and also the fructosamine test, the PZI is not really working at all. I would think you would have very low numbers all the time no matter how low a dose you were to give.

I would say that you would do well to read all the stickys on the Lantus forum and ask questions you have on how the shed works.

 

[Sienne and Gabby (GA)]

Re: Martin switching from PZI to Lantus - what should we kno

Welcome to Lantus Land!

There are a number of differences between PZI and Lantus. First and foremost, dosing with Lantus is based on nadir, not on the pre-shot value. It's important to get pre-shot tests so you know that it's safe to shoot but it's equally, important to get spot checks during both the AM and PM cycles. You will need to get more tests. If you take a look at the Tight Regulation Protocol sticky, it is important to get frequent tests especially since you are switching insulin.

Lantus is a depot-type of medication. It takes about 5 - 7 days for the insulin depot to form. This depot is what gives Lantus its duration and allows for its cumulative action.

Lantus is also an insulin that likes consistency. Shooting every 12 hours and being consistent with dose is important. This is not an insulin where you slide the dose based on your pre-shot. Doses are held for a minimum of 3 days unless a dose reduction is indicated.

You noted that your vet thinks PZI is too potent for Martin. Please understand that this doesn't mean that you won't see low numbers or that cats don't bounce. Low numbers happen and most cats who are used to spending time in high numbers (i.e., they're experiencing glucose toxicity) do bounce. I can provide you with a fair amount of information on Somogyi but the bottom line is that it is a concept that is controversial, at best. The original research (circa 1938) has never been replicated and was not conducted using a long-acting insulin. There is no evidence for Somogyi with Lantus or Levemir, or probably PZI for that matter. While the ideal Lantus curve is flat, it can take a while to get there. Bounces are normal and expected and it looks like Martin is very good at it.

Please let us know how we can help. The people here are very generous with their time and their knowledge. Please ask questions and I hope you will be posting on a regular basis.

 

[arozeboom]

Re: Martin switching from PZI to Lantus - what should we kno

Hey there! Ruby and I made the switch from PZI a few months back. She started on PZI and was all over the place for 2 months. We switched to Lantus and for the first 3 weeks she was still all over the place, then started to settle in really nicely. Check out her spreadsheet and you can see how it went for us. I was really freaked out to make the switch for some reason, but now am really glad we did! I don't know if I can offer much advice, but feel free to ask any questions you want.