Meatball 3/3

[Molly]

Good Evening!

So I woke up this AM to find Meatball eating rice out of the garbage. FANTASTIC.

He is very hungry lately, I guess bc of the high BG.

AMPS 720 4u
PMPS 469 4u
no ketones :razz: (as of last night)!

I have decided, after talking to my vet and reading this evening, to try lantus for awhile, as I am just 2 months out from diagnosis, and it seems it works better if you start it earlier, and, did i read correctly, an 85% remission rate if started w/in 6 months of diagnosis?

Also, I followed up with Nestle about the FF today. Requested info for: Beef Feast, Gourmet Chicken Feast, and Turkey & Giblets Feast. Will share it as soon as I get it!

 

[Gator & H (GA)]

Molly,
I'd follow Terri's advice if possible and forget the Lantus propaganda and proselytizers. Just my $0.02. Lev is like Lan but better.

 

[Joanna & Bix (GA)]

Yay, no ketones!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!! Rice ohmygod_smile c'mon kitty... LOW carb garbage eating only!!!! (rice is a carb, right? I never know, but it sure sounds t-a-s-t-y out of the trash can, lol!)

I don't know the pros & cons of L vs. L beyond what I have gleaned from the links in their forum stickes, but I think one of the reasons there is less hype about Lev's success rate is simply because fewer cats have used it, so there isn't as much data. I liked what I read about it personally, but then my cat is well past the 1 year mark so I may be biased (though Lev is also recommended for newbie kitties I believe).

The question I would want to know more about is what Terri said about Lev being more flexible than Lantus. I don't know why that is, I really am not clear on the differences between the 2 insulins, but I am interested in learning more, and am also not sure if that is something that might be of benefit to you.

If you do go with Lantus, be sure to get info about using a fast-acting insulin in conjunction. If you look at Sarah & Buzz's data when she switched over (Sarah, hope you don't mind that I nominated Buzz as an example!!!) you can see that it wasn't an immediate fix. WIth Ketones in the picture, as I see it you'll want to use a second insulin at first to bring the #s down. I want to say they use R, but I'm not sure if that's correct. It's some letter or other. ohmygod_smile

That's nice that your vet is open to it, that should make things less stressful for you. And it is nice that over in L & L Land there is a tidy protocol to follow for dosing (though I'm not sure if being ketone-prone changes the approach).

 

[Sarah and Buzz]

Molly,
I'd follow Terri's advice if possible and forget the Lantus propaganda and proselytizers.

This is very unlike you, Gator. "Propaganda and proselytizers"? Really? It's not a cult, it's an insulin. Do people get fanatical about it and spout off that they love it without maybe being able to articulate why it's better than others? Yes. Is it the only insulin lots of people have tried and thus they have nothing to compare it to? Yes. That doesn't mean that its results are propaganda. Everyone should make their own decisions based on research they do, and that includes talking to people who have had success with a product. All opinions should be considered, and the negative experiences should be taken into account as well.

Just my $0.02. Lev is like Lan but better.

How is Levemir better? I was trying to get an answer to this myself before the switch and I never could really find a solid reason why, other than the strict dosing dilemma which Joanna mentioned above (I'd love to hear from Terri about that, too). Monique wrote an excellent post on the old board in TT discussing some of the misconceptions about Lantus and how it must be handled and its shelf life, as well as touching on some specifics about Levemir. You can find it here if you are interested: http://www.felinediabetes.com/phorum5/r ... sg-1906669

I absolutely don't want to get into a pissing match over which insulin is better because I strongly believe that it varies for each individual. We can all give our opinions about our own experiences if asked, but ultimately it is up to the person making the switch to take all those opinions and facts and decide what works best for them and their kitty. I don't think it's fair to completely discount an insulin to someone who is considering making a switch without stating facts, or at least your own opinions, as to why you feel that way.

Molly: Here is one of the stickies in the Levemir ISG: viewtopic.php?f=10&t=681

And here is a link to the protocol, which is the same for both Lantus and Levemir: http://www.uq.edu.au/ccah/docs/diabetesinfo/link4.pdf (this is also linked in the sticky I linked to above)

 

[Sarah and Buzz]

If you do go with Lantus, be sure to get info about using a fast-acting insulin in conjunction. If you look at Sarah & Buzz's data when she switched over (Sarah, hope you don't mind that I nominated Buzz as an example!!!) you can see that it wasn't an immediate fix. WIth Ketones in the picture, as I see it you'll want to use a second insulin at first to bring the #s down. I want to say they use R, but I'm not sure if that's correct. It's some letter or other. ohmygod_smile

No, I don't mind. It definitely was not an immediate fix, and while I can't say whether or not that is really common, I do know quite a few people stepped in when I was wailing and gnashing my teeth to say that it takes awhile sometimes. And they do use R, but again, I can't say how many people do so. It was mentioned to a couple of people since I've started, so I don't think it's all that uncommon. Cindy + Mousie just made the switch last Friday, so she might be one you want to talk to or look at her posts/SS, Molly.

That's nice that your vet is open to it, that should make things less stressful for you. And it is nice that over in L & L Land there is a tidy protocol to follow for dosing (though I'm not sure if being ketone-prone changes the approach).

Ketones are specifically addressed in the protocol (you raise the dose in larger increments when ketones are present, basically).

 

[Terri and Lucy]

My statement that Levemir is more flexible than Lantus comes from tons of reading about how it works and the fact that using Tilly just didn't work for Lucy. Lucy at age 20 has multiple health problems other than diabetes. Most of the other Lev cats fall into a similar profile of hard-to-treat cats. Until recently Lev was the last ditch choice of many of us. That's not because of the insulin being inferior--just that is more unknown than others and our vets were less willing to prescribe it.

To get Lucy regulated, I've shot TID as have others. I've also used Cherie and Patriot's split dose technique to extend duration. Both worked quite well. Vicky and Gandalf (also elderly with multiple health issues) are using the split dose technique on the weekends (12/12 during the week) now to accommodate her crazy work schedule. You just can't get that kind of flexibility from Lantus.

 

[Sarah and Buzz]

Thanks for explaining that, Terri. It's definitely good to know.

 

[Ele & Blackie (GA)]

Just adding my 2 cents. I read on Cindy & Mousies' first post in LL that one of the reasons they are trying Lantus is because you can get a flat curve and stay at lower numbers longer. This is important to Mousie, because she was diagnosed young and may be diabetic her whole life. Here's a link to her post: viewtopic.php?f=9&t=7534 Jojo also posted farther down on that post about this. If this is true, then Meatball may be better off with Lantus because he would either go OTJ or be on the insulin for a very long time since he's so young.

 

[Gator & H (GA)]

Just adding my 2 cents. I read on Cindy & Mousies' first post in LL that one of the reasons they are trying Lantus is because you can get a flat curve and stay at lower numbers longer. This is important to Mousie, because she was diagnosed young and may be diabetic her whole life. Here's a link to her post: viewtopic.php?f=9&t=7534 Jojo also posted farther down on that post about this. If this is true, then Meatball may be better off with Lantus because he would either go OTJ or be on the insulin for a very long time since he's so young.

And she decided she wouldn't be able to do that with Lev? Maybe I was reading too quickly?

Sarah, I think I'm going to take the subjective part of "cult" on [without doing the full objective analysts if the word "cult"] and just say it sure "feels" like one sometimes. I think the bit of humor in the whole objective analysis thing might get lost.

Anyway, the propaganda are the studies that are promoted that have no analog for PZI or Lev. They are promoted as the reasons of Lan without having anything similar for other insulins. From what I know, no apple and apple type comparisons especially for Lev vs Lan which is what we are really talking about here.

An as for proselytizing, it is nothing but pure proselytizing to recommend one insulin over another when the full status of the cat or cat/bean situation is unknown. This happens almost daily in Health and IMHO doesn't speak well for those [or their insulin of choice] who engage in it.

And I love using consonance to promulgate a point :lol:

 

[Sarah and Buzz]

Molly: Pat + Raja + Shadow uses Levemir and Raja went OTJ in December and Shadow is doing very well. She is very nice and would be more than happy to talk to you about Levemir if you're interested.

 

[Sarah and Buzz]

Sarah, I think I'm going to take the subjective part of "cult" on [without doing the full objective analysts if the word "cult"] and just say it sure "feels" like one sometimes. I think the bit of humor in the whole objective analysis thing might get lost.

I've never been offended by your humor. I think you are a funny guy, in fact.

Anyway, the propaganda are the studies that are promoted that have no analog for PZI or Lev. They are promoted as the reasons of Lan without having anything similar for other insulins. From what I know, no apple and apple type comparisons especially for Lev vs Lan which is what we are really talking about here.

I am not familiar enough with either Lantus or Lev to know if there are any studies which compare solely those two, although I certainly haven't seen any. It is my (perhaps incorrect) understanding that because Lantus and Lev are so similar, their actions and properties are so as well. For example, the same protocol (Tilly or Queensland/Rand) applies to both of these insulins. As far as Lantus studies which have no analog for PZI, I am not really sure what you're getting at. That no one has done a study on PZI similar to that of Lantus? Well, that's not Lantus' fault. I apologize if I'm misunderstanding what you mean.

An as for proselytizing, it is nothing but pure proselytizing to recommend one insulin over another when the full status of the cat or cat/bean situation is unknown. This happens almost daily in Health and IMHO doesn't speak well for those [or their insulin of choice] who engage in it.

I couldn't agree more. It is irresponsible and foolish, as well as setting up the bean for failure or disappointment. However, if people go over to LL to inquire about switching, and they hear 20 stories of "I love Lantus, it has worked so well for Fluffy, you should look into it", I am not sure that's the same thing. That bean is seeking out opinions, and that is what people are giving them. If you recommended ProZinc to me because it's been wonderful for H, it would be irresponsible of ME to take your word for it and not do my own research and see how H's needs differ from Buzz's, and factor that in when making a decision. To say "Lantus is the best insulin for any cat, no matter what, because it's worked for me and 100 other people", THAT is careless. If people were going to other ISGs and trying to poach people and get them to switch to Lantus, unbidden, THAT would be careless.

I'm not trying to be difficult or start an argument, and I hope nothing I have said comes across that way. I just hate that we all can't use whatever insulin we want and be happy about it for ourselves and everyone else too. I guess what it comes down to for me is the difference in being aggressive and being helpful. I don't think people should aggressively promote any insulin. By that I mean assume that it's best for everyone without knowing their situation, as you said. Giving an opinion and stating how an insulin has worked for you and your cat, when asked, is helpful rather than aggressive. At least in my opinion.

 

[Terri and Lucy]

Just adding my 2 cents. I read on Cindy & Mousies' first post in LL that one of the reasons they are trying Lantus is because you can get a flat curve and stay at lower numbers longer. This is important to Mousie, because she was diagnosed young and may be diabetic her whole life. Here's a link to her post: viewtopic.php?f=9&t=7534 Jojo also posted farther down on that post about this. If this is true, then Meatball may be better off with Lantus because he would either go OTJ or be on the insulin for a very long time since he's so young.

Cindy made a choice to Lantus. Others make the choice to use Levemir. In terms of having a flat action, the two insulins are similar. In my community, Levemir is more cost effective. In general, Levemir is more stable. I use my pens down to the last drop while on the Lantus board you'll find most folks replacing their pen every 30 days.

The important point is that Lantus is not flexible--and for a cat with Meatball's current profile, the only way to Lantus work is with a bolus insulin like R. Molly needs to understand the extent of the care Meatball will need while on Lantus. I personally couldn't do it--I have to work and there's no one here to help. That's why I chose Levemir.

 

[Vicky & Gandalf (GA) & Murrlin]

Read this article: http://www.diabeteshealth.com/read/2007 ... ifference/

Please note the final paragraph. Those were human studies, but I think those of us using Levemir in cats would agree. I've seen extremely low blood glucose readings for Gandalf and although yes, they caused a bounce, he's never experienced a symptomatic hypo in the 2 1/2 years he's been on Levemir. I've seen it maintain his BGs within 10 points of one another for hours. I've tested 30s and 20s on him. The only alert I get is that he "parks" at his bowl to eat. No glassy-eyes, no loss of coordination. Food brings him up easily.

I call Levemir the Gentle Giant though because it can maintain blood glucose within normal range for a greater period of time than shorter acting insulins. But as with any insulin, Levemir can be overdosed and cause symptomatic hypo and should be respected with that regard. Raising dose too much and too fast is not advised. Curves often in the beginning are a must. Also true for proper management of Lantus.

In the end, it's up to the caregiver and their vet to decide which insulin they can work with successfully. They should both familiarize themselves with the Tilly protocol, because although Levemir can work well outside the protocol, it's the best place to start. And raising doses so quickly as was done here with Prozinc is NOT advised on either Lantus or Levemir. And raises are never based on preshot values, which a lot of the tests on Meatball are only that so I wonder if that is some of the reason for the constant dose increases.

Also, with ECID in mind, is it really so unusual to have a young cat with a pituitary tumor? Given the lack of response to high doses of insulin, even though it may seem unlikely in a cat so young, we all know cats don't read the rule books. And it's also unusual for a cat not given steroids to develop FD so young.

Meatball should be tested for acromegaly especially because Molly described him as originally big boned (at only 1 1/2 years 17 lbs??) and especially if his littermate brother does not appear to be of the same "big boned" body type.

Just my observation. Terri asked a few Lev folks to pop by and offer experiences. Molly, you're trying so hard! Hang in there, honey!

 

[Michele&Molly]

Just adding my 2 cents. I read on Cindy & Mousies' first post in LL that one of the reasons they are trying Lantus is because you can get a flat curve and stay at lower numbers longer. This is important to Mousie, because she was diagnosed young and may be diabetic her whole life. Here's a link to her post: viewtopic.php?f=9&t=7534 Jojo also posted farther down on that post about this. If this is true, then Meatball may be better off with Lantus because he would either go OTJ or be on the insulin for a very long time since he's so young.

I'm a bit confused by this. My Molly has been diabetic since she was young and we tried PZI for 4 of those years. For us, PZI worked but we found lev to be much more effective (flatter curves and a much more 'forgiving' insulin). The post quoted above could lead someone to believe that a cat may be better off with Lantus 'because he would either go OTJ or be on the insulin for a very long time since he's so young' . What is that statement based on? Is there data to support that the same isn't true of Levemir? Clearly ECID right?

I apologize to Molly for the confusion you may be feeling after reading all of this. Levemir and Lantus are both great insulins - read up on them and base your decision on your findings and not someone else's thoughts.

 

[Joanna & Bix (GA)]

Molly, how are you doing? This thread has gotten a little :? in spots hope you are doing ok digesting all this info.

My general take is that both Lantus & Lev are excellent insulins, but the most important consideration for Meatball is the ketones. I just don't want to see you switch from one boxed-in corner to another (if Lantus needs R in conjuntion to tackle the ketones, and that sounds like a daunting challenge for most people). I'm not clear on why Lev doesn't need that assistance, but I know there are people who can guide you on that. I haven't read up on the insulins lately, so I can't comment myself on what would be best for Meatball, but I'm glad people are giving you some info here! If you have any questions, please ask!

 

[Sheila & Beau GA & Jeddie GA]

Hi, Molly. I am from over on the Lev ISG. I am trying to catch up on Meatball's history.

What are you feeding him (other than rice from the garbage :mrgreen: )? Is he on a low carb wet food diet? And any treats are low carb? What about the insulin? I am assuming it is a month old? Handled ok - not dropped or placed in the fridge where it might get frozen (like the center of the top shelf)? Forgive me, this is like asking if the computer is plugged in when you can't get it to work, I know, but just covering the basics.

Normally, the starting dose of 5u and up from there would cause set in rebound - and very high numbers, but I have never seen a 700+ before, I don't think. I see that you did "start over" at 1u and got some lower PS's in the 300s. I does look like the raises after 1.5u were kinda fast, so there may be some missing data on the doses around 2u or so. I have never used PZI, but my sister uses it for her cat, and I wish I knew what her experience was more. Her cat had lots of issues with regulation until he has a complete dental extraction and is now on a low dose, .5u I think, and doing very well. But her cat is FIV+ and really beat up from living on the street. It would be uncommon for an 18 mos old to have those kinds of dental issues, but not impossible.

Right now you are spinning your wheels and the best course of action is to eliminate what you can from the equation. If the insulin is OK (what is the shelf life of ProZinc?) and he isn't eating carby dry food (or carby wet food), then getting the acromegaly test might be a good idea so you know what you are dealing with - or not. At least post over on the High Dose ISG, read their stickies on acromegaly and get some support there.

I really like lev. It got my diabetic who had been on vetsulin off insulin in 3 months. And I used it "off protocol" because that wasn't getting us anywhere. I can't recommend lev over lantus because I never used lantus, but I can just simply recommend lev as being a very good insulin. Beau was a tough case and it worked very well for him.

Hang in there!

 

[Gator & H (GA)]

what is the shelf life of ProZinc?

2 years from the date of manufacture [even after being opened if cared for appropriately]. It is a hardy insulin much like PZI Vet. Will take shaking and even being left out overnight I would assume. I do not think the status of the insulin is a problem at this point. Also something to know is that Meatball is only 1.5 years old and of course the keytones issue. Keytones came back with a reduction to 3u :-(

I've never been offended by your humor. I think you are a funny guy, in fact.

Aww you're either being sweet or trying to egg me on into doing the whole Wikipedia vs FDMB [Lantus Forum specifically] on the cult thing [or BOTH]. I'll do it if you make me :lol:

As far as Lantus studies which have no analog for PZI, I am not really sure what you're getting at. That no one has done a study on PZI similar to that of Lantus? Well, that's not Lantus' fault. I apologize if I'm misunderstanding what you mean.

I shouldn't have even brought PZI into the picture. So let's pretend I didn't. And let the focus remain on Lan vs Lev. I tried to focus on Lan vs Lev but introduced something else I shouldn't have. Anyways....

I am not sure that's the same thing.

No is is absolutely not the same thing. I'm talking about the Lantus proselytizing going on to the newly diagnosed in HEALTH when folks just arrive. That to me is WAY unneeded and does not speak well for the insulin those people have chosen. It's also one thing to say, "X insulin worked well for me," than it is to say, "I think you should read the LL forum - 8x% of cats go into remission with it." Or, "Lantus is great you should really think about it!" Or my favorite, "Most cats here are on L or L" or similar. Anyone ever think that maybe ECID and there is not a "most cat"?!!! OK I'm exhaling now... ahhhhhhh.

If you recommended ProZinc to me because it's been wonderful for H

I would only do this if Buzz was already on some sort of PZI OR Buzz was a complicated cat and was expected to have or had appetite issues [then you would really hear it from me about PZI]. Or if you were a party girl, I might say, "You know if you want to maximize your lifestyle with a DM cat you might look at PZI." Other than that, I really don't voice my opinion on the matter and I really haven't seen Lev folks [or other PZI folks] do it either to their credit.

THAT would be careless.

Careless is as careless does.

I hope nothing I have said comes across that way.

Not one iota.

 

[Molly]

My, what a crowd I've gathered. I guess I hit a nerve with this post.

You all have given me a lot to think about. I don't have a lot of reading time tonight, but I will certainly do some more research and reading over the weekend.

Some things you should know:
- If it is possible Plan A: remission. Plan B: If remission is not possible, then attaining a balance of flexibility and stability and cost.
- Shooting at 12/12 is really not a problem for me. Actually, I shoot at 8 and 8, right before I leave in the am, and as soon as I get home in the pm, and during the week that schedule is very regular. There is one day per weekend that will be off by about an hour in the AM as it is currently set, but if it needs to be absolutely 12/12 I could change that for awhile.
- I don't consider my choice now to be the one I ultimately stick with. I may try them both out and see which works best for Meatball and me. I have a feeling he is either going to get over it - and very quickly if I can ever regulate his sugar - bc he is young and otherwise very healthy. Or, he is going to be on insulin forever, which is a LONG time, plenty of time to try out a few things and figure out what works best for us.

And as far as I can tell, Lantus and Levemir work in much the same way. Both are long lasting and build up in the system over the course of a couple of days. They keep the BG #s lower and flatter, and the no shoot number is much lower. The main differences seem to be the stricter 12/12 schedule of the Lantus, and the initial period where R insulin may be needed to help regulate with Lantus, Levermir maybe be a little bit 'bouncier.' Am I missing any major differences? I can tell that both have worked very well and have many success stories which demonstrate their effectiveness.

then getting the acromegaly test might be a good idea so you know what you are dealing with - or not. At least post over on the High Dose ISG, read their stickies on acromegaly and get some support there.

How much does the acro test cost?

Meatball should be tested for acromegaly especially because Molly described him as originally big boned (at only 1 1/2 years 17 lbs??) and especially if his littermate brother does not appear to be of the same "big boned" body type.

Boss, the brother, is actually also quite a big cat. He weighed 18lbs at the December 23 checkup in which Meatball was diagnosed. Other than the fact that Meatball is now only 13 lbs to Boss' 18 lbs, they are very similar in size.

Joanna & Bix wrote:If you do go with Lantus, be sure to get info about using a fast-acting insulin in conjunction. If you look at Sarah & Buzz's data when she switched over (Sarah, hope you don't mind that I nominated Buzz as an example!!!) you can see that it wasn't an immediate fix. WIth Ketones in the picture, as I see it you'll want to use a second insulin at first to bring the #s down. I want to say they use R, but I'm not sure if that's correct. It's some letter or other. ohmygod_smile



No, I don't mind. It definitely was not an immediate fix, and while I can't say whether or not that is really common, I do know quite a few people stepped in when I was wailing and gnashing my teeth to say that it takes awhile sometimes. And they do use R, but again, I can't say how many people do so. It was mentioned to a couple of people since I've started, so I don't think it's all that uncommon. Cindy + Mousie just made the switch last Friday, so she might be one you want to talk to or look at her posts/SS, Molly.

Ok, first, how can I get to Sarah & Buzz's data sheet? Second, my vet is being.. hesitant.. to give me R. I think I would be okay with giving it, but this is something I definitely want to look into a bit more.

Ok, as to not set a record about the longest post ever, I'm going to end this one, and might start a new one.

On a bright note, Meatballs +4 tonight was 197. This could be bc the Relion reads a bit lower than the Alphatrak, but still I'm happy to see <200 at +4!

 

[Gator & H (GA)]

How much does the acro test cost?

Please ask Nancy & Cody they have just been through this. And there should be the FedEx or UPS overnight figured into that as well [NEVER EVER send USPS to a University] - and samples should be drawn on a Monday and send out overnight that same day on a frozen gel pack despite the minimum requirement often listed on the University's web site. If you have a FedEx account you can give that account to the vet and have them charge it to it. I'm PMing Nancy & Cody now to get her to chime in here.

Ok, first, how can I get to Sarah & Buzz's data sheet?

It's in her signature or here:
http://spreadsheets.google.com/pub?key= ... q6GmC_SiSg

I guess I hit a nerve with this post.

No real nerves that I can tell. Wait til' someone gets me started on most raw diets or the frustrations of dealing with uninformed [yet surprisingly well educated] vets.

 

[Monique & Spooky]

Ok, first, how can I get to Sarah & Buzz's data sheet? Second, my vet is being.. hesitant.. to give me R. I think I would be okay with giving it, but this is something I definitely want to look into a bit more.

You don't need a prescription to purchase R insulin, just go to any pharmacy and ask for Humalin or Novalin R insulin, it is a U100 insulin as well and uses the syringes as Lantus or Levemir.

 

[Jill & Alex (GA)]

hope you don't mind me crashing the party. i was reading the lev forum and saw terri's plea for support in choosing levemir over lantus because she's worried about meatball being ketone prone. just a few comments, if i may...

i've used BOTH lantus and levemir. three and a half years ago when alex was on lantus, we floundered about while learning how to use it effectively because it was still relatively new in the US at that time. thankfully, we've come a long way since then. the action of lantus and levemir are very similar.
i dare say, i found the action of the 2 insulins to be almost the same.

the ketone issue: BOTH lantus and levemir have a hard time bringing down higher numbers... which is why BOTH lantus and levemir users have been known to compliment their kitties treatment with the use of R as a bolus insulin when dealing with a ketone prone kitty. R pulls down the numbers enough to give the lantus or levemir something to grab on to.

flexibility: yes, lantus works best when pretty much sticking to a 12/12 schedule, but guess what? so does levemir.
however, we don't live in a perfect world. we have jobs, families, social obligations, etc. that sometimes interfere with shot times. life happens.
a caregiver i know (and there are others) HAD to routinely shoot lantus anywhere between +11 and +14 because she was working 3 jobs simultaneously. was it ideal? no, but she did the best she could and kitty still managed to go OTJ. "split" dosing and dosing tid are techniques which have been used by BOTH lantus and levemir users. ECID. if dosing bid doesn't work after giving it a fair shake, most try another method.

remission rates: you'll find the remission rates of kitties using lantus or levemir after starting a tight regulation protocol within 6 months of diagnosis strikingly similar in the studies done by Rand and Roomp.

levemir - "For cats that began the protocol within 6 months of diagnosis, the remission rate was 81% and for those that began 6 months after diagnosis, the remission rate was 42%."

lantus - "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."

stability of the insulin: this is such a gray area... with no single "right" or "wrong" answer. there are BOTH lantus and levemir users who have used their insulin to the last drop. there are BOTH lantus and levemir users who have used their insulin of choice for up to 6 months. there are BOTH lantus and levemir users who have tossed cartridges or pens long before others because they saw floaties or thought the insulin had punked out. i used my first vial of lantus for 9 weeks before seeing floaties. i used my first levemir flexpen for only 34 days before i saw floaties in it... and yet, the second pen is still in my refrigerator (unused since october)... and there are no floaties in it. go figure.

just wanted to reassure you... lantus and levemir are BOTH excellent insulin choices.

whether you change insulins or not... wishing you the best of luck, molly!

 

[Carolyn and Spot]

Hi Molly,
I'm a high dose Levemir user - we're in dose reduction mode but he's getting somewhere over 25u BID right now. Leo has acromegaly and his dose is based upon hormonal outputs that fluctuate. I have used both Lantus and Levemir, and must say I do prefer Levemir due to the high dose I'm shooting with Leo. It's more cost effective for me. Either insulin would be fine, as both insulins have very similar actions, however I took the opportunity to look at your numbers and see a fair amount of resistance there. If and when you switch, I would recommend you cross over at a higher than recommended dose (ie don't start at 1u) and increase rapidly. In my case, I increased at a rate of every 7th dose at 1/2u at a time, but that all depends on progress, or lack thereof. Both insulins can be increased the same way and both act in very much the same manner. One thing that I think you will greatly appreciate about the L insulins is the tremendous duration you will get with them. You won't see it right away but when the insulin begins to build up in the system and you get his dosing straightened out, it's an absolute dream.

I am also an R user and would be happy to help you with that, however guessing that R will control ketones when we don't know how the R works in Meatball is a problem. I would recommend that you pick up a vial of R (Humulin) now and we can help you test it's effect on Meatball at a very tiny dose (we generally start at .1 or .25u). R is a very short acting insulin and the goal of using R is to promote a quicker drop in glucose. It must be used carefully as it's actually a pretty dangerous insulin if used improperly, but once you have an idea how it works in him, you can use it at preshot and/or during cycle if necessary. Nothing will make up for lack of basal insulin however, and that would be your PZI/Lantus/Levemir. You must be diligent about increasing the doses of your basal insulin to prevent ketones and also to help stabilize Meatball.

Make certain that whichever of the two insulins you buy, that you do not get the vials. Get the cartridges/pens and U100 syringes to use with them. Lantus in particular has a short opened shelf life (as short as 28 days) and you don't want to be stuck pitching a half a vial of insulin. Levemir's recommended open shelf life is 42 days, though you will hear people say they use theirs to the last drop. I never have that problem at my dose so I can't weigh in there LOL :mrgreen:

Remember when picking up your vial of R, that you must also get the appropriate U100 syringes. I would deeply recommend you get the ones with half unit markings. *Much* easier to measure microdoses

I would also recommend you post on the High Dose forum as there are members there who have had experience with numbers like you are getting with Meatball. Hope this helps to alleviate some confusion and please do send me a PM if you pick up some R and I'll be glad to drop by your thread and help you learn to use it.

 

[Nancy and Cody]

Wow .... wow
OK I'll try to be brief. Gator asked me to chime in.

I've been lurking Molly and Meatball for awhile but have hesitated to jump in much because I am relatively new myself, I have loosely followed him because of our similarities:
his high numbers, his high doses, and use of Prozinc
Of note:
1) Early on a quick triage by the experienced acro moms suggested Molly start over with insulin at a start low, go slow approach. I thought you were doing well with this and getting somewhere around 1.5u, and hoped that maybe you could have held that dose or a slight increase for another week. I have noticed with Cody that a dose can take awhile to really kick in. My vet had me hold a dose for 2 weeks and although I thought she was crazy, his numbers did start to change in the second week. Maybe it has some similarities to the whole "shed" thing. Unfortunately, since Cody has acromegaly (and the nature of the disease is hormone fluctuations,) it is supposition only. (I would love to see some non acro cats on Prozinc try holding the dose a bit longer just to see what happens)

2) I have limited experience here (FDMB since 1-1-10), but I have to wonder if maybe Meatball warrants another look by the experienced acro moms. According to a very recent article, one of the many hallmarks of acromegaly is the 'food desperate' kitty. This can also be from plain vanilla FD, but in Cody's case, it was EXTREME. (fwiw I found Cody in a covered trash can, stuck face down, eating the styrofoam and leftovers inside, and many other wild desperate kitty moves before our diagnosis in Feb 2010) Meatball's rice escapade is familiar to me....
If you want to take a look at the stickies in the high dose forum there are links for the acro testing and other information. I will also search for the link to that recent article I mentioned (lost at the moment) If you want to talk more about the process, let me know, i'd be happy to share my experiences. Basically the test is only done at MSU (Mich), it costs $45 , shipping needs to be by ups or fed ex in an insulated cold shipper, not usps, and it is set up every Wed, and you know by Friday or monday. In addition, you pay your vet for a blood draw. It is smart to also test for IAA (which costs ~$11?). I paid the shipping myself (gave the vet my fed ex #)

3) all I know about the L's is that many high dose moms prefer Levimir because large doses of Lantus apparently sting. (forgive me if I'm wrong) If you knew you were a high dose mom because of an acro diagnosis, this might influence your decision of where to start.

I'm sorry this is all so difficult for you guys. (Glad you started those fluids tho)

((((((hugs))))))

 

[Nancy and Cody]

Here's that new Acromegaly article I mentioned. Open it as a PDF, or else you just get the highlights. It has some good details on characteristics of acrocats.

http://www.sciencedirect.com/science?_o ... 58b97d9ea5

 

[Joanna & Bix (GA)]

Just wanted to clarify for Molly, the $11 IAA test is for insulin resistance, right? So even if the Acro test were negative, that could be positive and could give her a clear sign that higher doses are needed. Please correct me if that is wrong.

I think it's clear but in case not, just wanted to note that the reason for the quick increases has been ketones. Molly has tried a couple times now to go slower and/or reduce dose to check for rebound, and each time the ketones have come back, so that's where the faster increases have come in.

 

[Nancy and Cody]

Yes, IAA stands for insulin auto antibody. Basically the body sees injected insulin as an invader and disables it before it gets into the blood stream. It is not common. I believe Jan and Buddy were diagnosed in Jan 2010 if you want to view their spreadsheet. I think she's on the lantus ISG.

The high dose link to a lot of this info is viewtopic.php?f=12&t=375

Molly, consider adding a post in high dose if you want some experienced high dose folks to check it out again.

I feel your pain, so many directions to go and it does get overwhelming. My tactic has been to investigate and only change one thing at a time, but then Cody has been FD for a long long time, so I'm not really dreaming of remission. You have to weigh your individual situation & finances and go from there to make your next move.

Another option no one has mentioned and I am thinking about for us, is the use of R with Prozinc. But for now we're still just increasing the dose. In a strange way it helps to have the diagnosis- you realize he needs the big doses.

Also BTW everytime Cody gets into something terrible (HC) like the dry dog food, it takes him a good week to start showing me good numbers again. (That would probably be a great time to add R to our arsenal- I'm warming my vet up to the idea)

and just to really confuse you, I 'm almost certain that I've noticed differences in action of the 4 vials that I have had in my possession, and since this stuff is manufactured in big lots, the explanations that jump out at me are 1) acromegally fluctuations or 2) transit/shipping/distribution problems. Something to consider...

So much for "brief"