Methylcobalamine for diabetic neuropathy

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Andra&Ozzy

Andra&Ozzy

Member Since 2016
Hi,

I've seen on this page and others that people use Methycobalamine to treat diabetic neuropathy. My boy Ozzy is diabetic (on Caninsulin, possibly switching to ProZinc), IBD and now having a pancreatitis flare-up. His hind legs are going, fast.

How much methylcobalamine do you give and how often? Anything I should know about possible side effects/ medicine clashes and dangers?

My vet didn't know about this drug and is "looking it up". I'd like to have as much info as possible.

Any advice about how to treat the pancreatitis for a diabetic would be greatly appreciated!

Thank you so much for your help!

I'm tagging a couple of people I've heard are a wealth of knowledge.

@Critter Mom @Chris & China
 
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Methylcobalamine is a form of B12. It is water soluble so any extra is flushed out through the kidneys. As far as I know there are no side effects. Not sure about with CKD kitties though. I use Zobaline which is made for diabetic cats, not sure if it's available where you are, but any methyl B12 will do as long as there is no sugar or sugar substitutes. If you can't get the Zobaline, be sure to add some Folic acid to the Methylcobalamine as it helps with absorption. The Zobaline contains 3mg methylcobalamine and 200mcg Folic Acid per pill. I gave Colin 2 pills/day to start and now have him on one/day.
 
Sharon14 said:
Methylcobalamine is a form of B12. It is water soluble so any extra is flushed out through the kidneys. As far as I know there are no side effects. Not sure about with CKD kitties though. I use Zobaline which is made for diabetic cats, not sure if it's available where you are, but any methyl B12 will do as long as there is no sugar or sugar substitutes. If you can't get the Zobaline, be sure to add some Folic acid to the Methylcobalamine as it helps with absorption. The Zobaline contains 3mg methylcobalamine and 200mcg Folic Acid per pill. I gave Colin 2 pills/day to start and now have him on one/day.
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Sharon, thank you for your advice. My vet is now saying that because his cobalamin levels were higher than normal on the last test, we should use this supplement yet. Do you know anything about why this is a contraindication, or might he be too cautious? Sorry if these are silly questions, I am only just learning about this.
 
Alexandra Popescu said:
Sharon, thank you for your advice. My vet is now saying that because his cobalamin levels were higher than normal on the last test, we should use this supplement yet. Do you know anything about why this is a contraindication, or might he be too cautious? Sorry if these are silly questions, I am only just learning about this.
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No questions are considered silly here! In fact I don't know the answer and shall read the links Mogs gave you. As far as I know any excess is excreted in the urine and there are different forms of cobalamine, methyl and cyanocobalamine. The methyl is the one that will help with neuropathy. Will be interesting to see what others may say.
 
T
Sharon14 said:
No questions are considered silly here! In fact I don't know the answer and shall read the links Mogs gave you. As far as I know any excess is excreted in the urine and there are different forms of cobalamine, methyl and cyanocobalamine. The methyl is the one that will help with neuropathy. Will be interesting to see what others may say.
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Thank you! ❤️
 
I use Zobaline also. Started 2 pills a day. Now using one a day. The pills are easily crushed and can be mixed in the food. It does take time to see improvement. I started it very early and saw improvement in about 2 weeks. In about 4 weeks his little wobbliness was gone.
 
scoobydoox said:
@Critter Mom where are you getting the lantus from in the uk? Alexandra is located in the uk. I thought maybe you could help her out with where you are getting things. thanks
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Hi Scoobs,

I've only just seen your tag.

Our vets prescribed Saoirse Lantus under the UK drug cascade rules because I was able to demonstrate that Caninsulin was not a suitable insulin for her. Our vets will either dispense the pen refill cartridges themselves or they will issue a written Rx for a 10ml vial which I can then fill at a local chemist (less than £50 earlier this year, IIRC).


Mogs
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Critter Mom said:
Hi Scoobs,

I've only just seen your tag.

Our vets prescribed Saoirse Lantus under the UK drug cascade rules because I was able to demonstrate that Caninsulin was not a suitable insulin for her. Our vets will either dispense the pen refill cartridges themselves or they will issue a written Rx for a 10ml vial which I can then fill at a local chemist (less than £50 earlier this year, IIRC).


Mogs
.
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Thank you! Vet seems to think that we "have" to try ProZinc first and only after that doesn't work , go to Lantus. I've heard Lantus is better and would like to skip to that, if so. Am I correct in thinking that and what would you advise I tell the vet to make the switch directly?
 
Hi Alexandra,

UK Veterinary Drug Cascade Rules

From the above web page:

The Cascade is a risk based decision tree that allows you to use your clinical judgement to treat an animal under your care by deciding which product to use when there is no authorised veterinary medicine available in the UK.
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[Emphasis mine]

Alexandra Popescu said:
Vet seems to think that we "have" to try ProZinc first and only after that doesn't work , go to Lantus.
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Now that Prozinc has been authorised for treatment of feline diabetes in the EU legally that may well be the case. When I asked for Saoirse to be switched from Caninsulin to Lantus there was no other approved insulin for treatment of feline diabetics at that time so there was no further impediment to getting her the Lantus Rx.

I've attached below a PDF of the published, peer-reviewed Roomp-Rand TR protocol. IIRC it does give information on the significant statistical increase in remission rates for cats on L insulins vs. those treated with P insulins. Maybe it might help to discuss it with your vet but if the cascade rules legally require that Prozinc has to be tried first then I don't think there's much your vet, however willing, would be able to do.

I've been wondering how the approval of Prozinc might affect UK vets' prescription choices. I'd be very interested to hear how you get on, so please post an update when you know more.


Mogs
.
 

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Critter Mom said:
Hi Alexandra,

UK Veterinary Drug Cascade Rules

From the above web page:



[Emphasis mine]



Now that Prozinc has been authorised for treatment of feline diabetes in the EU legally that may well be the case. When I asked for Saoirse to be switched from Caninsulin to Lantus there was no other approved insulin for treatment of feline diabetics at that time so there was no further impediment to getting her the Lantus Rx.

I've attached below a PDF of the published, peer-reviewed Roomp-Rand TR protocol. IIRC it does give information on the significant statistical increase in remission rates for cats on L insulins vs. those treated with P insulins. Maybe it might help to discuss it with your vet but if the cascade rules legally require that Prozinc has to be tried first then I don't think there's much your vet, however willing, would be able to do.

I've been wondering how the approval of Prozinc might affect UK vets' prescription choices. I'd be very interested to hear how you get on, so please post an update when you know more.


Mogs
.
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Thanks very much, Mogs! I'll read that and show it to my vet (the latter will be a bit tricky, I expect, since a lot of vets take offence to client research and take it to be a threat to their authority). I don't think that this is the case with my vet, but it's still a delicate issue to navigate, as in any professional context that involves health. Out of interest, how do you get around this?

I will definitely post updates on the progress and which insulin we end up trying. To your knowledge, is it the case that Lantus is better than ProZinc? Some people seem to think this. I asked my vet and she said that in an otherwise healthy cat, Lantus is, indeed, a favourite, since it tends to drop the numbers quite low and keep them there for a sustained period of time. In an otherwise unstable cat, like Ozzy, with a variety of issues, chiefly IBD (and now pancreatitis), which means that his eating will be all over the place, Lantus is riskier. This is because, she said, if he goes into a hypo that will last longer. ProZinc seems to be considered "safer", given these considerations. Any thoughts?
 
With Spitzer, he had some comorbid conditions which made the appetite variable, and threw in vomiting occasionally for good measure. While Lantus lasted longer, I couldn't push the dose up due to the variable food intake, so I used a supplemental short-acting insulin on the cycles he was high.
 
Alexandra Popescu said:
Thank you! Vet seems to think that we "have" to try ProZinc first and only after that doesn't work , go to Lantus. I've heard Lantus is better and would like to skip to that, if so. Am I correct in thinking that and what would you advise I tell the vet to make the switch directly?
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We have used both. If I could have s do over I would have started with lantus. :bighug:
 
BJM said:
With Spitzer, he had some comorbid conditions which made the appetite variable, and threw in vomiting occasionally for good measure. While Lantus lasted longer, I couldn't push the dose up due to the variable food intake, so I used a supplemental short-acting insulin on the cycles he was high.
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Thank you! which was the supplemental short-acting insulin you were using and how much? I didn't know you could do both... sounds promising, since this is the problem with Ozzym his variable food intake (of late)!
 
Woodsywife said:
Think of it this way. Prozinc, although it's not Lantus, it is better than caninsulin.
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Smokey! :) (I hope this is the same Smokey) Thank you! We might just have to bite the bullet on this and start with ProZinc. I am waiting for his upper respiratory infection to clear, but his numbers are really high in the meantime. How long would you say it's safe to wait with these high numbers (UK 31 this evening before insulin. He's on 10 units at the moment!), or should I rush him to the internist anyway? My concern about taking him there now is that if they run bloods, they'll get skewed results, because he's on antibiotics. He's also not well, so I'd like him to recover from the infection, at least, before making that long journey (over an hour each way) with the added stress of the appontment. My worry about not switching quicker is him running these high numbers, which is throwing up all kinds of potential problems, not least aggravating the pancreatitis flare-up he's going through. Thoughts?
 
Andra&Ozzy said:
Smokey! :) (I hope this is the same Smokey) Thank you! We might just have to bite the bullet on this and start with ProZinc. I am waiting for his upper respiratory infection to clear, but his numbers are really high in the meantime. How long would you say it's safe to wait with these high numbers (UK 31 this evening before insulin. He's on 10 units at the moment!), or should I rush him to the internist anyway? My concern about taking him there now is that if they run bloods, they'll get skewed results, because he's on antibiotics. He's also not well, so I'd like him to recover from the infection, at least, before making that long journey (over an hour each way) with the added stress of the appontment. My worry about not switching quicker is him running these high numbers, which is throwing up all kinds of potential problems, not least aggravating the pancreatitis flare-up he's going through. Thoughts?
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Are you testing for ketones? I don't see a spreadsheet to see what's going on. When are you starting a different insulin? The infection certainly isn't helping anything. If he isn't feeling better since the antibiotic started I think a trip to the vet is warranted.
 
Andra&Ozzy said:
Thank you! which was the supplemental short-acting insulin you were using and how much? I didn't know you could do both... sounds promising, since this is the problem with Ozzym his variable food intake (of late)!
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Humans do it frequently.
However, for safety, you would get as stabilized as possible on a long-acting insulin basal dose first.
Then, and only then, would you add in a 2nd, short-acting insulin. You would start at a tiny dose (ex 0.25 units) and you would curve it a few times to be sure how it worked with the long acting insulin and when optimal time was (avoid overlapping nadirs!!!). This means a lot more testing and monitoring, as once the insulin is in, you can't get it out... and with a cat that is vomiting often, you could wind up needing an emergency hospitalization for a dextrose drip.
 
BJM said:
Humans do it frequently.
However, for safety, you would get as stabilized as possible on a long-acting insulin basal dose first.
Then, and only then, would you add in a 2nd, short-acting insulin. You would start at a tiny dose (ex 0.25 units) and you would curve it a few times to be sure how it worked with the long acting insulin and when optimal time was (avoid overlapping nadirs!!!). This means a lot more testing and monitoring, as once the insulin is in, you can't get it out... and with a cat that is vomiting often, you could wind up needing an emergency hospitalization for a dextrose drip.
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Thank you for your advice! We'll do the switch to the main one, first, and then see. Hopefully he'll get stabilised on the new insulin and not need anything extra.
 
Woodsywife said:
Are you testing for ketones? I don't see a spreadsheet to see what's going on. When are you starting a different insulin? The infection certainly isn't helping anything. If he isn't feeling better since the antibiotic started I think a trip to the vet is warranted.
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Thank you. He's been back to the vet's and is not on a different antibiotic. Hopefully, this will clear the infection quickly, so that we can get him to the specialist.
 
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