Re: My female 6 year old cat was just diagnosed with diabete
I like lantus as it doesn't have so much of the day to day fiddle factor. With pzi its trying to work out what dose to give. Lantus you hold the same dose for 3-5 days before deciding if its going to work. Pzi feels to me (although I don't use it) that its more time intensive for newbies and may require a deeper understanding. Plus there is more lantus support on here.
I am going to PM Carl and see what his take is. He has a good understanding of both and if he thinks you stay on pzi then i would but we will need to make some tweaks.
Here's my take -
All 3 are good types of insulin (Lantus, Levemir, and Prozinc). The "L's" work alike, but a little bit different. Both are depot insulins, but users of each have their reasons for preferring one over the other, and a lot of it has to do with how well each of their cats responds to them.
Prozinc is different in that it is not a depot-type insulin.
I used compounded PZI, which is not exactly like Prozinc, but works the same way. Prozinc is supposed to work a little bit longer, but in terms of how they function in a cat's system, they are alike.
Here's the best way I have ever heard the question "which insulin is best?" answered:
"The best insulin is the one that works best for YOUR cat."
There is no "best" insulin outside of that specific answer, in my humble opinion.
I agree with what other people have said, in large part...
You are more likely to find users of Lantus on the board. It's the most popular and used insulin here, has been for several years, and most experienced members on the board are using it, or have used it.
The Tight Regulation protocol used by Lantus and Levemir users offers a cat the best chance at remission. Will it get every cat into remission? No. Every cat won't go into remission. Some need insulin for the rest of their lives. That's true no matter what type of insulin you use.
There have been kitties who have not done well on Lantus, and have done well on Levemir. Others have done well switching to Prozinc. Former Prozinc users have been able to get their cats off the juice by switching to either "L" type insulin.
The dosing logic is different between Prozinc and the "L's". The primary "number" that determines dosage and dosage adjustments if you are following the Tight Regulation Protocol is the "nadir" number. The protocol clearly sets out when you increase and decrease a dose, and how much you adjust the dose, usually in .25u increments.
With Prozinc, there are a couple of different approaches you can use, but there is not a formal protocol available "here" that tells you what to shoot, or when to reduce or increase, or by how much. Other feline diabetes boards exist where people follow a "tight regulation" protocol for Prozinc, but nobody here uses or advises on those protocols.
One way to use Prozinc is to determine a good starting dose, hold that dose for a few days, test at each preshot and test around nadir, then evaluate the data to determine if the dose needs to be adjusted. Most adjustments are also in .25u increments.
Another way is to test at preshot and nadir, calculate how far the BG drops on a given dose, and then develop a "sliding scale" where you adjust the dosage based on your preshot numbers, to try to achieve a "nadir goal". That way does require a good bit of testing, and a good bit of experimentation.
Many people believe that Prozinc is dosed just on the preshots, and can be adjusted based on the preshot test numbers, but that's not really true. You have to test mid-cycle just like you do with Lantus or Levemir, because you need to know if the dosage is too high, too low, or just right. You need to know "how low is low" in order to really know what a dose is doing.
The real difficult aspect to using Prozinc is that there isn't a protocol to follow, so like Wendy said, there can be a day by day fiddle factor. The TR protocol for Lantus/Lev, make it easier, in my opinion. At least there are guidelines to follow that are based on scientific studies and proven to work. That, and there are far fewer people using Prozinc and advising on it. The experienced people who use or have used Prozinc are all great people, there just aren't as many of them that are active on the board on a daily basis.
There are, in my opinion, a couple of benefits to Prozinc that don't exist with Lantus and Levemir.
You can adjust the dosage on a daily or shot by shot basis, and expect to see results quickly, because there isn't a depot, and dose adjustments don't normally take long to "show up" in the numbers. So while you may have to "fiddle", you see pretty quickly if the fiddling "worked".
You also have more flexibility as far as shot timing goes. If it's clear, based on data, that a shot isn't quite lasting 12 hours, you can shoot earlier, even an hour or two. And if it looks like the cycles last longer than 12 hours, you can shoot late, or you can adjust the dosage up (or down) to compensate for the adjustment in shot timing. But it takes data gathering, and experimentation. And mid-cycle testing.
Bottom line?
Cats can go into remission on any insulin. It's rare when you aren't using one of the "big three", but I have seen a couple that have gone into remission on Humulin, Caninsulin or others.
Bob went off the juice after ten weeks on compounded PZI. Would he have gone OTJ on Lantus or Levemir? Possibly, but I'll never know. I used a sliding scale, where I adjusted his dose on a shot by shot basis, and his preshot numbers determined the dosage. I didn't follow a protocol. I followed my vet's advice at first, and when I felt that his dosage had gone too high at 4u, I went "rogue" on my vet and just started winging it. I started shooting lower doses, based on what I felt comfortable giving him. And it worked. For whatever reason. He was fed LC fancy feast and Friskees from day one after a lifetime of dry food. I never gave him a shot without testing first, but I didn't test nearly enough "mid-cycle". I wasn't an active member here for most of the time he was on insulin, but did post on another feline diabetes message board back then. Most of what I learned here I did so just from lurking and reading a lot. Anything I know about Lantus or Levemir I have learned from reading, from looking at spreadsheets, and from asking the wonderful experienced people who populate the TR forum a million questions. I've had a large number of "tutors" who have helped me understand how those insulins work. Not because I needed to know, just because I wanted to understand and they are gracious enough to teach me.
There isn't any way for you to know for sure if a switch to Lantus will be best or will help Libby. If you feel you have been trying Prozinc for long enough to believe that it isn't working well, then yes, I think you should give a lot of thought to switching. I can tell you that if that is what you decide to do, you most definitely will not suffer from lack of input or experienced help. It would also be helpful if you have a vet who is willing to support switching, and who understands the Tight Regulation protocol. No matter which insulin you use, I think it is very important that your vet is "on board" and understands the logic behind what you are doing.
OK, if you're eyes aren't bleeding from my usual wordiness by now, I hope all of that input helps!
Carl
