Newly Diagnosed, switch to Lantas or PZI, why?

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Pogen

Member Since 2013
Hello to FDMB members.
My beloved Taser (tuxedo cat), a 7 year old neutered male had a DKA on Dec. 6, 2012. He was with the vet for 5 days and stabilized. Likely due to Pancreatitis and an infection from lab results. I took him to my secondary vet who treats dogs and cats since my primary cat vet was not available. (Initially, Taser had a checkup with my primary cat vet about two weeks before this incident because he was drinking much water and sleeping by the cat bowls. My cat vet checked his bladder since he had a bladder stones about two years ago. Unfortunately, she did not do any blood work). After bringing Taser home my secondary vet did a BG (veinous) once a week for two weeks. His first BG on 12/14/12 was 250 and his second BG was 300 on 12/18/12. On 12/28/12 they did a fasting BG at 9:30 am and his BG was 386 and 439 on my Relion confirm glucometer. So I was prescribed Humulin N (NPH), 1 unit BID. When I asked why this insulin, he mentioned that it was cheaper. When I left the office I read some of the printed materials recommended by members regarding the pros of using Lantus vs.NPH, I called the secondary vet’s office and spoke to the front office suggesting that I was willing to pay more for the non-cheaper insulin. She spoke to the vet who was more comfortable using NPH. I have a 10 ml vial of HPN. When the vet called to see how Taser was doing the following day I mentioned to him the large majority of people using Lantus vs HPN on this website. He said that when it first came out it was the latest and greatest thing and that now there was not much difference according to the latest info from conferences. I asked him which insulin Lantus or HPN would give the best chance of remission in cats and his response was that “insulin is insulin”. I asked him if he would change me over to Lantus if I chose and he said that he would.
During this two weeks prior to his diagnosis of diabetes, I checked the web and this site and proceeded to prepare for a Diabetes diagnosis. We now have 15 cats (many were rescues). They are free rangers. We had fed them friskies wet, mostly gravies, shredded and pates and mostly Costcos maintenance dry cat food. My wife always bought some of the cats, whiskas pouches and meow mix as treats. We are fazing out the treats. We stopped the dry food, kept the friskies pate, and added some fancy feast low calorie. I was hoping to read more about insulins but I’ve been going crazy with this new information regarding diet. It makes sense to me as I review our “clans” medical history. Now I feel like I’ve been “killing them softly” for the past 12 to 20 years.
Today is Taser’s seventh day on HPN and I have finally decided to switch him over to Lantus. I called my primary vet, who overall has managed our cats quite well to see if I could see her sooner than Monday’s scheduled appointment 1/7/13. I discovered that she uses PZI for her Diabetic cats. My understanding is that PZI needs to be formulated and also was the only feline approved insulin. At this point I am not to comfortable changing to Lantus with my secondary vet, but I will if I must. I’m comfortable with my primary vet, but am concerned about PZI formulation. I am thinking what is best for Taser long term? Any suggestions or advise?
 
Availability comes to mind - human insulins have a profitable market and are likely to have continued availability.

In the US:
Depot insulins, off label use for pets, duration about 12 - 14 hours
- Lantus
- Levemir
Non-depot insulins, animal specific, duration about 10 - 12 hours
- ProZinc
- BCCP PZI

Ask the vet to give you the article he is basing that claim on.
 
Lantus and PZI are the two types of insulin that are recommended by the American Animal Hospital Assn (AAHA) for use in cats. NPH is not recommended by the AAHA for dogs or cats. And, insulin is NOT insulin. The pharmacology of NPH is very different than Lantus. (I'm a Lantus user and don't want to misrepresent PZI.) Both Lantus and PZI have a longer duration than NPH. I've attached a copy of the AAHA Guidelines for you that you can share with your vet.



On page 216 of the AAHA guidelines:
Veterinarians use a variety of insulin products, but only two are presently approved by the Food and Drug Administration (FDA) for use in dogs and cats. One of these is a porcine lente product (porcine zinc insulin suspension) that is approved for both dogs and cats.9 If available, the authors’ recommendation is to use this product in dogs. The other FDA-approved insulin is a longer-acting product (human recombinant protamine zinc insulin [PZI]) and is currently approved for use in cats.10 For the majority of diabetic cats, insulin glargine (not veterinary approved) and PZI have appropriate duration of action.

The bovine variety of PZI that BJ referenced above is not endorsed by the AAHA due to its need to be compounded. There is some question about potential for contamination, production methods, and consistency of concentration.
 

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I asked my vet about Lantus vs. PZI/ProZinc when my kitty was first diagnosed and he said they used to prescribe PZI/ProZinc but there were protamine shortages in our area so often that he finally just stopped prescribing it. In fact, there was a shortage going on when I asked him about it. So, depending on where you're at, it might be a safer bet to go with the Lantus.
 
I asked him which insulin Lantus or HPN would give the best chance of remission in cats and his response was that “insulin is insulin”.

If your vet believes that "insulin is insulin", then he's either too busy, or too lazy, to keep up with current studies and information about feline diabetes.

Humulin
PZI
Prozinc
Levemir
Lantus

Five completely different insulins. They all are made differently. They all work differently. Your vet is "mistaken", to use a nice word for it.

According to studies, the insulin that would offer the best chance at remission is Lantus, providing you follow the "tight regulation" protocol.

Humulin would offer the lowest chance at remission. It might work for dogs, but very rarely for cats.

Lantus and Levemir, while similar, are not the exact same thing. Both are "depot" insulins that offer long duration.

Prozinc and compounded PZI are also similar, but not the same. Prozinc is an rDNA insulin, specifically designed for use in cats. Compounded PZI is bovine based. The problems with it are what Sienne said - it's getting harder and harder to come by, and finding a reliable source that will give you a consistent quality product is difficult. Of the 4, I'd probably rank that last (even though it is the type of insulin that I used, and my cat went into remission using it a year and half ago.)

A very experienced and wise woman on this site explained it to me (and to others) like this - "The best insulin is the one that works best for YOUR cat". The downside of that is that nobody knows which insulin is best for THEIR cat. The only way to find out is to try one. Personally, I'd go with the odds and probably pick Lantus, but there are no guarantees that your cat, or any cat, will go into remission.

There are basically three primary factors in treatment of feline diabetes.
Proper diet (low carb canned food).
Home testing of blood glucose.
An appropriate type of insulin and logical and safe dosing of that insulin.

Those three things will give your cat the best chance at regulation and possibly remission.

I've seen cats here go into remission using PZI, Prozinc, Levemir and Lantus.

Carl
 
Thank you everyone for your responses to my query. I appreciate everyone taking the time to read my post and everyone's feedback is valuable. Thanks. I'd like to add that my primary vet's office called recently to let me know that they would write me a prescription for Lantus since they have run out of PZI. Of course she wants to check Taser first and I need to take in some blood work panels (copies) from the vet who saved Taser's life and who also prescribed Humulin N. I posted this message on the Lantis forum since I will most likely need much help when I switch Taser over to Lantus. I will add the questions in this message that I included in the Lantus post and welcome any and all feedback.

1. Does anyone clean their vials with alcohol prior to withdrawing insulin? If not, why?

2. Having used HPN for 8 days now, does that decrease any chances of remission?

3. I did a curve yesterday and am posting the numbers. I am new at this and I am not following protocol yet, but I would just like to share my results. Also, I do not plan to increase his NPH dose since I will be be given a prescription for Lantus hopefully, on Monday. What I noticed with the curve is that his BG nadir is at about 3-5 hours. This is a short window of relief for Taser so I can see why no one likes to use this insulin. I would prefer a longer steadier nadir.

4. Taser’s First BG curve. I did the first test at three hours after his morning dose instead of two hours. I took a 2 hour test after his evening dose to more or less get an idea if his nadir might have started earlier than 3 hours. As I mentioned above, I am using a Relion Confirm Glucometer. When I compared my Relion meter to the vet’s venous sample the Relion value was 15% higher than the vet’s. I can divide my BG value by 1.15 to hopefully get something comparable to the vet’s. Listed are the BG values of my 1st curve using the Relion Confirm numbers.

10:00 am AMPS 417 / 1 unit NPH
1:00 pm 242
3:00 pm 245
5:00 pm 321
7:00 pm 392
9:00 pm 340 / 1 unit NPH
11:00 pm 277

5. Is it preferable to purchase a 10 ml vial or the syringes of insulin? Can I purchase just 1 syringe or do I have to purchase the package? I frequent Costco and Target. Are these the best places to purchase the Lantus?

6. Thank you all for any advice or suggestions!

 
 
1. I do not
2. I say no.
3.Yes, 3-5 hours is typical for N
4. I would not scale the BG values. The hand-held meters are designed to use capillary blood and convert that to the venious blood used by yur vet. Using venious blood in the hand-held meter results is a different value. Basically you want to look at trends and not absolute BGs.
5. Unless the cat is on a very high dosage like 10 unts twice a day the 300 ml pens are best. Some places will sell individual pens while other will only sell the pack of fire. See this post fro where to get insulin.
viewtopic.php?f=15&t=11530
here os a coupon for a discount if you purchase 5
viewtopic.php?f=15&t=36964
 
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