Opinions needed on next insulin to try

[ursa68]

So, it's going to be about 2-3 weeks before I get my sample of PZI from BCP. I don't think Colby can last that long on Vetsulin. Which do you think I should try, Prozinc or Lantus? I'm wondering about the Prozinc, since it might be more similar to what I'll get from BCP? Which is more forgiving as far as timing goes? At times, my work schedule can be erratic.

I feel like I'm losing Colby. In spite of the fact that he is getting B12 injections and oral methylcobalamin, he's showing signs of neuropathy. I think only because I've been giving Subqs at home, he isn't showing any ketosis. His eating is becoming more sporadic. Because of that, I've backed off on the enzyme he needs for the EPI. Things are not looking very encouraging and I'm beginning to think that a hard decision is not far off. I hope this is just a dip in the roller coaster ride that is this disease.

My last resort is trying the new insulin and possibly getting a referral for a specialist to address whatever underlying issues he has (EPI, acromegaly, IAA, ?). After that, I'm spent, both financially and emotionally.

 

[Larry and Kitties]

I agree with going to ProZinc because as you said, it is similar to BCP PZI but more expensive. Also, unless you can purchase an individual pen of Lantus or Levemir The ProZinc is less expensive to try as a test.

 

[phlika29]

Hi

It sounds like you are having a tough time.

It is my understanding that prozinc can have more flexibility with dosing times. Lantus works best given consistently, not sure about levemir.

 

[dirtybirdsoaps]

I would go with Prozinc if your schedule may vary. Hidey had great results with Prozinc, but of course every cat is different. I loved the flexibility with Prozinc. Some days I had to leave for work early, or got home late.....then there was him going into remission and only being able to give him one shot a day....you cant do that with Lantus.

 

[Critter Mom]

... then there was him going into remission and only being able to give him one shot a day....you cant do that with Lantus.

Not necessarily so. Due to my circumstances and health issues, I could not guarantee remaining conscious to monitor Saoirse at night if her BG went unexpectedly low. Towards the end of her treatment with Lantus, I used once-a-day (SID) dosing and took advantage of her natural tendency to run at lower numbers during the night cycle. Saoirse remained in tightly regulated numbers on one dose of Lantus per day and eventually moved off insulin altogether.

The (somewhat unorthodox) approach described above may not work for all cats, or even the majority of cats, but successful treatment with some Lantus SID dosing is possible.

 

[dirtybirdsoaps]

Not necessarily so. Due to my circumstances and health issues, I could not guarantee remaining conscious to monitor Saoirse at night if her BG went unexpectedly low. Towards the end of her treatment with Lantus, I used once-a-day (SID) dosing and took advantage of her natural tendency to run at lower numbers during the night cycle. Saoirse remained in tightly regulated numbers on one dose of Lantus per day and eventually moved off insulin altogether.

The approach described above may not work for all cats, or even the majority of cats, but successful treatment with some Lantus SID dosing is possible.

Interesting to know, thank you for the clarification.

 

[Critter Mom]

I just worked with Saoirse's body and what it was telling me, rather than trying to force her to fit any given protocol. I simply gave her sufficient Lantus to keep her numbers tightly regulated in a manner that also keep her safe.

 

[ursa68]

Sounds like Prozinc is the way to go. If you look at Colby's spreadsheet, you'll see he has been very difficult to regulate. I doubt I could ever do once a day dosing, but we'll see.

Thanks for the input.

 

[Elizabeth and Bertie]

In spite of the fact that he is getting B12 injections and oral methylcobalamin, he's showing signs of neuropathy.

Hi Cindy,

I know you're having a hard time right now, but please don't lose hope.
I just looked at your spreadsheet and Colby's numbers are very similar to the numbers my Bertie had originally. We started out on Vetsulin/Caninsulin and then moved on to a PZI (that had a similar duration to Prozinc). Bertie was quite a high dose cat too in the early days. With time, and a change of insulin, things got better for us.

I know your work schedule is erratic, but I'm wondering if it might be possible to give more frequent shots for some of the time....?
Some folks give Vetsulin/Caninsulin 8-hourly, for example ('TID' dosing). I did this for a while, and the schedule is tougher on the caregiver than shooting just twice a day, but it can be beneficial for some cats, and I wonder if it is something to consider until you get the new insulin? Some folks have done TID dosing just on the weekends when they have more time, and even that can have a benefit.
The benefits to the cat are that it has insulin in it's system for more of the day; and it often means that you are shooting at slightly lower preshot numbers, so the insulin doesn't have to 'work so hard' to get that blood glucose down.
Is this something that might be possible for you....?
Just wondering....

Also, is it the case that Colby's neuropathy has got worse? I'm wondering if there may be some potassium deficiency also, as the symptoms can look like neuropathy.

Eliz

 

[Critter Mom]

Also, is it the case that Colby's neuropathy has got worse? I'm wondering if there may be some potassium deficiency also, as the symptoms can look like neuropathy.

That thought crossed my mind, too. I've no experience with potassium deficiency but recently I have seen a few threads here where a potassium check at the vets and supplementation if required did help with 'neuropathy-like' weakness.

 

[ursa68]

@Elizabeth and Bertie Yes, I have thought about TID dosing. It would require a lot to be able to do that, but I will have to resort to that if I can't get new insulin asap. As for the potassium, I will definitely have that checked. Colby will be at the vets for boarding for a few days at the end of the week, and I'll have him do a blood panel then. But he is walking with a slight plantigrade stance and is getting rather unsteady.

 

[Critter Mom]

I wonder if aggressive B12 therapy might help? Maybe you could ask your vet about that, too?

 

[ursa68]

@Critter Mom He is getting weekly B12 injections right now. Should I up those? I know he can't overdose on B vitamins.

 

[Critter Mom]

I don't know. That's one for your vet.

From the IDEXX pancreatitis treatment guidelines:

Cobalamin (vitamin B12) is a water-soluble vitamin thatis absorbed in the ileum. Reduction in serum cobalamin concentrations can be seen in cats with gastrointestinaldisease such as inflammatory bowel disease. It is common for cats with pancreatitis to concurrently havegastrointestinal disease; therefore, measuring serum cobalamin concentrations in cats with pancreatitis is recommended. If a cobalamin deficiency is documented, it should be supplemented by parenteral injection. Generic formulations of cobalamin are readily available and extremely cost effective. The recommended dose for cats is 250 μg/injection; with one dose weekly for 6 weeks, followed by one dose every 2 weeks for 6 weeks, then monthly injections.

TAMU recommend more aggressive long-term B12 supplementation when GI disease is present:

We have recently changed our suggested dosing schedule for cobalamin supplementation: Every 7 days for 6 weeks, then one dose after 30 days, and retesting 30 days after the last dose. If the underlying disease process has resolved and cobalamin body stores have been replenished, serum cobalamin concentration should be supranormal at the time of reevaluation. However, if serum cobalamin concentration is within the normal range, treatment should be continued at least monthly and the owner should be forewarned that clinical signs may recur sometime in the future. Finally, if the serum cobalamin concentration at the time of reevaluation is subnormal, further work-up is required to definitively diagnose the underlying disease process and cobalamin supplementation should be continued weekly or bi-weekly.

It should be pointed out that in rare cases cobalamin supplementation fails to increase serum cobalamin concentration for reasons that are not currently understood. In these cases another formulation of cobalamin, such as hydroxocobalamin, might be effective. Cobalamin may also have a pharmacologic effect as an appetite stimulant. Anorectic feline patients with cobalamin deficiency often start to eat again once they are being supplemented and appetite wanes once again when cobalamin is no longer administered weekly, despite a normal serum cobalamin concentration. In these patients cobalamin supplementation should be continued on a weekly or biweekly dosing schedule.

I don't know how these might relate to neuropathy. Saoirse didn't really have any plantigrade stance but her legs definitely strengthened after her B12 therapy was introduced because she started jumping up onto the windowsill and to her testing station after receiving B12 supplementation.

 

[ursa68]

thank you, @Critter Mom ! I'll check the dose I'm giving w/ the amount they recommend. He is getting 0.25 ml every week, but I need to check the strength on the bottle. I'm going to try to get him in tomorrow for blood work.