Possibly switching to glargine but I have concerns...

[barrybuttonsmom]

Hi everyone,

Little update on Barry (I simply don't have enough time to upload his SS data I have a handwritten journal/log of what data and BG I do have):

Barry's neurologic episodes are still happening. They are not occurring as often, but still are a thing. He was having them up to every other day. Now, maybe once a week (that I know of at least). None of the five docs or myself had any clue what they were. So, we have seen both neurology and internal medicine specialists now. Neurology felt acromegaly was possibly the cause of the episodes but likely not. They think that Barry could be having small strokes or seizures. However, internal medicine thinks acromegaly is very likely. His IGF-1 was 111 nmol/L and IAA is 55 so, not super convincing. Both departments want to pursue an MRI of his brain + and CSF check to rule out any inflammatory conditions causing his 'episodes'.

He was diagnosed with a new grade 2/6 heart murmur yesterday. He still has a constant subtle anisocoria (right pupil being the larger one). But, he is acting better. He had an unexpected dental cleaning with two extractions last week. He is still having some issues chewing but overall, he is acting like a normal cat finally. This is the first time I have seen this side of him. I do worry a lot though. His curves are still v e r y irregular. He is still having high high's (400's) and not staying low much at all. He stays around 240 for an hour or two/day. He is on 4u Prozinc currently. Internal medicine wants to switch him to Glargine starting at 2u. If I do switch, I am putting another freestyle libre on him before to make sure his numbers stay safe without having to poke him a hundred times.
But I have a couple concerns about the glargine... cost is the first. I get prozinc at a relatively low cost right now. How do I find glargine cheaper than $100? GoodRX is not enough. Also, I worry about the transition overall. How hard is the change? Do I need to do anything special for him? How does dosing compare? Has anyone else had success going from prozinc --> glargine?

Any and all input would but highly appreciated!
Thank you!

 

[Bandit's Mom]

@Wendy&Neko
@Bron and Sheba (GA)

 

[Bron and Sheba (GA)]

If your kitty has acromegaly and IAA you would be better to think about swapping to Levemir because glargine as larger doses can sting and Levemir doesn’t. Glargine and Levemir are similar insulins in the way they act. Levemir has a later onset and nadir than Glargine.
Swapping from Prozinc to either Glargine or Levemir is just a matter of giving Prozinc one cycle and swapping the the new insulin at the next cycle. We usually suggest starting at 70% of the current dose of insulin just in case your kitty reacts strongly to the new insulin.
I would not go back to 2 units.
Glargine and Levemir are depot insulins and not ‘in and out’ insulin like Prozinc. It is necessary to hold the dose initially for 5 to 7 days for the depot to fill and settle before changing the dose, unless your kitty drops under 50 (if doing Tight Regulation method) or 90 (if you are doing Start Low Go Slow method) in which case you would reduce the dose.
I have used both Glargine and Levemir and liked them both.

Can you put the last 2 weeks data into a spreadsheet please so we can see it please. We are unable to help you with dosing at all without seeing a spreadsheet. If you need help with setting it up I’m sure @Bandit's Mom would be happy to help you.

 

[Wendy&Neko]

An IGF-1 of 111 is positive for acromegaly (positive above 92) and that IAA is also positive. So yes, very convincing for acromegaly. The pupil issues may also be related as the pituitary tumour grows close to the optic chiasm. Acromegaly can cause organmegaly, of which impacts on the heart are common. You might want to see if you can get an echocardiogram if he has a new heart murmur. Heart issues can be treated if caught in time.

I agree with Bron that Levemir is a much better option for cats with conditions that might cause a cat to need higher doses. People here get their Lantus/glargine and Levemir from Marks Marine, a bricks and mortar pharmacy not far from me, that does online sales of insulin as well. This post gives details on ordering from them. Costs are much better than you pay in the US. If the pens or vials are kept in the fridge, they can be used to the last drop. The length of time of course depends on the dose. We've had people on smaller doses use vials for 6 months. We've had lots of cats with acromegaly switch to Levemir with no problem, just get better duration. Onset and nadir are later than with Prozinc. You will need U-100 syringes if you don't have them already. We have had cats switch from Prozinc to Lantus as well, but for your situation, Levemir would be a better choice.

As for helping with dose when you switch, we'll have to see the last couple weeks of his data on Prozinc in a spreadsheet before commenting, but we likely would suggest a similar dose as his current dose on Prozinc. We have people who can help you getting a spreadsheet set up if you wish.