Question from long time Prozinc user

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KristenP&Sam

KristenP&Sam

Member Since 2010
I want to switch Sam to Levemir as he's up to 4 units of Prozinc a day and still has AMPS and PMPS in the mid-high 300's with occasional drifts into the low 400's. Yes, we do get some mid-high 200's as well, but lately they're few and far between. (Don't bother checking his spreadsheet - it's not up to date due to my insane schedule of late, but I still test before every shot.)

My question is this - do you guys use the pen or do you get a vial? I can't seem to find an answer to this. Which is better? I'm going to call my vet as soon as I know what I need her to order.

Thank you so much!
 
I could be wrong, but I thought Marcy and Klinger were using a 10 ml vial and then switched to the pens. Which ever way you decide to go, welcome to Lev, Kristen! Sure hope it helps bouncy boy Sam get regulated!
 
Grrr. For whatever reason, my vet wants to switch him to Glargine instead of Levemir because she thinks Levemir is too potent. This cat is on 4 units of Prozinc! Potent would be good!
 
KristenP&Sam said:
Grrr. For whatever reason, my vet wants to switch him to Glargine instead of Levemir because she thinks Levemir is too potent. This cat is on 4 units of Prozinc! Potent would be good!
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Levemir is not "too potent." It is a longer acting insulin, just like Lantus. I call it the Gentle Giant. Cats on insulin long term do very very well on Levemir. General thought on the board used to be that Levemir was better suited for long-term insulin users than Lantus, although I am not sure exactly why or what characteristics would make it so, other than the Gentle Giant aspect. It is Gentle because it can cause a gentle curve, but once you get it at a good dose it is Giant enough to hold the most desirable lower numbers (below 150) for hours.

Gandalf has been using Levemir for 4 years, as of today. he was a former PZI user, for 2 1/2 years. The difference for him can be seen in the stickies above.
 
Levimer is not more potent than lantus (glargine). She has some misinformation there somehow. It's as Vicky said a gentle giant.

What is has that I think is an advantage over lantus is that it last longer once you start the vial or pen (yes it comes both ways). Many of us have cats on very low doses (below 1u, even below .5u) and we can use a pen to the last drop. Vials will probably not last as long - its the nature of the container. This means that lev will cost you less over time. They are about the same to purchase, but you get your money's worth on the lev. Plus, lev has a more neutral PH than lantus.

In answer to your question: I use lev pens. If you still go with lantus get them in pens as well. That way you are throwing out less after it starts to lose potency (I think that's anywhere from 1 months to 2-3 months - not sure).
 
Thanks, everyone. Had a good visit with the vet today and after some testing, I think she's going to be fine with switching Sam to Lev.
 
That's good. Now you have to reformat your brain for using lev, lol! That seems to be the hardest thing to do for those of us that used a faster acting insulin and then switched to lev or lantus - but I'm happy to say that I have forgotten everything I knew about vetsulin and it's only been two years!
 
I've been reading the various protocols and it doesn't seem that tough. Basically start low, hold for at least 3 days (6 cycles) then adjust if needed, holding each adjustment for 3 days. Is that about right?
 
Well, the trick is to find out whether Sam needs only 3 days or more like 5 to 7 days to settle on a dose. I would not plan to change doses every 3 days, but sometimes that is enough. You just have to "dive in" and see how he does.

Posting his progress here and keeping his SS up to date will allow us to help you make the switch. If you haven't been updating his SS, maybe just skip to the beginning with Lev, but take a few mins every day to put in the numbers, especially in the beginning.

Did you decide on a starting dose? I would suggest 1u. You don't want to start out too high because he may react quite differently to lev than the PZ. If you haven't gotten spot checks in and have made dose changes based on PS, he could be getting too much insulin on PZ.

It really is important to start low and methodically raise the dose based on the numbers - the WHOLE cycle, not just the PSs. So, if you are busy and can't do a curve every 3-5 days (who can?!), try to get spot checks when you can, like before bed, so you have some data on how the dose is working. Then do a curve on weekends, or when you are going to be home enough to get tests in. Only after you can get the mid-cycle test should you raise the dose.

If you have schedule issues, post and let us know so we can figure out how to work around it. Nothing is set in stone, IMO. Life happens and you just have to try your best.
 
Today's AMPS - 430, +6 - 350

I always do preshot tests, I just haven't been writing them down in his SS. I'll probably start a new one for him soon. I plan on doing a curve Friday. I work at home so testing him isn't an issue.
 
No, his test results haven't come back yet. Just showing how much the prozinc isn't working, although this morning we had an AMPS of 309, so not nearly as bad.
 
OK. I understand now :roll:

I just looked at his SS. I should have ignored you telling me not too in the first place. Honestly? I think he is getting way too much insulin and rebounding. He had good numbers on doses below 1u back in January. As you increased he still had decent nadirs, but the PSs started to hit high 300s and 400s (above 1.5u), then the nadirs started climbing as well above about 2u.

Based on the data in the SS, I'd guess he would do well on something from .4u to .8u. You want him to start getting a nadir in the mid to low 100s first and PS that aren't hitting 300s. If you stop the swinging from very low to high then there is potential to slightly increase and bring the whole curve down so the nadir is just below 100. Slight increase would be .1u to .25u probably, but you have to find the dose that stops the swinging first and I think that is going to be below .5u. Right now he is just stuck in high numbers. That could also be insulin resistance because of the chronic rebound. Switching insulins may break through that, but you have to start low enough to not cause set in rebound on the new insulin. If that happens, you have to slowly raise the dose until it "breaks through" the resistance and then it usually is a rapid decrease in dose to something fairly low (like going from 3-4u to .5-.75u).

I have a lot of experience with rebound with Beau. He was on vetsulin and got up to 7u based on vet numbers. When I started testing everyone here told me to reduce the dose to 1u and start over, but I was afraid to do it. I started at .3u or something and had to just keep reducing until he was below 1u. And he rebounded on .5u of lev. Here is some good info on rebound if you haven't already read it: http://petdiabetes.wikia.com/wiki/Somogyi_rebound

Was he dx last December? Did he had DKA? (I saw your note about him coming home from the hospital at the top of the SS).

I am assuming that you are still feeding low carb, right? LOL on the whipped cream. Just so you know, if that was real cream with no sugar added it would be pretty low carb. It's all fat. Not Cool Whip or canned "whipped cream" that stuff is loaded with sugar. Beau used to love the canned stuff. I don't even buy it anymore and only have the real stuff around the holidays, but I give him a little of that.
 
Just want to pop in and say I agree with Sheila on rebounding on prozinc and starting at a low dose of Lev. Although sometimes the swinging on PZI type insulin is simply the nature of the insulin, not the dose since it is faster acting than Levemir or Lantus. But still you don't want 300s to 40s to 300s again.

Unless he has been a DKA kitty, I suggest starting at .25U, if you can measure that. Please see these posts for examples of microdosing techniques:

http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=34424#p360982

http://felinediabetes.com/FDMB/viewtopic.php?f=10&t=15637#p156967
 
If you look at the dates of 1/14-2/19, you can see reducing the dose didn't work. And yes, he was DKA. Spent a week in the hospital.

I'm doing a full curve today, so that might yield some further info. Either way, I'm switching insulin. I don't like the swings of Prozinc and I'm ready to get him on an even keel.
 
I guess I see what you mean about lowering the dose during that period, but again, it could be the nature of PZI/Prozinc for him. Some cats just don't do that well on it. Sam may be like Gandalf, who really needed TID dosing (3 times a day, every 8 hrs) because it just did not have the duration he needed.

If you're interested, take a look at Gandalf's spreadsheet currently. He is on a steroid now for cancer and I saw much of the same cycle results you are seeing on Prozinc. So I went to TID with Levemir and he's doing better.

Not saying you should stay with Prozinc by any means, TID is just not doable for a lot of people. If lack of duration is the problem for Sam, then Levemir will help him, without a doubt.

Just please be open to starting on a low dose and even lowering the dose as needed. We see a lot of people who have trouble understanding that although cycles can look similar to what they saw on Prozinc, high preshots, midcycle lows, that's a sure signal with Lev that the dose is too high. Lev should not be dosed based on preshot values.
 
I'm open to it, but since we've tried it without good results I don't see it as an option anymore. Recently, Sam's bottle of Prozinc crumble in my hands as I was rolling it. Took the vet two days to get me a new bottle and in that time, Sam didn't go over 350, so when I got the new bottle, I started him on a lower dose again, just to see. I think I started him at 1 unit. Anyway, in no time at all his numbers shot up again and we were back to where we are now, 4.4 units.

Lowering is great in theory, but how many times do you have to try it before you know it's not the right answer?
 
Well, since you are starting a new insulin you NEED to start lower. I have seen a number of cats on higher doses of PZ insulins start on .5u of lev (after much back and forth about that being too low) and they dropped into the low double digits on the first or second shot. It's a different insulin and their bodies respond to it differently. You have to think of it like a newly diagnosed cat. You would not start them out at 4u, right?

I think there is a rule of thumb to start at 70% of the old dose, but that is often too high. I started Beau at half his old dose and his first cycle was 318 --> 95 --> 269 (2nd cycle: I didn't get spot checks that night) and his 3rd cycle was 277 --> 37 --> 380. Beau had such a different response to lev over his old insulin. I could not have predicted he would respond that was based on his old numbers.

Even at 50% of his current dose, I don't think that 2u is a safe to start Sam on. I would not want to see anything above 1u, but since it looks like rebound, I'd rather see .5u. It's just safer to start low with such a different insulin even if you have the "expectation" that you will be raising him in steady steps.

Rebound is a complex process and it takes several days to clear the body of the hormones/reactions that cause it. If another rebound happens in that time, and so on, they stay in that response pattern.
 
Hi Kristen, If you are interested, feel free to check out Harley's Lev SS for a visual example of how the whole starting low, holding doses, and methodically raising them until the whole curve starts to come down is supposed to work. It takes patience and time and was nerve wracking for me as I wanted to just shoot those numbers down! We started at 0.5u and have gone up as high as 3u and are now to a point where I'm backing down the scale in 0.25u increments. I had to go really slow with Harley because he is very sick, on steriods, and also is an example of a cat that needs more than 3-5 days at a dose for it to show what it can do. The best data is between 4/9 and 6/24, and starting again on 9/11 - the summer was a washout.

Hope this helps & welcome to Lev!
 
Yep, I had planned to start Sam in the .5u - 1u range. I've done a lot of reading. ;-) Today's curve is showing a late nadir, which to me has always meant too little insulin, right? But the curve only matters in that the vet wants to see it, not in any relation to changing the dosing of the prozinc. I'm hoping to start him on Lev as soon as next week, if possible.

Laura, I'm going to look at Harley's SS now, thanks!
 
KristenP&Sam said:
Yep, I had planned to start Sam in the .5u - 1u range. I've done a lot of reading. ;-) Today's curve is showing a late nadir, which to me has always meant too little insulin, right? But the curve only matters in that the vet wants to see it, not in any relation to changing the dosing of the prozinc. I'm hoping to start him on Lev as soon as next week, if possible.

Laura, I'm going to look at Harley's SS now, thanks!
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How very cool! So you are the author of a book! I didn't know that. Noticed it in the icon under your avatar. So this is your first book? Congratulations! :)

I checked that icon because usually it leads to a person's profile for their cat if they don't already have it in their signature. So I was just looking to get some history on Sam. So on that note, if you get a chance maybe you could write up a profile.

profile instructions

You said you were waiting on some test results? What would they be? How old is Sam?

I also wanted to welcome you to the Lev forum! I am sure your Sam will love being on Levemir. It was the best decision we ever made switching Tigger from BCP PZI to Levemir. :)
 
Hi Pamela - Yep, I'm an author. I just had the first book in a new series come out on the 27th of Sept. It's my first for this publisher, but my fourth novel length book. Sam - still no results from the urine culture and blood panel that's being done, but I should have them Monday. Sam is probably 10 or 11, not sure as he was young, but full grown when I adopted him. Thanks for the welcome to Lev. I look forward to getting Sam regulated - fingers crossed! Will try to get a profile done for him.
 
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