Questions: Vet now wants use Lantus

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my Casey bear

my Casey bear

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Many questions have now entered my head....The vet originally was suggesting ProZinc (what she was familiar with), I was requesting Levemir, but the specialist that my vet talked with said to use Lantus.

From what I have heard and read, lantus was the insulin which has the most strict 12/12 protocal. :?: How much of a wiggle you would lantus allow me to have?

Casey's hometesting, w/o insulin, was successful for 6 of 7 days and ranged from 219 - 286. The day I did not get a home test reading, the vet had a reading of 415 (vet thought it was that high do to stress leave...it Casey's 2nd trip to the vet in 2 days). So I know in advance, :?: do any of you have an idea what a good starting dose would be? .5u? 1u? Just want to make sure whatever the vet suggests, that it would not be too high.

The another concern is finance. I have been told about being able to get aide, saw and opened links re: financial aide, but I seem to running circles and/or have many hoops to jump through to apply. (I have jumped through some already, yet seem to have gotten nowhere but back to squre 1.) :?: I have a $25 coupon for my first supply of lantus solostar, which will help a little bit, but what about after that? (I am already wondering how I am going to make the payments for the credit card I had to use to get Casey to this point.)

:?: If I go ahead with lantus, is it the "lantus solostar pen" that I should be requesting? Or should I stick with my original thought of requesting levemir pen, dispite the expert opinion.

I have been reading many sites, FDMB posts, and FDMB links...the ones about insulin support was mostly on levemir and then prozinc before tonight... @-) I have been reading so much that I have not been getting much sleep in the past couple weeks, am having trouble what I read about what, and that have of what I read left me scratching my head think "huh??"

I thank you for reading my post, and any advice/help would be greatful.

Roberta
and Casey
 
Roberta,
I completely understand you're feeling of being overwhelmed. Way too many questions at the same time. I am going to suggest that you copy everything you posted and paste it into a thread in the Lantus user forum. You are a lot more likely to get expert opinions on the board where many of the lantus users exchange information.
I am a PZI user so I can't give you any advice concerning Lantus, doses, or anything that is really going to help you.

Carl in SC
 
Roberta:

I'm sorry you have to be here but you are in the best place.

There isn't alot of difference between lantus and levemir; the few differences include
1. levemir peaks much later in the cycle....usually around 11 hours after you give the shot so that typically puts one shooting at the lowest point in the cycle; lantus can peak anywhere from 3-7/8 hours after the shot altho many cats peak around +6 but every cat is different and it can change even from cycle to cycle.
2. levemir doesn't sting as much; this is not so significant except for cats who get alot of insulin.

So it depends on your schedule and whether you can be around to do enough testing between onset and the peak of the insulin (known as the nadir). I'm not sure of the cost difference. Both need a consistent 12/12 shot time.

Lantus usually runs about $200 (costco) for five 2-ml solostar pens but in some places, you can buy single pens at hospital outpatient pharmacies for about $40. Vials of lantus run about $110 and contain about 10mls of lantus. I've yet to use an entire vial. Some folks religiously toss the solostar pen after 28 days; some use until it's gone.

You can check with DCIN and see if they can provide you with any assistance. There is a link on this page.

Typical recommendation on starting dose is .25u/kg. So if Casey weighs 10 lbs, that's 10/2.2 (there are 2.2 kg/lb) = 4.5 x .25 = 1.1 so that would be 1u twice a day (bid). We recommend start low, go slow so you could even start her at .5u and then following the protocol, increase her gradually .25u at a time to her fitting dose. We increase in no more than .25u when necessary or you will bypass her correct dose. We have a very specific protocol on when to increase, etc. but I won't go into that here. Once you are hometesting, have a spreadsheet set up, and are using lantus/levemir, you can pop over to the Lantus Insulin Support Group for additional help.

I hope this helps. Both are gentler insulins than the others out there and dosing is based on the nadir, not the preshot. They are longer lasting insulins than ProZinc or PZI.
 
Roberta,
I posted a message in the Lantus forum linking them to this thread so they'd know to look for it.

Carl
 
Welcome Roberta.

I'm one of the Lantus folks that Carl rounded up.

Lev and Lantus are different chemically but both are long acting, depot types of insulin. There are quite a few Lev users on the Lantus board since both insulins work the same and the dosing protocol is identical. Marje is correct in that many people find that Lev has a later nadir although I'm not sure it's typically as late as +11. My impression is that the nadir is around +8 but with either insulin, the nadir is not a fixed point. Lev typically costs a little less and according to the manufacturer, has a longer life once opened (42 days vs. 28 with Lantus). Some hospital outpatient pharmacies will sell a single pen. You can also mail order through Canada and the insulin will cost about half of what you will pay in the US.

With respect to schedule, you are correct -- both Lantus and Lev and the least forgiving. However, there are members who have difficult schedules and they make do. Things like work do interfere with diabetes management but you also need a way to pay for insulin and strips! Realistically, if you're off shot time by no more than 30 min. you're fine.

Either Lantus or Lev are very good types of insulin. Casey will do fine on either.
 
Hi Rebecca, you have found a great place to get information about FD. Come over to the Lantus Forum, there are several "Sitckies" at the beginning of the topics list with tons of information on Using Lantus.

I am now using Levemir for Tess and it is essentially the same as Lantus. The one big difference is the later onset and nadir. For Tess it is usually around 8 hours after the shot, but it can be later. For some people this can make a schedule difficult, because if the BG is low you need to keep testing to watch for hypoglycemia.

If finances are a problem DCIN (Diabetic Cats in Need) may be able to help you get a start. I think i just saw that they had some Lantus available, either here or in the Lantus forum.
 
Please read this discussion from Think Tank section of the old board concerning long lasting efficacy of both Lantus and Levemir. http://www.felinediabetes.com/phorum5/read.php?15,1906669
It is much longer than the manufacturer recommendations of 28 days for Lantus and 42 days for Levemir!

This comes up so often in posts concerning switching insulins and I don't want anyone making a decision on information which many of us here have proven to be false when it regards the use of these insulins for cats. Either Lantus or Levemir can last quite a while if cared for properly. Constant refrigeration is the key, as well as not injecting insulin back in to the pens, especially regarding Lantus. Levemir it makes no difference with, in my experience. I've used Lev for soon to be 4 years. I insert syringe, draw slowly more than needed, push plunger to get it to about the right dose, then remove and fine tune dose. Some insulin drawn goes back in to pen every time. I use 1 pen until it's nearly gone - at least 3 months of use.
 
Lantus gets my vote. Cedric was on that for a month. If you look at his spreadsheet below, you'll see that his numbers were similar to what you are getting for Casey. I took his dry food away on 5/19 and got normal numbers 2 days later. I hope that Lantus can get you the same results. Since I did not use it for a long time, I don't feel comfy giving doesin advice, but the others here will give you get info based on their experience. I had the vial, didn't know about the pens, and only used about 1/3 of the vial. I took very good care of it, even when it was being stored at the vet and the kennel (I was scheduled for vacation about 2 weeks after he was diagnosed). He even came into the office a couple of times for BG curves and we have a fridge here. I ended up giving the Lantus to a coworker w/a FD cat, and it looked as clear as could be, no particles, and that was after 2 months.

If you are thinking of ordering from Canada for future, get some opinions on where is a good place to order from. I swear there is a thread on that topic, I just don't remember in what forum I saw it (and I need to start working - lol).
 
I believe I wrote about this to you before and will repeat what I said.

If your schedule is a concern and you won't be around for a strict 12/12 hour shooting, then I would recommend you go with prozinc. This is a good insulin and I've seen how well it works in other cats. Last summer, I cat sat for three weeks a cat who was on prozinc and I got first hand experience using it.

I was able to more frequently adjust the insulin amount (I'm only talking about micro dosing amounts, but a drop here or there in this cat made a huge difference).

I also think the cost for the prozinc is a little cheaper than lantus or lev.

Now would I do recommend if you choose prozinc is to use the U100 syringes with 1/2 unit markings not the U40 that you get from vet and are supposed to use with prozinc. There is a conversion chart and if you print it out, it's easy to follow. This is vital when microdosing.

I used lantus with Maui and also understand what that insulin can do and yes, it's a great insulin. For all the reasons the others stated.

Hope this helps and lets you give serious thought to your schedule and what will work best for you.
 
Thank you everyone for all the advice, info, and links!! This helps me a great deal in being prepared for my upcoming vet visit/conversation with what to ask, request, or even just discuss.

Some of you brought up needing to copy a SS from google.com, I have been trying to do this for a few days now - without success. With each attempt I only get an error message stating that the SS could not be copied at this time.

Once again, thank you for all your help,

Roberta
and Casey
 
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