Switching insulin from Vetsulin to Lantus or ProZinc

[Jenna & Kitsu (GA)]

Hey, everyone. Hope you all are doing well.

I just want to get an idea on what insulin you all recommend for me based on my cat’s prior insulin history and my daily schedule. Right now I’m leaning towards Lantus, as it comes highly recommended, but I’m not sure if it would be the right insulin for my schedule. I also wonder if I could get it for less than $300, which is what my vet is quoting me.

Insulin history: To make a really long story short, Kitsu was diagnosed as diabetic on February 12, 2018. She was started on 1 unit of Vetsulin twice daily, so 2 units per day. At the advice of my vet, I was to not BG test her before each shot (I do not see this vet anymore), because the stress of testing her would make her BG levels spike and ‘cancel out the insulin’. The vet said I could test her once or twice a week, so I did that instead. A couple of weeks later, I increased her dose to 1.5 unit twice daily, so 3 units a day, because her water intake/urine output was still higher than it should be. The increase in dosage seemed to help with that, and she is still currently at that dosage now.

Now, of course at the advice of this forum and now that my brain has gotten over the shock of the diagnosis/learning everything I can and adapting to having a diabetic cat (and dumping my old vet’s advice), I’ve started blood testing her before each shot. I haven’t worked my way up to a curve yet, mainly because life has been overwhelmingly busy and I live by myself and have no family or friends nearby who can help me do this, but also because Kitsu does get really stressed during BG tests and twice a day is already pushing it. I know, I know… I do need to get a curve eventually. I’m working on it.

My schedule: I work a full time job, 8:30am – 5:00pm, with a 30-minute lunch break. I live about 12-15 minutes from home, so not terribly bad, but my job isn’t flexible enough for me to go home in the middle of the day to check on Kitsu. She is by herself all day in my apartment, with no other pets. I get home around 5:15pm most days, although some days I run errands and get home closer to 7:00pm. Her current shot times are between 7:30 – 8:00am and 7:30 – 8:00pm. When I go to visit friends or family on the weekends, I am very strict about returning home by a certain time to make sure her shot is at the right time.

However, there are times where I need to go to an event outside of my scheduling control (such as my cousin’s wedding last Saturday) and I won’t be home for her normal shot time. In this case, I knew I was getting back sometime between 10:30 – 11:00pm, so Friday night I moved her shot to 9:30pm, Saturday morning I moved her shot to 10:30am, and Saturday night I gave her shot at 11:00pm. Sunday morning, I switched her shot back to 9:40am, Sunday night was at 9:00pm, Monday morning was at 8:10am, and Monday night was back to the normal 7:30 – 8:00pm. I do this type of scheduling when I know I will be missing her normal shot time, and I usually opt out of any events that come up last minute where I can’t plan for it.

So we know that my schedule is pretty strict on getting her shots on time, but not always. From what I’ve been reading, Lantus seems to be stricter in not only shot times, but also with testing. I see a lot of people testing their Lantus cats during the middle of the day. I could pull this off on a Saturday/Sunday, but not every Saturday/Sunday, and certainly never during a work day. Is this going to impact my ability to use Lantus? Or should I switch to something like ProZinc?

Also, as for WHY I want to get away from Vetsulin: I’ve read that it’s more difficult to get a cat into remission on Vetsulin. My end-goal, as I’m sure everyone else can relate with, is remission. I’ve also read that it’s more difficult to regulate a cat on Vetsulin, as Lantus/ProZinc are longer-lasting insulins that do better with cats. I’m all for an easier experience and for an insulin that would be better for Kitsu. So is there anything inherently wrong with Vetsulin? No, but I still want to switch if it’s agreed that it will make my life easier and be better for her in the long run. I know I can’t really argue this topic 100% without having done a few curves on her to see how Vetsulin really does with her, but at the same time, reading all these success stories with Lantus and ProZinc just gives me this whole idea that Vetsulin is an inferior insulin that I need to get away from. Which I know is not true, because there are some success stories with Vetsulin, too. I guess I just need more guidance on this.

My current vet also recommends using Lantus, so that’s another reason why I would like to switch once Kitsu’s Vetsulin is up (she has less than half a vial left). This vet seems more knowledgeable in diabetes than my previous vet. However, she does recommend dosing Lantus once a day instead of twice a day, so that’s probably not a piece of advice that I will be following after reading about it on these forums. Still, Lantus seems like an all-around better choice over Vetsulin, so that’s why I’m wanting to switch, but I just want to make sure it’s the right insulin for my schedule. Also, if anyone knows how to get it for less than $300 a vial from a reliable source, that would be amazing.

Sorry for such a long post. Thanks in advance for reading and/or replying. I really appreciate how helpful these forums are and in due time, I will do my best to help new users out, as well. <3

Too long; didn’t read version: Cat is currently on Vetsulin. I want to switch to Lantus/ProZinc for better chances at remission, or even just regulation. I prefer Lantus over ProZinc, but only if it works with my schedule, which isn't always consistent. I am open to using ProZinc if it is a better choice.

 

[Chris & China (GA)]

Also, if anyone knows how to get it for less than $300 a vial from a reliable source, that would be amazing.

Most of us are getting our Lantus from Canada at Marks Marine Pharmacy.

Here's the information on buying insulin from Marks

Lantus does do best when given every 12 hours, but not everybody can do it so they do the best they can!!

Here's some information on "Is Tight Regulation Possible with a full time job"....but even if you don't do TR, there's some good tips on handling things!

 

[Elizabeth and Bertie]

To make a really long story short, Kitsu was diagnosed as diabetic on February 12, 2018. She was started on 1 unit of Vetsulin twice daily, so 2 units per day. At the advice of my vet, I was to not BG test her before each shot (I do not see this vet anymore), because the stress of testing her would make her BG levels spike and ‘cancel out the insulin’. The vet said I could test her once or twice a week, so I did that instead. A couple of weeks later, I increased her dose to 1.5 unit twice daily, so 3 units a day, because her water intake/urine output was still higher than it should be. The increase in dosage seemed to help with that, and she is still currently at that dosage now.

Hi Jenna,

Well done for learning to hometest. Yay!

It would super helpful to know how the current dose of insulin is working in Kitsu's body. I do realise (and indeed sympathise) that Kitsu isn't very comfortable with testing at the moment. But having that information would be enormously helpful to you in managing her diabetes.

When there is not a lot of blood testing data it is difficult to know what high blood glucose numbers signify. This is because high blood glucose levels can be caused by too little insulin or too much insulin.
It's easy to see why this might be the case with too little insulin; the insulin dose isn't sufficient to meet the cat's current requirement.
But too much insulin can also raise blood glucose levels. This is because when the blood glucose drops too low (and/or too fast) the body can often raise its own blood glucose levels as a defence mechanism against hypoglycemia. It can also release counter-regulatory hormones, the purpose of which is to keep the blood glucose high for a time (creating temporary insulin resistance). We call this 'bouncing'. And the effect can take up to a few days to clear from the system.
So, occasional tests can show us that the blood glucose is high, but not 'why' the blood glucose is high.

In Kitsu's case you say you've noticed that her clinical signs seem to have improved with the increased dose, so it may be that raising it was perhaps the right call.

It could well be that Kitsu would benefit from a change of insulin. Caninsulin/Vetsulin is generally considered one of the harder ones to work with. That is because in many cats it can drop the blood glucose quite fast, and it also often has quite a short duration; only lasting 8 - 10 hours in some cats.
That said, there are also cats that have done really well on it, and quite a few Vetsulin cats have gone into remission here.

In terms of options, Prozinc and Vetsulin are often referred to here as 'in and out' insulins. The insulin is injected, it does its stuff, and then is 'gone' from the body.
Prozinc usually has a longer duration than Vetsulin, and is more gentle in its action (doesn't drop the blood glucose so fast).
Because these insulins are 'in and out' the timing of the shots isn't so critical. So, they can suit people who have variable schedules.
These insulins can also be used in either 'fixed' dosage or 'sliding scale' dosage (the latter meaning that the dose of insulin is based on the pre-shot blood glucose (also bearing in mind the drop in blood glucose from any given dose)).

Then there are the longer-acting 'depot' insulins such as Lantus /glargine and Levemir. These insulins form a store (depot) in the body, so some of the insulin is released over time. Because of the way depot insulins work it is more important to try to keep shots on schedule. (For more information on the depot do see the information stickies in the Lantus/Lev subforum.)

It is reported here that cats on longer-acting insulins have a better chance at remission. But we've had cats on all types of insulin go into remission here. A lot depends on how the caregiver manages their cat's diabetes. Appropriate diet and regular hometesting are usually key to success.

It seems that hometesting is a bit of a challenge with your girl at the moment, so I wonder if there is some way we can help to make that easier for you both. Members here have lots of tips and tricks that can make the process smoother.

Jenna, how are you testing Kitsu at the moment? Can you walk us through exactly how you do it?

Oh, and when you can, do have a read of our beginner's guide to Caninsulin/Vetsulin. It's quite long, so you may want to get yourself a cup of coffee first . And do ask any questions that you wish to. We're here to help.
Beginner's Guide to Caninsulin (Vetsulin)


Eliz

 

[Jenna & Kitsu (GA)]

Chris, thanks for the link to that pharmacy! I’ll definitely check it out if I go the Lantus route. Do you, personally, think that Lantus would be a good insulin to switch to, considering my schedule? I just feel like with Lantus (and maybe it’s like this with ProZinc, too), I would need to be home at least once a day during working hours to test her. Is this true?

Elizabeth, thank you for all that information, I greatly appreciate it! I do agree that I need to get more data on Kitsu. I’ve kicked myself into gear over the past week on this and hope to be able to do a curve this weekend. As for testing her, I think I’ve pretty much nailed her routine now, it was more that I struggled in the past with it (especially because my old vet told me to stop doing it, so I wasn’t getting enough practice). I know in the OP, I said that more than twice a day is pushing it, but I mostly just feel that way because I’m still learning the best spots to stick her ear. So she does cry/growl/hiss quite a bit when I’m having to make several pokes for some blood.

This is how I do it: When she is out in the open area (not hiding), I go to her and pet her for a bit, sometimes I brush her because she likes that occasionally. Once I’m ready, I’ll grab the supplies and a blanket to wrap her up in, since she does have the tendency to claw my hands during testing. My old vet gave me some ointment (not Neosporin/Vaseline, but something similar in a small tube) to put on her ear to help the blood bead up. So I will rub Kitsu’s ears for a good 1-2 minutes, stimulating blood flow while I warm them up. She doesn’t mind this too much now, but she hated it at first. Then I will apply a bit of the ointment to one of her ears (I rotate them between tests), near the ‘sweet spot’. I have a 29g lancet that I uncap and manually stick her ear with until I draw enough blood. I use the ReliOn Prime meter, so it does take a bit more blood than the Micro/Confirm. This means I may have to stick her ears several times to get a big enough bead of blood, otherwise I get an error on the meter if I test a smaller bead.

As for the smaller beads, I do my best to increase their size by pushing gently on her ear to get more blood to come out, but this doesn’t always work. I sometimes have to wipe her ear off, put pressure on it, re-apply the ointment, and start over. I know I could very well switch to a different meter with a smaller blood requirement, but I want to give myself a bit more practice with Prime first. Her ears are also just now ‘learning to bleed’, so I think with time, it will get easier. Anyway, once I have enough blood on her ear, I load the testing strip into the meter and place it on the blood drop. It grabs the blood, then gives me the reading a few seconds later. After I have the reading, I turn the meter off, clean up her ear with a tissue/apply pressure to it. Then she gets a ‘good girl’ verbal confirmation and a treat (freeze dried salmon piece). In rare cases, I am unable to get any blood from either ear, but more likely than not, I can get blood from one ear, or the other if the first one isn’t bleeding. Sometimes I get really lucky and get blood on the first or second poke. Other times, it takes 15-20 pokes to get any blood, which really upsets me because I know it’s not a nice feeling for her. I try to aim for the ‘sweet spot’, but it’s either difficult to find or just non-existent with her ears. Being a black cat, even with a flashlight, all I can see is the vein and not the sweet spot where the blood pouch is.

So that’s the full detail of how I test her. Now that I’ve recently switched her from a ‘once in a blue moon’ testing cycle to a ‘must test before each shot’ cycle, I’m getting a bit better and getting practice in for the curve this weekend. I’ve taken a lot of tips from this forum on proper testing and getting the right routine down that works best for her. I’ll get that curve done this weekend and get some data up on here for you all to look at. I can also post some of her recent data sooner, if needed.

So I guess another thing I seem to see on other user’s spreadsheets is their feeding times, which may also play a part in which type of insulin is best for them? Kitsu is a grazer and doesn’t eat a lot at once. Sometimes it can be hard to get her to eat her recommended daily calories, but it’s something I’m working on. Here’s how I feed Kitsu now:

Wake up around 7:15am. Test sometime between 7:20 – 7:40am. Put a can of her wet food down for her immediately after. She licks the juices out of it, sometimes eating a little bit of the meat, but leaves most of it behind. Then I give her the shot sometime before 8:00am, if she was in the BG range of needing a shot. Otherwise I skip it. I leave for work, then return home at 5:15pm. Most of her food is gone, but there is still some remaining, which she refuses to eat. Around 7:00pm – 7:30pm, I will test her again. Feed immediately after, by cleaning out her old food and leaving a fresh can of food out. She will again lick up the juices and leave most of the food behind. I will either give the shot or skip it if she’s testing too low. She will continue to graze on that food lightly while I’m awake and nearby, but mainly begs me for my own food when I make dinner. I don’t give into her demands. By the time I go to bed (around 11:00pm – 12:00am), she will still have quite a bit of her canned food left in her bowl. I go to sleep, wake up and her food bowl is almost empty again, just like it is when I come home from work. She eats most of it except a little bit that she won’t touch, even if I mix it up with a little water. Rinse and repeat this cycle each day.

The two cans she is eating isn’t enough calories for her in a single day, but I find leaving 3 cans out doesn’t work because she won’t eat that much and it goes to waste, so I’ve had to substitute other things just to get her to eat. Thankfully I was recently introduced to Young Again Zero Mature, and I’m waiting on a bag to be shipped to me later this week, but Kitsu does like the small samples I give her between meals. This helps her get the extra calories she needs each day, so she isn’t losing weight rapidly.

Anyway, the reason I bring all of this up is because Kitsu eats when she feels like it, which isn’t always the same times every day. I’ve read that this can be good because it’s easier on the pancreas to eat little bits of food all day instead of two large meals. But I’ve also read it can be harder for regulating her. I’ve considered the automatic timed feeder, but I don’t really know what more this would accomplish since she’s already eating sparingly throughout the day and night. It’s not like she’s gobbling all of her food down as soon as I leave/go to bed. With her eating tendencies in mind, and my schedule with not being able to test her throughout the day (except on most weekends), is Lantus still viable for her?

I guess I really just need to get more of Kitsu’s numbers on Vetsulin before I consider switching to another insulin… but I also just want another option that’s easier, so that I can get the ball rolling before her Vetsulin runs out.

Sorry for another really long post, just wanted to give more info and detail on things. I’ll try not to make my future posts so long!

 

[tiffmaxee]

I had a testing spot for Max so he knew the rat if the time he was safe. It was one of my bathroom sinks. I gave a treat after every poke. He adjusted well. When I had to start fluids he was not happy. I found a special treat and instead of running under the bed when I was done, he waited at the kitchen door for his treat.

 

[Jenna & Kitsu (GA)]

Thanks for the suggestion, Tiff! I tried a testing spot for Kitsu, but she does better with being tested wherever I find her at testing time. She hates being picked up for any reason, so even just carrying her to a testing spot would cause her to lash out to me before I could even get her wrapped up. I definitely give her a treat after testing, though!

 

[Elizabeth and Bertie]

I try to aim for the ‘sweet spot’, but it’s either difficult to find or just non-existent with her ears. Being a black cat, even with a flashlight, all I can see is the vein and not the sweet spot where the blood pouch is.

Hi Jenna,
Bertie is also black, so I do understand it is harder to see the edge of the ear and the drop of blood.
And yes, Vaseline (or similar) really does help. It only needs the teensiest weensiest smear, just enough to 'wet' the fur, but no more, otherwise things can get messy.

Sometimes the ear bleeds better more toward the tip of the ear, sometimes further down; or more toward the edge, or a little further in. It can take a little experimentation.

Have you tried using the lancet pen thingy rather than just poking freehand?

It may be that Kitsu doesn't like to be restrained. Some cats are just fine with testing but not with restraint.
Being relaxed about testing can really help too. Cats pick up on our moods. So, the calmer and more 'matter of fact' we are about testing, the more relaxed our kitties will be.

My cat Bertie was a big, strong cat with 'attitude' when he was first diagnosed (11 years ago), and I knew I'd only be able to test him if he was OK with that. There was no way he would be restrained. So, I had to 'sell' the idea to him in such a way that he was comfortable with the process.
I started out by popping him up on a desk, or getting him to jump up onto the coffee table (where I had the test kit set up), and giving him a treat.
Then I'd do the same but also hold or massage his ear, and then give him a treat.
Then I'd do the same and also click the lancet pen thingy next to his ear, and then give him a treat.
I then found that if I crumbled a couple of treats for him he wasn't bothered that I was massaging his ear, and he wasn't bothered by the click of the lancet pen thingy; so, I tried a test for real, and....he didn't even notice....
What worked for us was gradually getting him to associate the sights, sounds, and sensations of hometesting with rewards.
Soon after we began testing I was able to rattle the test strip vial, and he would come running.
Over time he started jumping up on the coffee table or desk at random times of the day, waiting to be tested! (He still does...although these days, at age 19, he 'clambers up' rather than jumps... )

You will find a way that works for you and Kitsu. It's a partnership, and you will work it out between you.

Have you seen the FDMB page of hometesting tips? Here's the link:
Hometesting Links and Tips
.

 

[Jenna & Kitsu (GA)]

Thanks for sharing your method, Elizabeth! I’m definitely still working on mine with Kitsu, but I think we are making good progress so far. She doesn’t mind being restrained now, but does get ticked off when I have to poke her ear more than a few times. I totally understand why, too. Being lanced isn’t fun.

I’ve seen the tips and have been using a few of them myself! The resources on this site are truly amazing and I’m very grateful for everyone’s help. As for using a pen instead of free-handing, I’ve considered it, but I hear they can associate the click of the pen with something bad and get really stressed at testing time. If I can’t get any better at free-handing within a week or two, I’ll probably pick up a pen and give it a try.

 

[Elizabeth and Bertie]

Jenna @Jenna & Kitsu , there's a little video that you may find helpful (the link below is to one of Critter Mom's posts, where she posts the video link). It's about 'counter-conditioning techniques'. The video focuses on getting a cat to accept shots, but the process could also be used for hometesting.

Newbie needs Help
.

 

[PiePie]

Hi Jenna.
I share so many of your struggles! Just a couple thoughts with food- my cats were always dry food grazers and it's an ongoing adjustment to get them to wait for their food. Around 5pm they start acting like they haven't eaten for days. I put down 8.5oz of wet food for two cats in the morning. If there's still some left when I leave for work, I just put some water on it so it's turns to mush. They will come back and eat it if it doesn't get too dry. I still really struggle with the AMPS test, so we bought an auto feeder and drop a serving of Dr. Elseys dry food at 1 am. This makes them less like snapping dragons in the morning and I'm not finding puddles of bile vomit anymore. I had trouble w/ the YA food, so make sure you introduce it very slowly, even if Kitsu liked the samples. Also, while every cat is different, my guys loved that Iams food, but I found that it spiked Keaton's BG.