Switching insulin (Prozinc to Lantus)

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stacia

stacia

Member Since 2014
UPDATE Below: We made the switch, looking for next steps. Thanks!

Hi everyone. I'm at the point of either reordering Prozinc, which we've been using since Tasha's diagnosis in August 2014 or possibly switching. I'm not sure what to do so I turn to the smartest folks I know on the topic - you!

The vet we've been seeing since January (due to relocation) has been great. She usually goes with Lantus and her thought was that if Prozinc was what Tasha was responding to and we were comfortable with it, no need to change.

Then Tasha was diagnosed with CKD (stage 3) and we tried switching her food to a lower phosphate diet and putting her on Calcitriol. Her numbers started going insane. I contacted the compounding pharmacy to confirm there was nothing in the calcitriol causing a BG spike and also removed it to see if it regulated her numbers (no). I put her back on the Friskies pates (her original food) and still no progress.

At this point, she's on the Friskies pate and the Calcitriol and we've raised her Prozinc dose from the tiny 0.1 or 0.2 u she was getting before all this happened to 0.5u. She seems to be leveling out (her spreadsheet in my signature is up-to-date if you find the April 16 tab) the last couple of weeks.

Would you keep her on the Prozinc or switch to Lantus? One concern I have is that our schedules are often screwy and I understand Prozinc is more forgiving of that. We're sometimes up to a couple of hours off one way or another. Since we always test and we know our girl, it seems to work out OK. Is that not OK with Lantus? Any other considerations?

Thanks for any input you can share for my girl!
 
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Our SS shows very few BG taken between shots. Those few show that dose could likely have been increased.
Ther advantage with ProZinc is as you said it is more amenable to variable time between shots. Also, since it is a U40 insulin it is easier to accurately measure small doses.
My experience is that Lantus or Levemir results in a flatter curve and thus you get better, lower BGs.
 
Hi!
I have used both and vetsulin-
Pro zinc is more forgiving which is a plus-
Lantus for us was a better choice because Dre does not eat right away and lantus does not take affect right away....usually 1-2 hours

In my opinion as soon as you find the nadir (lowest number in cycle) it isn't that hard to monitor if you have a somewhat flexible schedule.
Lantus has a depot that can be a a plus or a minus-depending how you look at it...
All that said if I could go back I would have started on lantus from the beginning.
Good luck with what works best for you:bighug:
 
So we could probably keep her flatter with Lantus but the schedule wouldn't be as forgiving.

She usually eats well for us, unless we're out of town. In the past, we boarded her with our vet so that wasn't a huge deal. We haven't been able to travel since moving because we haven't sorted the boarding/sitter situation. We're hoping to do that soon, likely with an in-home sitter. The boarding that was recommended to us horrifed me so I can only imagine how stressed she would be there. We generally travel enough that it's a consideration.

Any thoughts on whether switching insulins might inspire remission? I know that's always the dream, though I've given it up at this point.
 
We were doing so well with her BG on a teensy dose for so long (not that her current dose is high) and I was hopeful. Then we did her dental and we got the CKD diagnosis and it all kind of fell apart. I should be happy that at 16, she's doing really well. I'm inclined to keep her on the Prozinc, I think, unless the vet has something convincing to say. At least I trust this vet to be honest and not push an agenda based on manufacturers or kickbacks.
 
stacia said:
Any thoughts on whether switching insulins might inspire remission? I know that's always the dream, though I've given it up at this point.
Click to expand...

The study done on Lantus showed the 80-85% remission rate on Lantus in newly diagnosed, for long term that dropped to 30%. In either category there are some cats that just cannot achieve remission. With a LT FD I don't think there are any reassurances. Some cats on the board have made it years later, but I don't know that we have any key factors in play to say what got them there. Prozinc is already one of the better insulin. For any newly diagnosed my insulin of choice is always Lantus because of its history of good remission rates, for LT diabetics, its more of finding what works for your cat.

I've had one of our current fosters down to 0.75U and looking well on the way to remission, then BOOM, numbers went to heck and we are still dancing all over the place. If I could put my finger on why, I'd fix it. We gave him DM for a while because it was donated and his dose needs dropped a unit, so now he eats DM. What he was eating was perfectly fine for a diabetic, but for some reason this change helped him.
 
If we could've gone with Lantus at the beginning, it probably would've been the better option. But our vet at the time only knew one insulin. We switched vets just a couple of months later but the new vet didn't recommend a change in insulin, and here we are. If I had half a bottle of Prozinc, I'd keep playing with her dose but the bottle's heading to empty AND nearing expiration (which could also be affecting the situation) so I need to make a choice soon since the vet doesn't stock it.

I'm glad to see kitties who do hit remission. And how awesome that you managed such a reduction with the DM. I really thought switching her to lower carb/lower phosphate food was going to be some miracle but everything seemed to fall apart with that. At this point, I truly believe she doesn't want remission because she likes the twice-daily testing in order to get her chicky treats. She's that kind of evil.
 
I don't see how an insulin change could hurt, as you've tried Prozinc out for this long and it hasn't worked well for you. Lantus does have better remission rates, but as Melanie mentioned, it drops from 80+ to about 30% when started after 6 months. All of the cats I've helped treat with Lantus went into remission (Bandit is on his third remission right now!), and two of them (not Bandit) were past the 6 month mark (one started Lantus a year after diagnosis, the other started about 8 months after).

Just a few caveats--if you're looking to try for remission, you will need to figure at least one more daily test into your schedule, about halfway through either cycle. While it's possible to regulate a cat and maintain decent BG with just preshot tests, it's very difficult to achieve remission if you're not getting mid-cycle tests to adjust the dose. Lantus also likes consistency, so shooting as much as you can on a 12/12 schedule is important. However if you know the times you may be late/early with the shot ahead of time and they're not super frequent, you can plan for those sorts of changes with minimal effect on BG--typically moving the dose up or down 15 minutes per cycle won't cause a lot of upset.
 
stacia said:
I'm glad to see kitties who do hit remission.
Click to expand...

We've had 5 become diet controlled, all using Lantus, low carb wet food (non-prescription), and tight regulation. Smokey came out of remission about 1.5yrs later and we found a mass on her pancreas that likely caused it. ChrisFarley stayed in remission until he passed away from cancer. The rest are all still in remission.
My current fosters are different ducks :D
Lincoln was so close, and when his numbers went haywire, we did bloodwork and his CBC had quite a few values off. We just sent in b.w. after 2 months on flagyl to see if we've made any improvement there. The doc suspects there is some inflammation or infection somewhere in him that we are fighting. I suspect some liver issues since he bounces so stinkin' easily.
Anikan came to us as a long term diabetic. His previous owner said he quickly went into remission and stayed diet controlled until recently. But when I look at his records, she considered remission 200-250. If she pretty much left him untreated with numbers over 200 for the last 2 years, I don't see remission likely for him. The way his BG shoots up when he gets into dry food or carbs tells me he does not have a healthy functioning pancreas and is probably going to need his little bit of insulin permanently.
Percy just came to us and the only insulin the vet had on hand was Prozinc and he needed to get started immediately because of the risk of DKA. His early response to the insulin tells me he probably has a good chance at becoming diet controlled. He does have a mass in his mouth and some stomach issues that may complicate his treatment, but his diabetes looks like it is coming quickly under control.
 
Thanks everyone for all the input. I'm going to update the last couple of spreadsheet entries (she was 367 this morning but we had a rough night of storms and my Civvie was a freak) and also get the vet's opinion. Then we'll go from there.
 
Update: We bought the Lantus yesterday. Because we're moving this week, things are going to be a complete disaster around here and we're going to wait until we're a little more settled and Tasha has a couple of days to check out her new surroundings before making the switch. That way we can monitor, get some mid-day readings, and hopefully she won't be spazzed because we're dragging furniture around. She's always adapted well to moves and there's no lengthy car ride (we're moving upstairs, same building) so stress should be minimal.

She's currently on 0.5u Prozinc and the vet advised 0.5u Lantus. Other than Lantus being a depot vs more quick-acting, any big differences I should know about, anything to look for?

Also,We ended up with a vial (as opposed to pends) and it says everywhere on it to toss 28 days after opening but I've also read around here to disregard. For the cost of it, I certainly hope we don't have to buy a new vial every month. Especially with her on such a small dose.
 
Based on your SS and lack of recent between shot BGs I agree with starting with 1/2 unit Lantus.
Before changing does you really need between shot BGs and should not increase unleess on same dose for 5 days. If yo get a abnormally low PS then you should decrease immediately.
 
Larry - that's part of why we need to wait to switch her. This week especially isn't going to be good for monitoring or remembering to take mid-cycle tests and I know how important that's going to be. We haven't prioritized it enough in the past and I have to do it now.

BJM - thanks for the link. Another reason I'm not starting right away - I have a lot to read. I feel a bit like I'm starting all over, except this time I'm not afraid of testing or injecting.
 
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