Types of insulin?
- Thread starter Casey9195
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Carl & Polly & Bob (GA)
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Well, it depends who you ask... :smile:
Yes, there are several types of insulin.
There are 3 that are very well suited for treatment of feline diabetes:
Lantus (glargine)
Levimir (Detemir)
Prozinc/PZI
The first two are "human" insulins that work great in cats.
The last is an insulin made specifically for use in cats.
The "L's" can be purchased from any pharmacy while Prozinc can only be purchased from a vet (although I've read that a few Costco's sell it).
All three require a vet's prescription.
There are also a couple of others, like Humulin and Caninsulin that are sometimes prescribed for cats but are more suited for use on dogs.
There are published studies that show that Lantus offers the best rate of remission on newly diagnosed cats using what is called the "tight regulation" protocol. The key, no matter which insulin, seems to be early diagnosis and early treatment in order to regulate the cat as quickly as possible to get him down to "normal" ranges of blood glucose. That combined with home testing and an all-canned low carbohydrate diet are the keys to successful management of the disease.
Welcome to the FDMB. Ask any questions you can think of, because somebody here will have an answer for you!
Carl
Yes, there are several types of insulin.
There are 3 that are very well suited for treatment of feline diabetes:
Lantus (glargine)
Levimir (Detemir)
Prozinc/PZI
The first two are "human" insulins that work great in cats.
The last is an insulin made specifically for use in cats.
The "L's" can be purchased from any pharmacy while Prozinc can only be purchased from a vet (although I've read that a few Costco's sell it).
All three require a vet's prescription.
There are also a couple of others, like Humulin and Caninsulin that are sometimes prescribed for cats but are more suited for use on dogs.
There are published studies that show that Lantus offers the best rate of remission on newly diagnosed cats using what is called the "tight regulation" protocol. The key, no matter which insulin, seems to be early diagnosis and early treatment in order to regulate the cat as quickly as possible to get him down to "normal" ranges of blood glucose. That combined with home testing and an all-canned low carbohydrate diet are the keys to successful management of the disease.
Welcome to the FDMB. Ask any questions you can think of, because somebody here will have an answer for you!
Carl
akbahsMum
Active Member
I think also, it depends a bit on your cat. I have noticed reading people's posts, that there is a cat-insulin interaction which is different for every cat.
This is a principle called "every cat is different", sometimes shortened to ECID.
My cat was on Humulin N, which isn't seen as the best insulin for cats, but as someone commented when looking at his numbers, he was "getting good duration out of it".
This meant that he was able to get a fairly long lasting effect from the dose. I found he responded well to diet change, and he is currently off the juice (OTJ!)
What you want is an insulin that will keep your cat on a relatively steady (preferably normal) range of blood glucose. This has to do with how your cat's system is affected by the insulin.
I think I just talked in a circle there.
This is a principle called "every cat is different", sometimes shortened to ECID.
My cat was on Humulin N, which isn't seen as the best insulin for cats, but as someone commented when looking at his numbers, he was "getting good duration out of it".
This meant that he was able to get a fairly long lasting effect from the dose. I found he responded well to diet change, and he is currently off the juice (OTJ!)
What you want is an insulin that will keep your cat on a relatively steady (preferably normal) range of blood glucose. This has to do with how your cat's system is affected by the insulin.
I think I just talked in a circle there.
MommaOfMuse
Very Active Member
alexford said:
While Lantus and Levermir and NPH all work fine for humans, that isn't true when it comes to cats...cats have a much high metabolism rate than either humans or dogs, thus NPH (Humuin N0 hits very hard causing steep drops quickly and wears off long before 12 hours. Causing the cat to be on a constant roller coaster ride of highs and lows.
The 3 best insulins for use in cats as others have said are Lantus, Levemir, PZI/Prozinc all 3 are long lasting gentle insulins. Levemir and Lantus both need to build up a shed/depot under the skin while PZI/Prozinc are a one shot insulin in that you give the shot it does its thing and then has worn off by the end of the next shot with very little if any overlap or carry over. Of those 3 PZI is probably the most flexible with it comes to shooting schedules as both of the Ls need to be dosed as close to a strict 12/12 shot schedule as possible because of the build up of the shed.
But what is the best insulin for your particular cat? Well the one that works best for them...granted that isn't a very definite answer but the best anyone can give you because every cat is different and some will do better on one than on other types.
A good example to give you would be my two diabetics. Maxwell did fantastic on Lantus and quickly went into remission, Musette however was also started on Lantus and her numbers were all over the place, not wasn't she doing well on it, it was effecting her personality, she was tense and unhappy. I tried multiple tricks to get Lantus to work for her, and nothing did. Then out of desperation I switched her to Levemir. After 7 months of struggling with Lantus to smooth out her curves, a simple switch of insulin and her curves smoothed out, and now she is flirting with remission.
Mel, Maxwell, Musette & The Fur Gang
Julia & Bandit (GA)
Very Active Member
MommaOfMuse said:
Whoops! I think Mel accidentally added "Lantus and Levemir" in that first sentence. I think what she meant to say is that while Humulin N (NPH) works well for humans, it doesn't work well for cats because of their metabolisms. Lantus and Levemir are long-acting insulins in people (24 hrs), so they last a full 12 hrs in cats, which is what you're aiming for when attempting to control blood glucose. They also have a proven 84% remission rate in newly diagnosed cats when used in conjunction with a low carb, canned diet and regulation via daily home testing.
No studies have been done on the rates of remission for Prozinc, but it does have the next best duration after Lantus and Levemir. Studies were done with Bovine PZI, which showed a 40+% remission rate, but since Prozinc has a longer duration, it's expected to have a higher remission rate than the older Bovine PZI used in that study, again, in conjunction with a low carb canned diet and regulation via home testing.
MommaOfMuse
Very Active Member
Thanks for clarifying that Julia, still tired after Musette's dance yesterday...I know what I meant to write but didn't come out as clear as I had hope for. :roll:
What I meant to say was all 3 Lantus, Levemir and NPH work fine for humans, however only Lantus and Levemir work well in cats, that NPH is too harsh and short acting for a cat's high metabolism rate.
Glad you caught what my sleep deprived brain didn't.
Mel, Maxwell, Musette & The Fur Gang
What I meant to say was all 3 Lantus, Levemir and NPH work fine for humans, however only Lantus and Levemir work well in cats, that NPH is too harsh and short acting for a cat's high metabolism rate.
Glad you caught what my sleep deprived brain didn't.
Mel, Maxwell, Musette & The Fur Gang
Julia & Bandit (GA)
Very Active Member
MommaOfMuse said:Thanks for clarifying that Julia, still tired after Musette's dance yesterday...I know what I meant to write but didn't come out as clear as I had hope for. :roll:
What I meant to say was all 3 Lantus, Levemir and NPH work fine for humans, however only Lantus and Levemir work well in cats, that NPH is too harsh and short acting for a cat's high metabolism rate.
Glad you caught what my sleep deprived brain didn't.
Mel, Maxwell, Musette & The Fur Gang
Gotcha! I see what you were getting at now. I'm really glad Musette is doing better today! I was catching up on posts and she gave you quite a scare!
C
Carl & Polly & Bob (GA)
Guest
Yes, definitely ask! If they will switch to one of the "L's", you'll be able to use the same U100 syringes. The "P's" require a different type of syringe (U40).
Carl
Carl
Julia & Bandit (GA)
Very Active Member
Casey9195 said:
Definitely change the insulin! It is very rare for a cat to do well on Humulin N, and it's more dangerous than the other insulins because it has a much higher rate of hypoglycemic incidents. No studies have been done on remission rates, but studies have been done on Caninsulin, which works in a similar manner to Humulin N, and it only has a 25% remission rate, and that's likely due to the diet change and not the insulin (meaning the cat would have gone into remission regardless of insulin).
My friend's vet had her diabetic cat on Humulin N for 4 months without home testing, and her cat's diabetes worsened to the point where he couldn't walk more than 3 steps at a time and had to urinate on a puppy pad on her kitchen floor. He looked awful and really was on death's door. She got in touch with me because she had heard through a mutual friend that Bandit was doing really well with his diabetes (he's currently in remission), and asked me me if I could help her figure out what was wrong. I had her switch to Lantus and taught her how to home test, and had her get rid of all the high carb (dry) food in the house. 5 months later, he's running around the house and playing like a kitten, and he starts his remission trial this week.
The sooner you change insulins and start home testing, the sooner and better are your chances of getting your cat regulated, and likely off insulin all together.
I'm not sure if you're feeding a low carb canned diet yet, but vets who prescribe the wrong insulin usually don't encourage home testing or know the connection between diabetes and diet (which should be common sense, if you think about it! We all know human diabetics can't eat lots of sugars and carb-laden junk foods). They also tend to overdose the insulin since the cat is showing very high blood sugar levels due to the dry diet. If you change to a low carb canned diet, make sure you are dropping the dose of insulin to 1u or less and home testing. If not, a deadly hypoglycemic incident can occur, since most cats see immediate drops in their blood glucose levels of 100-300 points. Also, blood sugar readings obtained at the vets office are usually falsely high, because stress will elevate cats' blood sugar levels, which is another reason cats get overdosed without testing at home.
When treated in a similar manner to the way human diabetics treat themselves, cats have the amazing ability for their pancreas to heal which is why most cats will go into remission with the right insulin therapy and diet.
Julia & Bandit (GA)
Very Active Member
Casey9195 said:
Yes, an insulin change can be made easily. You just need a script for the new insulin from your vet. And as long as you are home testing, there is no reason to pay for any monitoring at the vet if diabetes is the only health issue (some diabetic cats develop a dangerous condition called diabetic ketoacidosis--if there are more than trace ketones present that is the time to go to the vet. You can test for these at home using urine ketostix that you can pick up at any drug store). You can use any human meter to test. One popular meter here is the Relion Confirm or Micro from Walmart. It's a reliable meter with very inexpensive test strips (which is where the real costs lie). Not only is home testing more accurate than vet testing, it's much safer for your cat, you have a far better chance of remission, and it saves you a ton of money. Check out this link, which has videos and tips. It seems hard at first, but nearly everyone finds that within a week or two even fractious cats not only accept testing, they enjoy and expect it as long as you give them a treat with each test. They don't have many nerve endings in the tips of their ears, so it doesn't hurt them at all. They just need a little time to get used to it because it's something new.
Home testing links and tips: http://felinediabetes.com/FDMB/viewtopic.php?f=14&t=287
Is the food canned DM? If so, then you do have her on a good diet. Purina DM canned is the only prescription food that is suitable for a diabetic cat. However, only some Fancy Feast is low carb. Here is a link to the diabetic safe flavors of Fancy Feast: http://felinediabetes.com/glutenfree.htm.
If it's dry DM, it is too high in carbs for a diabetic.
You don't have to feed the DM, and you can feed just the grain-free flavors of Fancy Feast if you want. If you read the ingredients on the back of the DM, you'll see that it's pretty much the exact same thing as Fancy Feast. Here are the ingredients for the DM:
And this is Fancy Feast Liver and Chicken:
With DM, you're paying a huge markup for just the label. And of course your vet likes the DM, because they make money selling it. If you ask your vet what special ingredients are in the DM as opposed to low carb grocery store foods that make it a better food, the answer (or lack of one) will be very telling. Here's a link to the cat food nutrition charts, where you can compare the carb content of many different foods. You just need something under 10% carbs, preferably less than 7%. http://felinediabetes.com/diabetic-cat-diets.htm
I was fortunate that my vet handed me a list of commercial low carb canned foods in different price ranges, and told me the prescription food was a waste of money for diabetes because all you're looking for is low carbs. I didn't realize how lucky I was until I found these boards!
Julia & Bandit (GA)
Very Active Member
Casey9195 said:
Ummm, that was true maybe 10 years ago. There have been a lot of changes in feline diabetes in just the past 4 years. Lantus and Prozinc are the most widely used insulins for cats. Here is some info for you to send that vet, so hopefully they stop prescribing cats the wrong insulin. So many cats suffer needlessly when this sort of thing happens. The vet is either years behind in their research, or they simply don't know that diabetes treatment for cats differs drastically than treatment for dogs. Perhaps they need to learn how to search the internet for scholarly articles? Even a simple wikipedia search states that Humulin N is not good for cats (and provides references): http://en.wikipedia.org/wiki/Diabetes_in_cats#Insulin_injections
Sorry, it's a huge pet peeve of mine when vets say stuff like this. This information is from scientific studies from peer reviewed veterinary journals that can easily be found with a google scholar search, not some crackpot web page! They should be encouraging you to do MORE research, not less! You're an intelligent, discerning adult, not a child!
Here are the AAHA diabetes guidelines: http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf
See p. 218 (4) where it says under Insulin Therapy in the cat : "The insulin preparations with the appropriate duration of action in most diabetic cats are glargine(U-100) or the veterinary-approved human protamine zinc insulin(PZIU-40). This panel does not recommend the veterinary-approved porcine zinc(lente) insulin suspension as the initial treatment for the cat, because its duration of action is short and control of clinical signs is poor."
Porcine zinc was sold in the united states as Vetsulin, and is no longer being produced. It's duration of action is similar Humulin N. Humulin N is not mentioned because it's no longer supposed to be prescribed to cats. If you look under the clinical management guidelines for dogs, p. 221 (7) it states: "When porcine zinc insulin is not available, U-100 human recombinant Neutral Protamine Hagedorn(NPH) insulin is a good initial alternative, although its duration of action is often <12hours in many dogs."
I've also attached veterinary articles that compare Lantus(glargine), PZI, and Vetsulin(porcine zinc), and a second article that discusses the safe and effective treatment with Lantus, and it's 84% proven remission rate. I would bring these articles to your vet when you ask for a different insulin.
Julia & Bandit (GA)
Very Active Member
Casey9195 said:
It seems like there is a never ending stream of information in the beginning, and it's even more confusing when your vet is contradicting the information you're reading. I would ALWAYS recommend printing out the information you find and giving it to your vet to discuss with her. Good vets WANT you to ask questions and show them research they haven't yet seen. Vets have to know a lot about many different diseases for many different animals, so it rare to find one that is up to date with all the aspects of feline diabetes. Even if you decide to take charge of treatment yourself (which many people do with the help of this board), giving your vet the information you found may help save the diabetic cats that show up at the practice from now on.
C
Carl & Polly & Bob (GA)
Guest
LOL, maybe the ER vet should spend a little bit more time on Google, or maybe even take some online courses. Julia beat me to it, but one of those links is to the
American Animal Hospital Association! Safe bet they have a sticker on their door or window that says AAHA on it. Geez, it's not like we make this stuff up..
Tell him we're not "crazy inter-web cat people". You know, we all have diabetic cats and lots of them have gone into remission and stuff. :lol: Of those, maybe 1 in 100 have used Humulin to get there.
Carl
C
Carl & Polly & Bob (GA)
Guest
We recommend that you home-test with every insulin. We think of it this way..... if kitty was your infant daughter, would you give her a shot not knowing what her blood glucose number was before you shot? A shot of insulin will push the BG down. If the number is too low, and you don't know it before giving the insulin, the result can be fatal.
Is Lantus tricky to use? Actually, because of the documentation that exists in the Lantus forums (sticky threads), it's not really tricky at all if you are following the protocol. None of them are really tricky, there are just logical "rules" to follow with all of them. At the same time, I guess you could say that all of them are tricky, because the day to day management of the disease isn't black and white. And the cats don't read the manuals! :lol:
Insulin specific information and advice will eventually be easily found in that insulin's forum. That's for when you feel comfortable enough to post there. Most everyone starts in "Health" though. If it is Lantus, for instance, you would be likely to get quick answers to questions specific to Lantus one of the two Lantus forums.
Carl
Is Lantus tricky to use? Actually, because of the documentation that exists in the Lantus forums (sticky threads), it's not really tricky at all if you are following the protocol. None of them are really tricky, there are just logical "rules" to follow with all of them. At the same time, I guess you could say that all of them are tricky, because the day to day management of the disease isn't black and white. And the cats don't read the manuals! :lol:
Insulin specific information and advice will eventually be easily found in that insulin's forum. That's for when you feel comfortable enough to post there. Most everyone starts in "Health" though. If it is Lantus, for instance, you would be likely to get quick answers to questions specific to Lantus one of the two Lantus forums.
Carl
Vicky & Gandalf (GA) & Murrlin
Very Active Member
Casey9195 said:
The ER vet needs to read up on their AAHA guidelines then. Lantus is now the more preferred insulin by the AAHA for cats, in addition to ProZinc/PZI, since 2010.
http://www.aahanet.org/PublicDocuments/AAHADiabetesGuidelines.pdf
I see Julie & Carl already hopped on that, but it bears repeating. Continuing education is required for vets to keep their license, but as I understand they can pick and chose what they learn about each year to qualify and their continued ed requirements probably vary from state to state.
There are many people here who owe their pet's life to this board when their vet let them down. That is not to say all vets are bad or uneducated, certainly not, but unfortunately we see people who know something is wrong but don't know the questions to ask or are uncomfortable going against professional advice, so by the time they find us, their pet is already in serious trouble.
The newer insulins work much differently than those vets previously used for pets, such as Humulin N. Home testing is a must with them to use them most effectively. But home-testing is surprisingly easy. It sounds like you might need help with that. You can actually request a link via the box "Home Testing Kits - Need one?" at the top of each page of the message board. Or you can go to Wal-Mart and buy their Reli-On brand which their test strips are fairly inexpensive and it was rated well by Consumer Reports. Then we can help with tips and tricks to get you started, there are also quite a few YouTube videos.
No one should be made to feel like the internet is a big bad place anymore. This is probably one of the best message boards regarding cat health on the web! Glad you found us.
akbahsMum
Active Member
I can vouch for the help I got from this board, which got me through the learning curve especially for home testing. Home testing was the key for me.
I learned and learned, and still keep learning, by reading the interactions here which involve the kinds of questions asked by people new to fb, and a range of commentary from people with a range of experiences. So long as you read enough, you start to get a balanced picture.
I learned and learned, and still keep learning, by reading the interactions here which involve the kinds of questions asked by people new to fb, and a range of commentary from people with a range of experiences. So long as you read enough, you start to get a balanced picture.
Vicky & Gandalf (GA) & Murrlin
Very Active Member
akbahsMum said:
Well said!
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