Switching from Prozinc to Lantus - Please share experience

Hi There,

My 10 y/o male neutered kitty Tigger was diagnosed 5/15/13 with diabetes from prep bloodwork for a dental - he'd had his first steroid shot for a dental infection a month earlier, & we believe this was the cause/catalyst.

Our original (now ex-)vet put him on glipizide, & with the help of this wonderful group, we got a new vet & switched Tigger to Prozinc 6/8/13

With the help of another great Member (thanks Anne & Tess!) we just found a MORE fantastic vet today, who would like to switch Tigger to Lantus, because that's her insulin of choice.

Have any of you made the switch, & if so, is there any specific protocol I should follow for 'detoxing' the prozinc before starting Lantus? My vet was going to check as well - we'd be her first.

Also, does anyone know of a reason why we shouldn't switch to Lantus, especially as Tigger's only been on Prozinc 3 weeks? Tigger is currently on 1.25 units of Prozinc twice daily & is ready for an increase. We do feel we've seen improvement with Prozinc, but this vet feels Tigger has a better chance for remission with Lantus.

We are already switched to low-carb canned food, & do testing multiple times daily, so we'd like to be in the tight regulation group. My goal is to do what we can to get him into remission, & I hope the 3-week delay with glipizide & now this change from Prozinc to Lantus won't be a problem.

Thanks in advance for sharing your experience & advice!

 

Re: Switching from Prozinc to Lantus - Please share experien

Hey, welcome to Lantus Land! So you are going with Dr. S.? Isn't she great?

The change should be pretty easy, I don't think Prozinc has a shed so there should be no detox necessary. Several here have switched. A lot of the dose advisors are in the east, so tonight is a little late. When were you planning to switch? Often the dose is lowered slightly to be on the safe side.

The only problem would be that you chose Prozinc because it is a bit more forgiving as to schedule. To get the best results w/ Lantus you really need to be consistent with shot time and dosing. We don't use the sliding scale like Prozinc.

We still need to get together for coffee and I have those lancets for you too.

 

Re: Switching from Prozinc to Lantus - Please share experien

Welcome to Lantus Land!

There's no problem with a direct switch from Prozinc to Lantus.

Prozinc is a good insulin and one of the few insulins that's recommended for cats by the American Animal Hospital Assn (AAHA). Personally, I think the issue may be more of a political consideration with your vet than a "which is best" discussion. Each insulin has its proponents. Many vets (and MDs) prefer to prescribe drugs they feel comfortable with or have the most experience with. While I'm biased in favor of Lantus, what I can point out is that there is a dosing protocol for Lantus (Tight Regulation Protocol) that is backed by research and that has been published in a leading veterinary journal. There is not a similar dosing protocol for Prozinc.

Lantus is very different than Prozinc. Lantus dosing is based on the nadir (lowest point in the cycle) vs. on your pre-shot numbers. As a result, you don't slide the dose from cycle to cycle. Rather, doses are held for a minimum of 3 days unless a dose reduction is warranted. Lantus is a depot-type of insulin (what Anne referred to as a "shed"). This makes Lantus a long-acting insulin that has a cumulative effect. Other insuin, like Prozinc, is in and out of a cat's system by the end of the cycle.

 

Re: Switching from Prozinc to Lantus - Please share experien

When I made the switch with Ruby last year, I planned it over a weekend so I could monitor her very closely. On her second shot, she dipped really low so it's good that I had planned it that way. I think its better to be overly cautious than not.

She liked to dive late in the evening so we had some really long nights for awhile there. She was on Lantus for 8 weeks (had been on PZI for a couple of months prior) and then went OTJ. She's been there ever since! I was super freaked out about the switch but I'm so happy I did it. And it was with the help of everyone here that we are where we are today.

Good luck!
Amy & Ruby

 

Re: Switching from Prozinc to Lantus - Please share experien

Suzanne -
My Dusty was recently switched to Lantus from Prozinc. Just as Tigger was, Dusty was initially put on Glipizide.
And just as you have had a time with vets, I have too, but as you have found a great vet,
I haven't found one to date that knows much about the treatment of Feline Diabetes whose practice is in the general area of where I live. :sad:
This message board is a God send to me. Such awesome information and encouragement.

Ann & Sienne are absolutely correct in how they describe Lantus use. For Dusty Lantus has been a miracle worker.
Dusty was up to 10u twice a day of the Prozinc (he had been on Prozinc for almost 3 years) and had never regulated.

He has been on the Lantus about 1 month and once a dose was found that began bringing his BG down, well I've never (NEVER) seen numbers like this that are so consistent. Dusty has always gone up and down day to day in great lengths with the Prozinc but with the Lantus, to me, it seems to give more control.
I could tell that each dose truly does build up into a Depot/Shed, because he continued to drop in BG some each day of use.
I am still working on finding that one dose that is Dusty's fit for maintaining his BG every day, but as I said, we are working on it.

Just as Ann has told you, if you have the time to be consistent with the shot time and dosing, Lantus will probably work best for Tigger.
Look at it this way, it’s a great proven to work on FD insulin. Dusty was put on Prozinc back when it first hit the market, and I'll just say, it didn't do Dusty any favors to be put on an insulin that his vets knew very little about along with them not knowing much about the treatment of FD.
Why not go with Dr. S's suggestion to switch to Lantus you have a vet that is experienced with a great proven insulin, it's early in Tigger's diagnosis which gives the greater chance of him healing and beating the diabetes.

I'm sorry I still haven't figured out how to attach my condo's so you could read back on our 1st month experiences but you can always check out Dusty's
SS.

 

Re: Switching from Prozinc to Lantus - Please share experien

Thanks so much everyone for all your input & experience.

You have all been able to convince me this is the right choice for Tigger.

Do you all use the pens vs. the bottle of insulin? If so, Dr. S. wasn't sure how to write the prescription - it needs to be specific for the pens, correct?

I'll take some time tonight (after grandbaby is in bed) to read the stickies - read some amazing info there last night.

Thanks again - I don't think we could've got here without the support of this wonderful board. We have to have vets for our prescriptions, but the most valuable information & feedback I've consistently received has been from the FDMB. So glad our new vet likes the Board, too!

 

Re: Switching from Prozinc to Lantus - Please share experien

I know there are some people here who use vials. However, I want to guess that most of us use the pens. You vet needs to write the Rx for Lantus Solostar pens. They come 5 to a box. You end up with more insulin with a box of pens than you would get in a vial.

You may want to call around to find out whether there are any pharmacies that will dispense one pen at a time if you can't swing the cost for a box. The cost for a box runs somewhere around $225. This is a link to a coupon for Lantus. Do not say this is for a cat. Also, when you enter the info, indicate you don't have insurance (I'm presuming your cat doesn't have insurance.) and indicate the age as over 18 yo.

 

Re: Switching from Prozinc to Lantus - Please share experien

Good morning! I never found anywhere around here that would sell single pens, but I haven't looked into it in a couple of years. Costco has the best price that I've found too. Dr. S definitely has to specify the Solostar pens in the Rx, but you DO NOT want the needles that attach to them. We use half unit marked U100 syringes, not the U40 syringes you have for the Prozinc. It is cheapest to order syringes from ADW and I have extras you can have until you can get an order from them.

Stay cool!

 

Re: Switching from Prozinc to Lantus - Please share experien

Thanks, everyone!

I got the Lantus pens today from Costco - $290 including tax, with the Costco no insurance discount. Too bad I just saw your post about coupons, Sienne, but I'll still check it out tomorrow & maybe can use it retroactively, thanks for the info.

I'll probably do the changeover Monday AM - that'll give me time to prep & have the time to test every 3 hours for 4 full cyces. I really like that you don't have to mix the Lantus - that's just another layer that can go wrong.

I have 'another question': Dr. S's prescription has Tigger on 1 unit Lantus twice a day. He's currently on 1.3 units Prozinc &I was going to raise it per the Prozinc support group's consult - he's hanging in the upper 200's & low 300's. Now I'll hold that dose till Monday, maybe raise it a hair.

Do you feel 1 unit is a good starting dose or should Tigger be higher? I read a post yesterday about conversions of Prozinc to Lantus but can't find it now.

Tigger weighs 14.15 pounds & isn't overweight, if that helps.

Thanks, Anne - I already ordered the u-100s from ADW to help with the conversions for Prozinc quarter-doses.

Feels like it's been a long haul, but we're getting to where we should be - Thanks again to all of you for your support, wisdom, & experience. It all helps soooo much. Good night!

 

Re: Switching from Prozinc to Lantus - Please share experien

WOW!! :shock: That's a price jump! I think it was $190 last time we got a box.

1u is often used as a starting dose and on the changeover and a little lower dose is a good idea for safety. You can always increase after a few days. Just a reminder, it can take up to a week for Lantus to fill the "depot" so you will not see the full effect of the dose until then.

 

Re: Switching from Prozinc to Lantus - Please share experien

Ann, maybe the $100 difference is that you used the coupon? I'm going to try Monday & see if Costco will take the coupon retroactively. Will post results for any others in my position. Also, Costco told us recently on a different rx (doxycycline), that the costs can vary substantially day-to-day, with each order.

Ok - with your explanation 1 unit to start makes sense. Tigger had a 433 test at +10 last night - his first +400 nailbite_smile. I'm really wanting to get him regulated (I know like everyone else!), he's had so many changes to deal with since his diagnosis, poor guy.

The Lantus depot - I'm still trying to understand that - when & how do you know it's filling/filled? Will there not be as great a curve between onset & nadir? Or....????

I guess if Tigger's depot hasn't been filled after 3 days & his numbers are high, it's still best to wait a full week before any dose increases to avoid hypos once the depot is filled, correct?

Thanks again everyone for all the assistance!

 

Re: Switching from Prozinc to Lantus - Please share experien

Well, we switched to Levemir a year and a half ago so it has been close to 2 years since we bought Lantus. Costco members do get a discount, perhaps that was it. We didn't use a coupon. Or prices have just gone up! :shock:

here's an article to help you understand how the depot forms w/ Lantus.

 

One MORE Question..........!

i, Lantus Land!

I've been reading & taking notes of the stickies, but can't seem to find where I read about this:

With Prozinc, if the PS was 200 or below, newbies were advised to hold off unless it went up after feeding, etc., & to consult with more experienced members.

I understand with Lantus we're looking more at the nadir for direction, but if the PS is below 200, is it still advisable to hold off on shooting, especially if food, etc. don't bring it up?

Thank you for your help!

 

Re: Switching from Prozinc to Lantus - Please share experien

Here we are a little more aggressive and use 150. Many of us will get a +10 or +11, it lets us know what direction the BG is heading.

If you preshot number is 150 or below (or a number you are uncomfortable shooting) post for advice and retest in 15 minutes to see if the number is rising on it's own. DO NOT FEED while stalling! We want to see a level or rising number for the end of the cycle. Feeding will raise the BG and cover where the cycle was headed.

Fortunately here there is nearly always someone around to advise you. Just try to give yourself a little breathing room/time to get an answer. Put a question mark on your post an a brief note like "low BG. shoot???"

 

Re: Switching from Prozinc to Lantus - Please share experien

OK, I understand & that makes sense - Thank you so much, Anne.

I forgot about the no feeding part to see if the numbers rise on their own, tho' - it's that way as well with Prozinc. So much to remember!

I'm hoping our lives will settle a bit & maybe we could do coffee (Or ?) the week of July 8th? I'd love to meet you in person - I'm so lucky to have a fellow fdm nearby! flip_cat

 

Re: Switching from Prozinc to Lantus - Please share experien

Suzanne:

You might want to make a note on your SS when you started Lantus.

Also once you start, we suggest opening a new thread each day that your post. You'll notice that we use a particular format for subject lines:

Date...Cat's name...AMPS-#, +time-#​

The format let's us quickly scan to see if there are numbers that require a comment. Likewise, if you have a question, you can put that in your subject line and folks will stop by to answer.

 

Re: Switching from Prozinc to Lantus - Please share experien

I made the switch from ProZinc to Lantus back in 2010. Before the switch, Blackie was getting 8u of ProZinc 2x/day. If I recall, ProZinc isn't a long acting insulin like Lantus is, and usually peters out before the 12 hours is up, which typically results in higher PS #s. I remember starting out at 1u, and then worked up from there using the TRP (Tight Regulation Protocol). I highly recommend Lantus as I've seen very nice results from it. Good luck, and welcome!

 

Re: Switching from Prozinc to Lantus - Please share experien

Thanks, Angela & Blackie, it really helps to hear from others who've gone through the switch with positive results.

And Sienne, I will start posting numbers in a new topic daily - starting today - BUT - so far (+2), so good!