Rom 09/29 AMPS 356 +5 229 +9 304 PMPS 329 +5 254

http://www.felinediabetes.com/FDMB/threads/rom-09-28-amps-250-5-234-9-173-pmps-340-6-131.165738/

AMPS Rom was 19.8 (356)

 

<sigh>

 

Is there any reason why Rom's not on Lantus, Sue?

 

@Critter Mom. I am planning to put Rom on Lantus, even using Frankie's if the vet is not helpful. It's just I bought a bulk order of Caninsulin and I only have 2 vials left, so about two months worth. Usually whenever I mention it, she says she will refer him to the RVC and Rom does not travel well the two miles to the current vet (he poops everywhere in his carrier and gets it all over himself) let alone 10ish miles to the RVC. I spoke to a vet just recently at the RVC seeing if she would reccommend Lantus to my vet,hoping to head her off at the pass, but she said that he was responding well (it was around the time of all day blues. Typical!!) She said the next step would be ProZinc anyway as you have to use the animal insulins first under the Cascade system. I am hoping to persuade my vet though. All I want is the prescription, I don't want any tests or all day curves as I have all the data and it's not necessary.

 

+5 he's at 12.7 (229)

 

I recently asked our vets about the possibility of getting an Rx for Levemir. He told me that under cascade rules I'd have to go to Prozinc first by law now that it's an approved insulin for feline diabetics . I think your vet's prescribing hands will most likely be similarly tied, Sue. No harm in asking, mind.

Know what you mean by travel accidents. One of my boys could always be relied on to poop on a trip to the vets. Saoirse's forté? Pee. Placing a pee pad over the blanket in the bottom of the carrier helps with clean-up of the latter, and it's a good plan to keep a spare in one's handbag to replace the soiled one.

One tricky area is when there is a difference between what a vet considers to be "responding well" compared to what is possible for a given insulin where the caregiver does the necessary monitoring to refine the dosing of same. The majority of vets I've encountered or read about here tend to have very unambitious - and less than healthy - regulation objectives for their patients. You know the sort: "No need to home test; if the animal isn't drinking excessively then its regulation is just peachy."

When Saoirse was on Caninsulin I could have fallen into the "responding well" trap were it not for my presenting her data side by side with a record of her clinical signs. A vet would have approved of her response to the Vetsulin in terms of BG but she felt like carp on it. Thankfully the full journal provided enough evidence for our main vet to be able to issue the Lantus Rx. I don't know whether doing similar might help you with Rom.

Ironically the approval of Prozinc over here is in some ways a backward step for newly-diagnosed kitties. Given that remission rates are higher for Lantus and Lev (on Tight Regulation Protocol) provided the kitty gets onto one of them very soon after Dx now that in Europe they have to be treated with two in-out insulins before any switch to an L insulin can be considered pushes the start date for treatment with the latter further out from the Dx date and may very well reduce the cat's chances of achieving remission.

Sue, @Elizabeth and Bertie, @Alexi - do any of you know whether there are any moves at the RVC or elsewhere to get approval in the UK for Lantus treatment of feline diabetics?


Mogs
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The vet I spoke to said that the trials are concentrating on ProZinc. I can drop her an email and ask the question though.

 

Here is the email I received from the RVC vet (edited to exclude comments about Rom)

As far as I am aware, there have been no plans in regards to licensing Lantus for cats in the UK and this insulin has not been licensed for use in cats or dogs (or other animals) outside UK. So I don’t think this is going to happen in the near future unfortunately.

 

She sent another email. Again edited.

"Lantus has been used in countries outside UK/Europe but as far as I am aware the product has not been licensed for use in animals in other countries (USA, Australia) either – probably their prescription cascade is just not as strong as in UK/European countries. But as I said, if the duration of action seems to be a problem at the moment, ProZinc would be a suitable insulin.

In the Diabetic Remission Clinic we investigate the optimal treatment for diabetic cats but we have no influence on pharmaceutical companies. We have compared Lantus and ProZinc as a part of our research but this is something which has not been finalised yet. But you will hear from us as soon as we have all the data."

I have no idea how I will find out about the conclusion of these trials as neither of my cats are on it, but I can always ask at a later date.

 

I emailed asking when the trial will be over and I got this reply. Fingers crossed it helps loosen up this ridiculous Cascade system.

The trial has finished but my colleague is in the process of evaluating the data and writing it up. I am pretty sure we will put the results on our Facebook page, so you cannot miss this

 

+9 Rom is 16.9 (304). I'm thinking maybe I should just cut my losses and change his insulin.

 

Prozinc is not a bad insulin - I am finding it better than Caninsulin and the RVC are using it in their current clinical trial, Cappuccino is due there soon for her next visit as part of the trial so I can certainly ask about the conclusions of the Lantus trial and whether they can formally recommend it as an option for treatment. Unfortunately drugs licensing is 100% in the hands of the drug companies, some of whom are very selective in what they seek to license as it is all about profit, and even go to court to force prescribing of their licensed drug over a cheaper unlicensed alternative which is just as good (and so costing the NHS money it can't afford in drugs costs).

There is an argument that if the RVC can show it is superior to the licensed insulins then vets may feel more confident in recommending it - even allowing for cascade rules, but if the vets own license to practice may be on the line then it is fairly predictable that they will just follow the rules, and who can blame them?

 

Seems like I will have to switch to ProZinc. I should have just gone to the RVC a few months ago before ProZinc was licensed. I thought I was saving him unnecessary stress at the time, but at least he would have been on Lantus. I could kick myself!!!!

Anyway, PMPS Rom was 18.3 (329) and +5 14.1 (254)

 

You could use the argument that you are already a Lantus user, are used to how it works and that you are used to the regime. I am getting good results with Prozinc - Cappuccino is always a bit all over the place with her numbers but clincially I have seen a major improvement since the switch so I wouldn't dismiss Prozinc as an option. I am glad we made the switch and we did so before she started in the trial.

 

Thanks. I am not dismissing ProZinc. If I have to have it I will, but as you say I am used to Lantus, and how it works.