Switching from PZI to Lantus - tips?

Hi guys, I'm a fairly new user whose cat has been on PZI for 4 mos. with little effect on BG numbers (you can see them in his chart). I'm contemplating trying a different insulin and wondering if anyone here had to switch from PZI to Lantus, and how that worked out for your cat. Let me know, thanks!

 

Hi Samson's Mom.

Welcome! We have had quite a few people switch from PZI to Lantus or Levemir, generally with good results. I'm not one of them, but I'm bumping you up to get eyes on your question. If you decide to make the switch, you will find plenty of people here to help you with the transition and going forward! This is the nicest place you never wanted to be!

 

Hi @Tricia Cinco(GA) & Harvey ! Thanks for the bump - it's busy here Do people generally switch because they're not seeing fast results on PZI?

A few other q's: will I need to order different syringes? Are the unit doses generally comparable or different (ie, what would a starting dose be)? Is dosing schedule similar (12 hrs apart)? THANKS!

ps. Is there a difference between Lantus and Levemir?
pps. Whoa! Is there a reason Lantus is double the price of PZI, and is there any way to save money on ordering in the U.S.?

 

Yes, this is a very busy forum, and unfortunately, sometimes new posts get overlooked. If you ever feel like you're getting lost in the shuffle, you can just post a reply with "bump" in it to boost your condo to the top. Also, sometimes rephrasing your subject line to add a question helps: "Any Former Prozinc Uses - Are You Glad you Switched?" or something like that.

I never used anything but Lantus, so I'm not sure about the syringes you are using. Lantus and Lev use U100 syringes.

We usually recommend that you start at a dose close to what you were giving in the previous insulin. If you decide to make the switch, we can help you figure that out.

Yes. A Lantus/Lev cycle lasts 12 hours. Since it is a long lasting, depot insulin, sticking to a 12/12 schedule is very important.

Have you had a chance to read the stickies at the top of the page? There is a ton of great info there. Especially useful when switching from another insulin is this one: http://www.felinediabetes.com/FDMB/threads/lantus-levemir-what-is-the-insulin-depot.150/

 

Yes, you will need to order and use u100 syringes. Prozinc is u40.
You can save money on lantus by ordering from Mark's in Canada. I will try to find the link. You can get 5 pens for around $150-$170 and I believe that includes shipping. I could be wrong on the shipping.
I switched Chuck from ProZinc to Lantus after 7 months. He was on a higher dose (8 units) at the time and we switched over to Lantus at the same dose.
He did not get a full cycle of control on prozinc. He was also VERY bouncy. He is doing great on lantus compared to prozinc. I'm very happy that we switched.
You can also buy lantus from the supply closet here. Usually around $20 a pen or $100 for a 5 pack. 300 units in each pen. 1000 units in each 10ml vial.

 

@Chris & China always has the link to Mark's at her fingertips.

 

Sorry I took so long. I believe this is the right link.
https://rxcanada4less.com/insulin.html

 

Have you been using PZI or ProZinc??

While it's true that ProZinc is a U40 insulin and uses different syringes from Lantus, PZI comes in two strengths, U40 and U100 so if you're using PZI, you need to know what concentration you've been using.....If it's the U100, you probably already have U100 syringes

Here's all the info on buying Lantus from Canada

 

Hi guys, I'm back because I'm still not happy with Samson's numbers on PZI and I was wondering if you can help me figure out a starting dose of Lantus for him. He has been on 1.75 units (U40) of PZI and he is underweight and weighs 12.5 lbs. Could you guys take a look at his chart @Chris & China @Steph & Cuddles (GA) @Tricia Cinco(GA) & Harvey and help me out with a starting dose and any pointers on making the switch?

I'd like to order the box of 5 pens from that Canadian pharmacy but it takes a long time to ship from Canada - is it not necc. to refrigerate Lantus? do you guys use syringes to draw from the pens and if so can you explain that process? any links to where to buy the U100 syringes? THANK YOU!

 

When Chuck switched we had similar numbers as Samson. We switched at almost the same dose. I think it's easier to start with a marked dose, like 1.5 units because you say l can draw it up easier.
I bought syringes online. 100 for around $15 if I remember right. I'll add the website in a few minutes. Edited to add: these are the syringes I use.
https://www.adwdiabetes.com/product/6941/bd-ultra-fine-insulin-syringes

I use the pen as a vial. Pull the cap off, insert needle and pull back the plunger to the desired dose. I go a tiny bit past it, pull the needle out, flick any bubbles to the top and carefully push out the bubble until I get to the dose I need. Don't push air into the pen and don't push insulin back in from the syringe. You might waste a drop or two each time but it's better than risking any contamination.
It is not necessary to refrigerate it so shipping really isn't an issue. Once you have it, it's best to keep it in the fridge but don't let it freeze. Helps it last longer. One pen has 300 units in it so it could last you up to 100 days if you use 1.5 units twice a day. With a small dose like Samson's it's probably best to use the pens. Vial would probably go bad before you could use it all.

 

One aspect of using Lantus that is different from ProZinc is that Lantus dosing is based on the nadir, not on the pre-shot values and you do not slide the dose. Doses are held for a minimum of 3 days unless a reduction is warranted. (The initial dose is held longer in order for the depot to be established.) What that often means is that you don't see much movement in the numbers until the depot is formed. It also means using Lantus takes a great deal more patience that other typed os insulin.

As others have noted, you can make the switch at the same dose of Lantus as you're currently using with Prozinc.

Because Lantus dosing is based on the nadir, it's important to get PM tests. If you don't test during the PM cycle, you're missing half of your data and you risk missing a dose reduction.

 

Thanks guys! So start Samson off at 1.75 units?

 

Yes. BUT -- monitor carefully. Some kitties can have a marked response to a switch in insulin. It typically levels out but our kitties do not like to do the expected any more than they like being taken for granted!

 

I'd probably start at 1.5 just because some cats do have a lot different response to a different insulin and there's a recent 77 with the PZI at 1.75

You can get U100 syringes at any pharmacy that carries diabetic supplies. WalMart has their Relion 3/10cc, 31 gauge, 8mm (or 6mm) insulin syringes for $12.58/100 but any brand will work. You just want to make sure you get 3/10cc syringes that have half unit markings. (The Relion's DO)

You use the pen just like a vial except you don't put air into it...just pull the cap off, insert the syringe and pull out the dose you want.

 

Thank you all so much! So you hold the insulin pen upright when drawing a dose?

 

No....the picture is "upside down" from how you'd pull the insulin out....I think that was just easier for whoever made the picture in the first place

 

OK, so upside down then like a vial? Does it need to be at an angle?

 

Yes, just pretend it's a mini-vial and pull the insulin out the same way as always....you just don't shoot any air into the pens like you do with a vial.

It can be at an angle or straight up and down.

 

Is a 1.5 dose marked "15" on the new syringes?

 

No!! It's between the 1U and 2U lines

 

Bump - do users keep Lantus in the fridge once the pen has been started or at room temp? Tx @Chris & China @Steph & Cuddles (GA) @Tricia Cinco(GA) & Harvey

 

In the fridge to last longer. I think it only keeps for 28 days at room temp and most people use the pen until it runs out when it is refrigerated.

 

in the fridge....the makers of the pen say not to refrigerate it, but that's because of the "dial-a-dose" mechanism.....refrigeration can make it "stick"

But since we use regular insulin syringes to pull the insulin out of the pen instead of the mechanism, it doesn't matter and the insulin will last until you use every last drop

 

Hi guys, as you can see I switched Samson to Lantus 5 days ago. He's at 1.5 units but looks like he could go higher and I was hoping some eyes here could look at his chart and advise. Thanks! @Chris & China @StephG

 

I didn't increase until after 10 doses of lantus but I started at a much higher dose. I think the 5 days is standard when switching. If you can't monitor as much on a PM cycle increase you could hold out another cycle if you choose to do the 10 doses, then increase on the 11th which would be a morning cycle. (Hope that makes sense.)
I think you could increase to 1.75 units based off the data on your SS.
Let's see what the others say...

 

I think you could go up to 1.75 tomorrow

Do you know if you're going to do Tight Regulation or Start Low, Go Slow?
You're currently testing enough to do TR and that will allow you to increase every 6 cycles until you start to see some lower blue numbers

 

@SamsonsMom - Welcome back!!! I bet it's nice to see your fur baby again! How long will you be stateside? I hope the switch in insulin works well for you and Samson's caregiver

 

Hey there and welcome to Lantus and Lev forum. I was previously a ProZinc user and switched to Lantus after 6 month. After discovering Bubba was a late nadir kitty and getting rid of ketones, he finally started coming down for me and I got him OTJ after DX in 14 months, the first time. Unfortunately, he's back on the juice again for time # 4.......but, that said, hopefully for another remission.

I find Lantus a lot easier to use as it has a more precise protocol TR or the Start Low Go Slow method. Wishing you luck and ask all the questions you need to.

 

Thanks everyone! You guys are so helpful. @Djamila, hi! I'm back here til the 11th. Yes, it's wonderful to get in some QT with my babies. I don't know which method I'm using - I have to confess that although I've read the sticky I don't really understand what TR is. I'm testing as often as I can because I'll only be here another few weeks. I did bump him up to 1.75 yesterday. Question, though: for the past few days his nadir has been higher than his +3 number. What's up with that, and will it level out? Thanks!

 

Hmm. What time in the cycle does he eat? Or is he free fed?
It could be a food influenced number depending on his feeding schedule.

ONE difference is Tight regulation calls for you to shoot on lower preshots than SLGS.
Another: you earn reductions on anything under 50 on TR and I believe anything under 90 on SLGS. (Correct me if I'm wrong!)

So TR is, bare basics, a protocol to get them into the best numbers possible with more aggressive (persistent?) treatment.
SLGS is a more relaxed approach with slightly higher numbers than TR. They are still GOOD numbers, just higher than TR number goals.
This was just a little bit of each protocol out of my memory! Others might give a more detailed explanation.
I'm happy I decided to go with TR but I still get nervous shooting on those lower PS. You can always switch if you try one and think the other would be better for you.

 

I think I would lean towards SLGS (Start Low Go Slow) since after you leave, the caretaker doesn't test as frequently. As Steph said, SLGS takes reductions at 90, so Samson would be in slightly higher (and therefore safer) numbers with the less frequent monitoring.

We'll miss you over in Prozinc, but I think this switch will be good - especially while you're gone.

As for your question, nadir is the lowest number in the cycle, it doesn't necessarily happen at +6, it can happen any time. Some kitties have an early nadir, some have a late nadir. Every cat is different. That being said, sometimes an early nadir is an indication that the kitty needs a bigger dose. If that's the case here or not, I'll leave up to the Lantus experts to say. I've used this insulin, but only for a few months so I think it would be better if others help you with dosing.