Change to Lantus from PZI Vet

Hello. I need some advice. Our cat, Stu, now 12-years old, 15.8 lbs., was diagnosed with diabetes in January 2006, when he was a little over 9 years old. He was put on 2 units of Idexx PZI Vet (bid) and we immediately changed his diet to low carbs. To this day we feed EVO cat & kitten/ turkey & chicken/ wet food (a little less than a 5-oz can a day, doled out in 4 feedings) with a little EVO dry food available all the time for snacking. We have never home tested for blood glucose. Over the last 3 years Stu was gradually raised to 5 units bid of PZI Vet (based on occasional testing at the vet's). In October of 2009, when it became impossible to get PZI Vet, he was switched to Lantus. The vet at first put him on 4 units of Lantus bid. Stu was tested after 2 weeks (+5 hours after his morning insulin shot) and his blood glucose numbers had soared (to above 300—with PZI Vet his nadir numbers were around 130). The vet raised him to 5 units bid. The next time, in early December, he tested at almost 400 (same time of day: + 5 hours). He was raised to 7 units. Several days ago, after receiving 7 units bid for about 3 weeks, he was again tested (same time of day) and his blood glucose was 78!! Through it all, and I mean since Jan. 2006—not just since he was switched to Lantus) he seems unchanged: he is active, healthy, friendly, drinks and urinates about the same as always (he has always drunk a lot of water), has good appetite, and still weighs 15.8 lbs. He has never had a hypo episode. He is very even-keeled. The vet says to bring him in for testing in another 2 weeks and if his numbers are still low, he (the vet) will begin to reduce the insulin dose. I, however, am worried that his dose is way too high, especially after reading the posts on this website. I reduced it to 6 units the very day we returned from the vet! I would be interested to hear comments from you experienced people. I am seriously considering home testing and would like advice about meters other than the Walmart Relion (the nearest Walmart is 100 miles away and not easy to get to in the winter; ideally I would like to order something online). My other question is about the new PROZINC PZI. My vet has been reading up on it, but since Stu's blood glucose was so much lower the last time he tested, the vet thinks we should stick with Lantus. Any thoughts about this? Thank you so much for your help.

 

I'll try to keep this polite.....

Your vet is dangerous. The lantus should have been started at 1 unit max and raised by 0.5 units at a time, not 1 or two units based on one or two readings at a vet clinic. Your cat is in serious jeopardy of hypoglycemia due to repeated overdosing; it is called rebound or somogi effect when the cat's liver is desparately trying to protect itself. This presents with higher numbers but eventually the body can't do it anymore and the cat crashes.

Yes, you totally need to start hometesting, just as humans do. and you need better advice on how to work with lantus. You have no idea whether it is the right insulin or not because of the protocol your vet has been using, and hometesting will give you the answers you need and hopefully protect your cat from damage.

I know this is harsh and scary, but it really is dangerous. I commend you in coming here and wanting to learn, and I promise we will help you.

 

Further, please click on the forum called health links. There you will find the FDMB which is the first document you should start with. It deals with insulin, hometesting, etc. Note that the insulin type section is about to be updated. Then head to http://en.wikipedia.org/wiki/Chronic_Somogyi_rebound to read more about somogi rebound.

 

Regarding meters, I prefer the AccuCheck Aviva for it's ease. It sips the blood droplet so quickly and effeciently. I have also used, and like, the One Touch Ultra and True Track meters.

I believe you can still get a free One Touch Ultra Mini, I just ordered a few about 3 weeks ago that just arrived. Check this thread from the old board.

http://www.felinediabetes.com/phorum5/r ... 17,1952281

 

Hi Ella,

glad u found the FDMB. You'll find it very useful in learning how to treat feline diabetes.

I have to agree with home testing and monitoring at home.

Think of it this way - if it were your child and u had to give your child 6 or 7 units of insulin, would you shoot that without knowing if it were safe to shoot?
All of our kitties here are like family members, they are our fur babies.
Please consider home testing and start today!
If you are near a Walmart, you can easily pick up the Relion Ultima or Micro meter for testing blood glucose. These are human meters, and they are just as good for pets. If you go for the Relion, make sure you get the right test strips for the appropriate Relion meter. Relion is your least expensive choice and a reliable meter.

This link will show you meter comparisons as done by Consumer Reports:
http://docs.google.com/View?docID=dd5ck ... on=_latest

Please read about home testing in the HEALTH LINKS forum.
viewtopic.php?f=14&t=287

There are also links to nutrition sites.
This one is for Dr Lisa's Feline Nutrition and she covers the drawbacks of feeding dry food even if it's just for snacking.
http://catinfo.org/

Please try to stay calm and I know it's all overwhelming and scary, we've been there too, and thru this amazing board, have begun treating Feline Diabetes and getting our kitties back to their happy healthy selves again.

 

I totally agree with Jen and I would get a glucometer and start testing immediately at home. . Walmart has meters and test strips at a reasonable price.

You can seriously, and maybe permanently, hurt your cat with high doses of any insulin. The 78 reading at the vets was taken when the cat was stressed and his actual glucose was probably actually much lower.

Please read all the info here that has been suggested, start testing, reduce your dose, and continue to post for more help. Feel free to ask questions about anything that you don't fully understand - there are no "dumb" questions.

 

Hi there Ella,
Welcome You're gonna see some gasping about the dosing decisions that have been made for Stu, and I don't want you to be offended. It's scary for us to see this kind of dosing protocol, especially with the lantus decisions. Lantus can't be raised like that without causing significant problems with the kitty. I am thinking your vet probably didn't know how it was supposed to work, and that lantus requires very minor adjustments rather than full unit increases. You were right to decrease Stu's dose, as it was the safe thing to do. A 78 at the vet is very very low, especially when you consider that stress, such as being at the vet, actually increases bg's. It's likely that his HI's were caused by his dose being too high. Lantus is fairly well known for showing no, or very minor, symptoms at hypo numbers. It's possible for a lantus cat to have a symptomatic hypo, but it's often they show none.

I'm super glad to hear you asking about hometesting. We'd be more than happy to help you with this, and you can even get them online. Check ebay, hock's and the supply closet as well as Cindy and Mousie's sticky right here on the Health board. I like I use both the Maxima meter at Hocks, http://hocks.com/Merchant5/merchant.mvc?Screen=PROD&Product_Code=MAXKIT that has inexpensive strips, and also the Accucheck aviva, which I absolutely love. I pick up strips on ebay for that one. I have used the relion and think it's a good meter, but I hate going to walmart so I don't still use it LOL

Your topic of Lantus to PZI Vet is not quite right. PZI Vet and Prozinc are two different insulins. PZI Vet is now discontinued and Prozinc is based more along the lines of a human insulin much like lantus and levemir. You can do whatever you are comfortable with, but right now, my advice would be to take baby steps. Start your testing regimen and track his numbers and then you will see whether he needs another insulin. It's not abnormal for cats to change insulins during their diabetic illness if one is not working, but if you have registered a 78 at the vet, it's quite likely that lantus is working just fine for him.

Next thing is his weight. We have noticed thru the years that higher dosed kitties can gain weight, and that overdosed cats are much the same as overdosed human diabetics in that they gain weight. 15.8lbs is rather large for a cat, unless you have a Maine Coon or other extremely large breed cat. I notice you are also feeding Evo, which is a high calorie food and that may contributing as well.

Anyway, all that aside, welcome! We'll be glad to help you and Stu

 

Does Stu get stressed at the vet's office? If he seems stressed, then maybe his glucose levels are too low. But if he is one of those laid back kitties that doesn't let anything bother him, I wouldn't automatically assume he was getting too much insulin. Since he isn't showing any hypo symptoms, I'd ask the vet to retest ASAP instead waiting two weeks. In the meantime, I'd learn how to test him at home. Once you start testing, you'll be able to determine for yourself whether he is being overdosed or not. There are many high-dose kitties who really need that much, or close to that much insulin. Dropping them to 1 unit and starting over puts those cats at risk for ketones:http://www.felinediabetes.com/ketones.htm

 

Thanks to you all! Tomorrow I shall get a glucose meter and learn how to use it. I am certainly worried that the increased dose of Lantus might have hurt Stu. By the way, Stu is a large domestic shorthair. He has always weighed between 15.5 and 16.5 lbs. We adopted him from a shelter when he was 4 years old. I will keep you posted on how we are doing with the blood testing.

 

Hi Ella

Glad you came back. Sorry if I was tough on you; I was having a moment at work and I think it translated through to you. But irregardless of that, I stand by what I said. Increasing a dose of lantus by 2 units at a time is grounds for overdosing, regardless of whether he's stressed at the vet or not, and regardless of his weight as dosing isn't really done by weight.

Post here when you start testing and we'll help. Also, consider posting your general location of you want help in person!

Jen