Changing insulin

So,

Lily has gone to her kitty hotel now and as standard, she gets a full vet check beforehand. The vet couldn't understand why she was so sensitive to insulin but mentioned that in his experience, sensitive kitties responded better to prozinc or caninsulin. She was on caninsulin before but not much.

I guess I was just wondering if anyone had experience of a really sensitive kitty being much better regulated on prozinc or caninsulin (vetsulin)?

I am wondering whether I transfer Lily to this vets. It is so nice and they seem to actually know what they are doing with regards diabetes. As in, they are more up to date.

I guess just some opinion and advice needed please?

Thanks!

 

Cats that are on a low carb, canned diet usually do not need a lot of insulin, and it looks to me like you still just haven't found the right consistent dose yet for Lily to get her regulated. You're seeing good action with the Lantus and it's possible she just needs even less than .25u. Has anyone discussed microdosing with you yet? Or "fat" or "skinny" doses? I'm wondering if you shot a consistent "skinny" .25u (meaning .25u minus a drop or so), if that might be a good dose for her? With Lantus, you want to find a dose you can shoot consistently twice a day to get her regulated, even if it's a very small one.

 

I can't afford the calipers... I have been giving a tiny 0.1 u when she has had a lower amps. Problem is, she nose dives and I can't be there all the time. I truly don't want another hypo.

 

I would not recommend Vetsulin for any cat, especially one that is sensitive to insulin. It is shorter acting and harsher. Your drops will be quicker and steeper and then it will quit working at about +8-+10 and let the kitty soar.

With no testing in the evenings, its hard to know what is happening. Even if you skip a shot you want to catch some testsas it will tell you how Lily's pancreas is functioning and how she is affected by the skipped shot.

If you feel the need to go to a U40 insulin to have the lower concentration, prozinc is a much better option of the two.

 

I agree with Julia - you need to find a dose that you can shoot the same dose AM and PM. With the Lantus depot, it works best if you shoot the same dose AM and PM. And yes, we have seen some kitties that need super small doses like 0.1 unit. Don't just give 0.1 with a low preshot number, try doing it all the time. We determine the Lantus dose by the nadir or low point, not just the preshot value. If you are worried about her dropping lower, try feeding her a slightly higher % carb low carb food.

I definitely wouldn't go back to Caninsulin.

 

Lily-Fish, I wish you the best! I will be watching your results as I can't seem to get Shoes regulated on the Lantus so am still considering the change to Pro Zinc.

 

We shall try! I will try and get her more sorted after I get back.

 

Are you having trouble eye-balling the numbers on the syringe without the calipers? There's some good pictures in the lantus forum of how to do .25, .1u of insulin. I never used the calipers, I just measured the best I could on the syringe using those pictures as a guide.

While cats can certainly drop a bit low on microdoses, it's very unlikely that a cat will have a life threatening hypoglycemic incident on a microdose of Lantus (.25u of insulin or less). As long as there's some food out for her if she does drop a little low (I use an auto feeder to release food at Bandit's +6), she should be fine when you're not home.

 

I'm doing that thing where you push the plunger in tight, stick it in the vial and then let go so there is a half drop in the needle to administer. I think that is 0.1 u. Anything other than that, I don't know what I am doing.
hmm.

 

Given that not every cat will react the same way on the same insulin, I'd say if Lantus isn't working and knowing Lily has such dramatic drops - perhaps trying something (ProZinc) that from everything I have been able to read/glean, supposedly works better for hard to regulate kitties, it is worth a shot. Just because Lantus typically works well on many cats definitely doesn't mean it will work well for your cat, or my cat, or someone else's cat. Same to be said with every other medication, insulin, food, so on and so forth. There is no set rule we are not all the same, nor is every animal the same. If we were, this wouldn't even be a discussion. I don't see why it would hurt to find something that may work better for her. I know you've had her on absolutely minute doses and her swings are outrageous all while monitoring her food and BG closely. It sounds to me that she's just a sensitive little beast. Also it sounds like a vet switch is necessary, if this vet is more up to date, it never hurts to find someone who is more informed and willing to have a good working relationship with you where you can also openly discuss situations, such as this, and sort out the best possible solution for you and your little fishy.

Rooting for you guys!

 

Got it! Check out this post in the Lantus Forum: http://www.felinediabetes.com/FDMB/...insulin-info-handling-drawing-fine-doses.151/

There's some great photos about halfway down that show you where the plunger should be for the fine doses. I usually pull more insulin into the syringe than I need, and slowly take out the insulin one drop at at time until it's where I need for the fine dose. If you accidentally go too far and need to start over measuring the dose, that's ok! It's not like you need to worry about wasting insulin with doses that small.

 

If you are using the BD MicroFine syringes, there are a set of paper rulers that can be printed out here. The document called Management of Diabetic Cats attached to this post, has a section on Administering small doses that shows pictures how to use the ruler.

 

http://www.felinediabetes.com/pzi.htm

Just a small blurb found directly on this site. May be helpful in assisting any decision making.

 

Lantus has better remission rates than Prozinc, and I wouldn't switch until the Lantus has been given a fair shot at regulation (meaning, a consistent dose has been shot for both cycles). Needing a smaller dose of insulin typically isn't a bad sign, it's a good one!

If the Lantus is given a fair shot and it doesn't work, then sure, perhaps a change to Prozinc is in order. But I don't think that's happened yet.

 

Thank you! I had seen that before, I believe that the 0.25 units on the BD syringe is actually slightly less than the picture as the line should be measured halfway between the bottom and top of the bung (as it says on the fine dosing ruler, I believe)

Problem is, too little, she goes too high...A tiny bit more....She goes MEGA Low! Which is why I mention the dosing rulers etc. Any inconsistency and she is hypo!

 

Keep in mind that some of that information is now outdated. The current Prozinc is a human recombinant insulin with a slightly better duration of action than the old PZI.

 

So far, she hasn't dropped into hypo numbers on .25u...the lowest I'm seeing is 50, and that was mid-cycle. I would give a skinny .25u or .1u a shot (no pun intended) twice a day and see if that helps level her out. Also, what type of BG meter are you using? Have you tested the meter on yourself to make sure that it's not being inconsistent on you? Some of the generic drug store brand "True" meters have had issues with giving inconsistent readings.

 

Hey!
I have actually done a curve on myself and calibrate the meter 3x a week. I got the vet to also check it against theirs. It was out by a matter of 10 or so points.
When I get back from NY I will be trying to figure out a way to manage her better but for now, while she is in the cattery I don't want her getting stupidly low so she will stay where she is. As long as she is not in the danger zone.

 

No, that makes sense! I would also be overly cautious if I wasn't there to keep an eye on her, so I understand. I agree to wait until you get back to try anything new.

Have a great trip to NY! I was just there myself. If you get a chance to see a show while you're there, Hamilton is AMAZING.

 

I wouldn't recommend a switch to Caninsulin either. It's much harsher in its action than Lantus and nigh on impossible to microdose safely and effectively. (I've used both insulins for Saoirse's treatment - no choice but to start with Caninsulin in the UK.)


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