I'm a scaredy cat about changing insulin - but here we go

Hi. Mia has been on ProZinc since her diagnosis 7/5/17, so almost 9 months now. We are on our last vial, and I will very soon be scheduling a vet visit to check things out (bloodwork, urinalysis) and get a new prescription. Her current dose is 2.5 units. We cannot really go any higher, because that causes her to go too low, but her pre-shot numbers continue to be quite high the majority of the time.

I feel like I may be doing her a disservice if I do not try another insulin, but I am scared. I am used to ProZinc and comfortable with how it works. I worry about going to a 'depot' insulin. Some of the potential side effects I have read about for Lantus have scared me off (stinging, twitching, changes in behavior), so I think I would want to try Levemir instead, but I am still scared. Part of me thinks it will not matter, and I should just stay with what I know (including knowing it does not cause any issues for Mia) and accept that the degree of regulation we have now may be as good as it gets for her. Of course, without trying something else, I cannot know for sure.

If you have any insights, thoughts, personal experiences you would be willing to share that might help me out with this decision, I would appreciate it. I do not know why it scares me, but it does.

 

Hi, I have heard that Lantus stings on th e larger doses - probably 5+U but I never heard of the other things.

I wanted to trow my voice in support for Lantus - but I think Lev is just as good.
There are several ppl who switched not too long ago - so you'll have a lot o f tips.

One thing I think you'll enjoy is the Lantus or Lev's duration - at the moment it looks like Mia having higher Pre-shots due to the short duration of ProZ - but it's my impression only.

The hardest in my opinion is going to be learning the cycles all over again - both L&L act very differently from PZ and require another test timing and you probably got used to your current schedule. It might be chaotic in the begging but then it will settle once you'll figure out her responses.
@Kris & Teasel used all 3 insulins mentioned - I hope she'll share her experiences.

Just like many others I fear the unknown. It passes with learning/ gaining understanding. Perhaps that's what is keeping you back?

PS. I am sure you 'v e heard but Lantus and Lev are much cheaper in Mark's Marine pharmacy in Canada.

 

Trying something new can be scary. It's a natural feeling. However, the L & L forum remains active enough to help you overcome any fears you may have. There is a learning curve, but you'll be fine once you prepare yourself for the change.

FWIW, seems like former PZI/Prozinc kitties like Levemir...

 

I switched insulin’s 6 days ago and it was scary and a big change, but oh my gosh it’s so much better for bella, we were on Novolin N and switched to lantus, I’ve noticed no twitching or any odd behavior, the first shot I thought it might have stung him a bit but he I haven’t noticed it since, so it was probably just me cause I was nervous, good luck

 

I think we were all scared when we switched, just like we were scared when we first started insulin! It takes awhile to wrap your head around the depot thing, but I think once you do you will love the gentle curves and longer duration.

 

Sharon, I so much agree, can’t tell you how much

 

Yessirree! Teasel's been on ProZinc, Lantus (twice!) and now Lev. He's a very bouncy and unpredictable cat and has been from the start (2 years ago). No signs of it changing either. Here's a brief synopsis of my experience:

ProZinc:

• my 2016 and 2017 SSs show his performance on ProZinc and I was using an AT meter and later AT meter with Freestyle Lite strips
• lots of ups and downs - couldn't keep him flat at all
• he was lethargic the first half of the cycle often and perked up when the dose was wearing off.

Lantus:

• was on it for two months right after diagnosis but I was doing the usual vet thing of keep the dose for a week then do a curve
• got nowhere and he had DKA at the end of the two months
• switched to ProZinc after DKA
• I put him back on Lantus (on my own - available OTC in Canada) after 9 months on ProZinc because of the issues above and I wanted to use my FDMB knowledge to see if I could make it work
• also switched to a human meter and SS reflects that
• he did get flatter numbers overall but still lots of volatility and dives into lime green
• if I wanted to get him into dark green and keep him there longer I had to do a lot of food steering and the extra testing that goes with it - not a routine I wanted day in and day out for myself.
• his onset was early-ish (+2 to +3) and he'd dive early sometimes so I'd have to cancel plans to steer his BG
• the Lantus depot seemed stronger in its effect than Lev (to follow) for Teasel
• he was sometimes lethargic and/or grumpy like he felt vaguely unwell.

Levemir:

• again, I can buy it OTC and wanted to see how it would work in Teasel
• started it 6 months ago
• he definitely feels better
• the depot seems to have a "lighter touch" in Teasel's case - doesn't seem to "clamp down" on BG like Lantus did (only way I can describe it)
• onset is slow and later - around +4 or +5 so I rarely test before then
• nadir moves around quite a bit - anywhere from mid to end of cycle
• he still bounces and will have a long run that's OK but uneventful at a dose then drop like a rock out of the blue (those lime greens on my SS) - I'm used to that now
• duration of a dose can vary - long sometimes (nadir at PS), less than 12 hours at others
• I almost never have to steer with food because I purposely err on the side of caution with dosing because of his propensity to have surprise drops
• I can leave early in the day for several hours and not worry because onset is later - suits me well
• I've described it as acting more like a hybrid of Lantus and ProZinc - my words and my impressions in my cat
• he feels better on it and I feel far less constrained - testing, steering, leaving the house (greater freedom without a doubt).

I agonized a long time over switching from ProZinc to Lantus so I know how you feel. I had less angst over the switch to Lev because I felt I had nothing to lose and had learned how a depot insulin works in Teasel.

I hope this helps.

 

I know you’re not suppose to switch in 3 months time, but I feel like the depots would work better for Baby. She just hasn’t seemed right or happy with this journey. @FurBabiesMama I think you’d be great on it! You already have so much knowledge yourself! Especially if it runs out like Baby’s does. It is scary I’m sure.

 

Caninsulin worked miracles with Nigel but has been a nightmare with Noah. Now I feel like he's too old to switch. I defer to the Wisdom of Kris!
All hail Kris

 

Thank you everyone. I really appreciate your responses.

 

My cat is an L/L dropout having tried both of them. He just does better and feels better on Prozinc. But he is definitely the exception. Most cats do very very well on the L's, and looking at Mia's SS over the past several months, I think the switch is a good idea for her. Her SS has the look and patterns of a kitty who will do better on a longer acting insulin (whichever one you choose). And you can always come back if you don't like them!

 

I was absolutely terrified when I switched Squallie from Vetsulin to Lantus, and it felt like it took me forever to understand the difference between the dosing, how to interpret the results, etc, but now I am so glad I made the change! It really made a huge difference in getting him regulated, and now he is doing great. Remember to reach out to the helpful folks at L&L Land if you have questions or just need a little support!

 

We didn't know it until after the change that Phoebe was miserable on lantus. It pains me to think I went over a year, giving her meds that made her feel crappy. Once we've given the lev now, totally different cat. Happy, purring, social animal. It's a miracle drug, and I was scared to death to change, wish I'd gotten the balls to do it sooner.

 

I was thrilled I got Smokey switched to Lantus (against medical advice). He did fair on it. It was 6-12 months I wanted to change to lev but Dr would not right script as he was told by colleagues it was to dangerous. He had never heard of it for cats.

When Olive arrived I wanted to start lev immediately but she arrived with Lantus. As being brand new on insulin I figured we'd give it a try. Once she hit 5 units I was definitely on the quest for lev. Vet said he would call in a script he has yet to do it. So I got some elsewhere. We have been on it almost a week. I think and it could be wishful thinking, it is better for Olive. She has a shallow, slower curve and has popped 2 blues already. On Lantus it was over a month before she popped a blue. It could be lev blue is because she has been on insulin of any kind. There are so many people's here to help you if you want to switch. You won't be alone.

 

We went to the vet today. I have a detemir prescription in hand! Please, please let me be doing the right thing. I hope shooting for 'excellent' doesn't mess up the 'good' that we have.. know what I mean? I think the vet was pretty happy with how Mia is doing and would not have recommended a change, but she did it at my request.

I asked the vet to do a fructosamine today. I do a lot of home monitoring, but I think they can be just another indicator, and I wanted to see the results. Anyway.. it was 339. (She had one last July, two weeks after starting insulin, and it was 513.) The normal range on this one says 191-349, so she is in the tippy top of 'normal'. The report says this represents 'good' glycemic control in a diabetic receiving therapy. I am always so worried about wanting things to be better, not wanting to see her PS numbers in the 300s, that I may not really have acknowledged how well she is doing. I feel like there are days when she does not feel great (I see it in her eyes, and/or she seems tired), but she has not had issues with excessive drinking or urinating since she started the ProZinc. Her coat is full and soft and she does not have issues with knots/mats like she did before. She was down to 9.42 lbs at the lowest, but is now holding her own just under 12 lbs. She has not had any other health issues occur as a result of her diabetes or otherwise. So, maybe I expect/want too much.

Back to the detemir... the vet said to start at 1u. I still have some ProZinc and plan to finish it up, that will give me a few days to get the Levemir and new syringes.

 

This is exciting!

FYI - and let me know if this is intentional - I can't access Mia's SS. The link isn't "live".

 

Oh, no! I wonder why that happened. Should be fixed now. Thanks for telling me.

 

Just remember lev has to build a depot so you might see some higher readings. I started lev 3/25 from Lantus. Just know Olive is on high dose. Since starting she is popping more blues, they don't last long but a couple hours each cycle. She still likes those pink preshot. Overall I think the lev has been good for her.