Insulin Questions

I started a thread yesterday about BG testing http://felinediabetes.com/FDMB/viewtopic.php?f=3&t=1453 and got some great information from everyone. Thank you!

Originally Mal, my diabetic cat, was scheduled to go back to the vet on January 14th, but I called and rescheduled her for an appointment for tomorrow. When talking with the vet tech on the phone, I asked which types of insulin the vet uses and she told me Vetsulin and PZI. I don't want to use Vetsulin because of the FDA recall, even though one of the vet techs said it's only for certain batches. Reading through several threads here over the past week, I see that people have much better luck getting their cats' diabetes under control using either Lantus or Levemir.

I want to go to the vet tomorrow armed with plenty of information about how we are going to treat Mal's diabetes. He's a good vet and told me to immediately switch her over to wet food when she was diagnosed. I'm going to talk to him about possibly using Lantus or Levemir.

Do those of you who use Lantus or Levemir get your insulin directly from your vet? If my vet is unfamiliar with either of these and doesn't carry them, what should I do?

As for syringes, again, do you typically get those from your vet? And what are the best syringes to use?

Thanks again to everyone for all your help and for your patience with a newbie.

 

Lantus and Levemir are insulins for human use, so they are available from pharmacies. Your vet would have to write a prescription which you take to the pharmacy of your choice.

You may have better luck asking about Lantus. Ask them to check with University vet schools about it if they resist.

Levemir's use in cats has very little clinical documentation in the US. The University of Illinois vet school has published an abstract about its promising use in cats. See Abstract #96 in this PDF file: http://images3.wikia.nocookie.net/petdi ... alPres.pdf

That is from 2008 and although they state the use of Levemir in cats has not been reported "to their knowledge," the first feline user in 2005 was Jocularity of our very own Steve & Jock! Please see the Pet Diabetes Wiki: http://petdiabetes.wikia.com/wiki/Levemir

Those would each be good links for you to print out for your vet. The Wiki link has technical information your vet might find more comforting than hearing "A lot of people on the internet use it." There are more links in the stickies in the Lantus & Levemir ISG's. viewforum.php?f=5

 

You may also wish to ask about Lantus by its generic name, insulin glargine. My vet had never heard the name Lantus, but was familiar with the name glargine.

 

I'm doing some reading right now and found it interesting to note that Lantus is manufactured by Sanofi-Aventis. One of their facility locations is very close to me.

 

Lantus and Levemir are Human insulins. You have to buy them at the Human pharmacy with a prescription. Your vet can write you one.

If you want to use the Lantus cartidges or pre-filled SoloStar pens or the Levemir FlexPens instead of a 10 ml bottle, the prescription has to specify it. "5 x 3ml cartridges" (or SoloStar pen or FlexPen) will usually suffice.

Both Lantus and Levemir are U100 insulins. Use only U100 insulin syringes. There are various U100 insulin syringe specs out there. The best ones for cats are U100 3/10 cc (30 units) with half unit markings. The half unit markings makes it easy to measure tiny doses of insulin.


You can buy U100 insulins at the Human pharmacy with a prescription. Be aware that some pharmacists will insist that there is no such thing as a half unit marked insulin syringe :roll: They may try to sell you 1/2 cc (50 unit) insulin syringes instead. Make sure you have the insulin syringes you want before you leave the pharmacy counter!

FDMB members who live in the US often buy their insulin syringes online from Hocks.com or other place because they cost less and no prescription is required. Use the Hocks.com blue ad on the main site ---> http://www.felinediabetes.com/pet-supplies.htm By using that link to make a purchase, FelineDiabetes.com will get a commission which helps keep the site and this board running :smile:

Here is a thread on the old board with members' preferred brands of U100 3/10 cc insulin syringes ----> http://www.felinediabetes.com/phorum5/r ... 22,1959486

 

Perhaps but ALL Lantus insulin is manufactured in Frankfurt-Hochst, Germany for worldwide distribution.

I posted this earlier please read it and show it to your vet. I would recommend Lantus for any newly diagnosed cat.

Note: Glargine=Lantus, Lente=Caninsulin/Vetsulin

I have marked important points in green and points that are contrary to current dosing stratagies in red

IMHO there is considerable data to show that Lantus (recently data is emerging that Levemir is equally succesful) is the preffered insulin for newly diagnosed diabetic cats, and offers the greatest potential for remission, in addition a lower risk of clinical hypoglycemia. I also belive that it offers in general an all around "healthier" cat.

 

Levimer is made by Novo Nordisk - and all this company makes is diabetes drugs.

Anyway, as an FYI - I found that Costco was the least expensive place to get the insulin (Lantus/Glargine). You don't have to be a member to use the pharmacy, if you are a member, you'll get a bit more of a discount.

And Walmart was the least expensive place for the U-100 syringes with 1/2 unit markings. They sell Relion brand.

 

Levemir is also known as insulin detemir. Levemir hasn't been used for cats very long, a few years at most I think. There are very few published studies on how Levemir works for diabetic cats. Many vets are not familiar with using Levemir and some may be wary of prescribing it for their patients. If you want to use Levemir, you may have to do your own research on how it is used for diabetic cats and show your vet your findings and convince the vet to let you try it. Print everything you can about the use of Levemir for cats. The Pet Wiki site has some info, http://petdiabetes.wikia.com/wiki/Levemir The Tilly protocol is what many Levemir cats here follow, http://www.tillydiabetes.net/en_index.htm

 

Please note that the PZI referenced in the article Monique quotes is not the same PZI as is used here in the US. A whole heck of a lot of cats have gone into remission on PZI Idexx over the years; until a couple of years ago, it was the preferred insulin here. The new ProZinc PZI is supposed to be very comparable to it.

If your vet is uncomfortable prescribing an insulin he is not familiar with, I wouldn't argue about using the ProZinc. If you're willing to collect sufficient data to understand how your cat responds to the insulin and then give enough insulin that his body can recognize the meds, you should have no problem.

There are a couple of qualities with PZI that I love. First, it is U-40 so you can dose in .2 unit increments. For those with microdose cats, it's a lot easier to dose consistently when you have syringe markings as guides. Second, PZI is more flexible than Lantus or Levemir when it comes to shot timing. If your life doesn't fit neatly into 12-hour time slots, you can shoot early or late with PZI without the 3-4 day consequences that you face with Lantus or Lev.

 

This is the route I took, although with PZI Vet (then still available) rather than ProZinc (supposed to be very similar, though I don't know much about it). I wanted to try one of the L's but my vet was not comfortable prescribing something she didn't know anything about. We compromised on PZI Vet, at the point where I told her I was ready to get off of Vetsulin (which we tried 1st). My cat has done very well on PZI, and is toying with going OTJ. party_cat

If he were not doing better I would switch to one of the Ls, but so far, so good. Not trying to push you in one direction or another (except to say I prefer PZI to Vetsulin, the only 2 insulins I have experience with), just wanted to mention it so you aware that PZI can work out very well. Since I have been here, I have seen several come through with newly-diagnosed cats that have gone OTJ on PZI, as well as some whose cats have not done as well, and have ended up going to one of the Ls.

 

I echo the sentiments about PZI. If you do your research and decide that you think Lantus or Levemir will fit best with YOUR lifestyle and your kitty's needs, then by all means, see if your vet will write you a prescription for either one.

However, like Terri said, please don't be scared off of PZI. Does your vet prescribe ProZinc (likely) or BCP PZI (compounded insulin)? ProZinc is very new on the market and not many here have any experience with it, so we're short on info so far. From the limited things I have heard on the PZI board, it seems to be working VERY much like the old PZI Idexx.

My kitty went into remission on Idexx PZI, so obviously it worked well for me. Lantus/Lev have a LOT of success stories, though. Again, it's really about what you think will suit you and your kitty the best. We can give pros and cons for all insulins all day. I apologize if someone already mentioned this (my memory is very short!) but I will do so as well: one of the main reasons to consider Lantus over PZI (at least in my opinion) is that Lantus seems to smooth out the wild swings that some cats can experience on PZI. This was a struggle for me and is pretty much the only reason I was considering making the switch myself. I'm sure others have more, and different reasons; just wanted to point out a common one.

Good luck, and let us know what happens.

 

Ok I have already given you the studay data and my opinion but I'll state it again.

If I were faced with another diabetic kitty today I would choose to start on Lantus or Levemir immediately. I have excperienced first hand good results and have witnessed many others who have had great sucess with those insulins. I have read the studies and am convinced that they are the first choice for a newly diagnosed cat. I also don't belive that they are more expensive, given the fact that my cat has a probably close to 85% chance of going into remission after a short period of time and not requiring ANY insulin at all, it makes them much cheaper!

As far as the warnings about vetsulin, the manufacturer says that cats who are not already on Vetsulin should NOT be prescribed it, and those which are already on it should be monitored closely and if adverse effects are noticed should be switched to another insulin. As far as only certain batch numbers being affected...that may be so, but as far as I know the manufacturer has not issued a list of those affected batch numbers so how do you know that the ones the vet has on hand are good or not?

You will get other opinions, that is certain. You need to decide for yourself. If it were me and it were my decision (not my vets, I('m the one who's going to be using that insulin and paying for it all) I would choose Lantus or Levemir, I would find a new vet or another way if I had to to get it. As a matter of fact that's what I did, because here in Germany Vetsulin (Caninsulin) is the only insulin that is approved for animals and theoretically the only a vet can prescribe at first. A vet can prescribe other human insulins if he/she feels Vetsulin is not effective under the so called "off label use" clause. Most vets mine included are reluctant to do this (in my opinion because they either don't have experience with it, or because they don't sell Lantus and it has to be bought from a human pharmacy which means no profit for them). I was so convinced that Lantus was a better choice for my cat, I went to my family doctor and asked him for a prescription for Lantus for my cat! He gave it to me (actually he gave me a sample vial of Levemir from his storage for free!) and a prescription for a refill if I needed it. I spent 3 months struggeling with Vetsulin (Caninsulin) I switch and after 2 weeks I saw great improvement in my cats BG and overall health. After 5 months he was in remission. My story is not unique, I have witnessed simular occurances almost every week in the year I have been reading and posting on this and the german feline diabetes forums.

I wish you lots of success which ever path you take.

 

The study referred to, Treatment of newly diagnosed diabetic cats with glargine insulin improves glycaemic control and results in higher probability of remission than protamine zinc and lente insulins, was published in the Journal of Feline Medicine and Surgery.
The article lists the insulins used in this study:

"The lente, PZI and glargine insulins tested were, respectively, porcine lente insulin 40 U/ml (Caninsulin; Intervet, Netherlands Boxmeer, Netherlands), PZI 40U/ml (PZI-Vet, Idexx Pharmaceuticals USA, Westbrook, Maine, USA) and glargine 100 U/ml (Lantus; Aventis Pharmaceuticals, Germany, Frankfurt, Germany)."

I've never used PZI so I have to ask... isn't that the same PZI used here in the USA?

While I agree Lantus or Levemir does seem to work best when shot on a 12/12 schedule, not every caregiver using Lantus or Levemir has that luxury.
Check out Desi/Tink's spreadsheet (recent numbers at the top): http://spreadsheets.google.com/pub?key=p0LfIXUyIKlHcj5qxwdTuXA&gid=0.
Desi uses Lantus with Tinkerbell. She worked 3 jobs and found it very difficult to adhere to a 12/12 schedule. Kitty is doing very well considering her mom's busy schedule.

 

You're right Jill. It was the same PZI so many of us have had such great success with here on FDMB.

 

That's good news Joanna, Contratulations! I agree completely that anything is better than Vetsulin, especially in the new wake of warnings, who knows if it will even be available in the near future. I also agree that PZI (have never used it though) CAN work out ok for some cats and people, you say that had it not worked for you you have switched to L's, which some people have done just that. I'm just curious here (I know this should be on Think Tank) we have PZI users who have only used Vetsulin and PZI or just PZI, we have former PZI users that switched to L's for various reasons like you mention, and we have L users who have used Vetsulin and L or just L but never PZI......Is there ANYONE out there who used Lantus/Levemir and then switched to PZI?

 

I also wanted to say that Flo did extremely well on Idexx PZI. She started on Lantus, but at the time I hadn't found this board, so was feeding the crap food the vet sold me. I wonder if I had done the food switch at the same time if she would've done better on it. She ended up going from Lantus to Glipizide (again, I hadn't found this board yet), and then to PZI. So the planets aligned and I found this wonderful place, changed food, and within 3 weeks of her food change, she went otj and has been for over 18 months. Towards the end I was giving just a drop of PZI 2-3 times per day. It was easier to microdose because you have the option to use u100 syringes with a u40 insulin, using the conversion numbers here: http://www.felinediabetes.com/insulin-conversions.htm

In any case, you're way ahead of the game having found this board. Good luck with whichever insulin you decide to use.

 

If you are deciding between PZI and Lantus, my personal choice would be Lantus all the way.

Take a look at Maui's ss, she was on and off lantus so quickly, ok at the time it seemed like forever, but she took to it well, that along with diet change that as a newly diagnosed cat the lantus worked wonders on her. And for the record, she is almost officially 8 months OTJ (off insulin).

You can get lantus in pen form, which while the initial outlay is sticker shock, in the long term, it's less waste and more cost effective.

As I wrote earlier, I called several pharmacies and priced it out and learned that Costco was the cheapest seller of it.

Please do let us know what you decide. Also, be sure to read the information on the Lantus ISG about using the insulin. And no matter what the pharmacy or vet may say - ALWAYS keep the insulin the fridge (opened and unopened containers). It will help it to last longer.

 

My cat Blue has had diabetes for 1 1/2 yrs. He originally was given Vetsulin, then I changed vets and he was given PZI (which he did well on). Recently, the same vet switched him to Vetsulin because I am a single mom and have trouble affording the PZI (very expensive). He has not done well on Vetsulin and my vet never told me about the recall! The vial had alot of white suspension, even when "rolled to mix". Today, I ordered Humulin (human insulin) from pet.meds.com to try it. It is more affordable and I don't need a prescription to get it. I know to use the u-100 needles rather than the u-40 used with Vetsulin. I have them left over from when my cat was on PZI. Here is my query: Has anyone out there used Humulin with any success? If Blue doesn't do better on Humulin, I will be returning to PZI, eventhough it hurts money-wise. Also, my vet said he could not get "PZI" anymore, only a generic form, and I'll tell you, it didn't work as well. I can tell just by looking at Blue's coat...it is smooth and soft when his diabetes is under control, but gets greasy-looking and choppy when it is out-of-control. Any thoughts?

Thanks. suite

 

Hi Suite

You may want to start a new thread as you are at the end of someone elses

But meanwhile...humulin N is not a great substitute as it is even shorter acting than vetsulin. I understand that the cost is a factor but if your cat doesn't do well on it then you may have increased vet costs, etc. Your better bet is either the BCP PZI (still being made), the new Prozinc PZI or lantus/glargine or levemir. They are more expensive but if your cat is healthier then you are likely better off.

yes, condition of your cat's fur/skin is an indication of regulation, but a much safer way to do it is hometesting with a glucometer just like human diabetics do. Please, read the faq at http://binkyspage.tripod.com/ and come on back with more info and questions

Jen

 

Hello!! I'm a bit concerned... You're using Humulin N, yes? NOT HUMULIN R?
I ask b/c humulin R, as far as I know, is a short acting insulin (duration is... 4-6 hrs?) and considered pretty powerful stuff.

 

I took Mal to my vet yesterday and he did not put her on any insulin. He did a fructosamine test and called me back this morning with the results. According to that test her sugar has averaged 560 for the last two weeks. He told me to come back in and pick up the glipizide pills that he wanted her on when she was first diagnosed and make an appointment to see him in a month.

My vet is a pretty good vet, but I think he's too old school. Also, he not a people person and when I tried to have a conversation with him about the results of the home testing I was doing he told me just looking at a cat funny can raise their blood sugar. Basically he just blew off my home testing results. I took a copy of Janet & Binky's list with me and he said no one tests cat food so he wouldn't put much stock in the information on that list.

I was really put off by my vet's attitude about me doing my own research about FD. So, I contacted some other vets in my area. One clinic I called put one of the nurses on for me. When I spoke to him, he did say they use a prescription diet but I told him I wouldn't go that route. Then I asked him what he knew about Lantus because I had heard good things about it. Even though he wasn't familiar with it, he thanked me for asking him about it and said he was going to do some research on it. I asked if they advocate home testing and they do.

So I am back at square one with Mal's diabetes. I'm going to make an appointment with the clinic where the nurse was willing to research an insulin they were unfamiliar with. I'm not going to take Mal back to my regular vet because he won't discuss anything with me and he doesn't respect the fact that even though I'm not a vet myself, I do have the intelligence and ability to do my own research.

Chris

 

I am sorry about your old vet but am glad you didn't use glip. The new vet sounds promisng so don't give up hope!

 

Lots of vets think prescription food is best. Mine did and still does. But she supported our hometesting, and was willing to take those numbers to consider dosage changes. So we just agreed to disagree on the food thing. She doesn't like Fancy Feast at all, but couldn't argue too much when he got off insulin within a few months.

I am pretty sure we asked if anyone knew a good vet in the Poconos and got no responses.. Right?

 

Sue, I'm not sure if the question was asked about a good vet in the Poconos. There is one I will absolutely not use because of a recent experience with my parrot.

As for prescription food, I have four cats that eat together and share bowls. Since prescription food is not a necessity for Mal's wellbeing, I'm not even going to entertain the idea.

If I hadn't taken the initiative and done some research of my own, Mal would be on the glipizide right now.

 

Well, let's try. I started a new topic asking about a vet in the Poconos.