Not adjusting to vetsulin... what to try next?

Hi everyone,

As a follow-on from another thread, I am fairly convinced that I need to look at changing the type of insulin we are using for Abby. We have been working for a few months to get her BG regulated on vetsulin. Please see my spreadsheet in my signature, and in particular the chart of her curves at the bottom of it.

For a while there we had gotten her down to a nice gentle curve (green and yellow lines) which just needed to be shifted downward. But as I continue to increase her dose slowly, instead of the curve shifting down, it just kind of stretches, meaning the nadir gets lower but both ends get higher. You can see this on the chart.

Also, possibly related is that Abby is experiencing some severe behavioral issues which seem to have started not when she was diagnosed with the diabetes, but instead after we started her on this insulin.

I am going to the vet for a pre-scheduled appointment on 5 Aug and I'll be bringing my spreadsheet in hopes of my vet maybe being willing to try something different. However I'd like to get myself better educated before we go.

Based on Abby's curves, is there a particular type of insulin that might be good to try next? Do her curves indicate vetsulin is too short-acting for her, or something different? Are there significant cost differences that I should be aware of?

Thanks so much, as always, for everyone's help!

 

Actually, her near mid cycle numbers are around 50% of the PSs so that's not bad at all. Yes, her numbers need to come down overall but the curve profile is better than many cats on Vetsulin would have. BTW, I can't see the line graphs that seem to be superimposed on your SS.

It's true, though, that different insulins suit different cats and a kitty can give you good numbers on an insulin but might feel awful on it. It's possible that she might feel better on an insulin that is gentler in its action - slower in onset with less tendency to drop the BG low. ProZinc could work. It's similar to Vetsulin but gentler. The L insulins (Lantus and Levemir) are known for their ability to produce flat BG curves in many cats. They might be your best bet.

 

I replied on your other post. If you change insulins, I also recommend starting over with 1 unit and gradually increasing over several weeks to find the optimal dose. By starting with a low dose you also reduce the risk of hypoglycemia

 

I switched to Lantus after 9 months on Vetsulin. My kitty actually did reasonably well on Vetsulin, but still did much better with Lantus. I am glad I made the switch!

 

I also started the sugar dance with Vetsulin but made the switch to Lantus after about 8 months. Lantus works in a very different way than Vetsulin so it took us humans a while to learn how to use it effectively. We are so glad we made the switch because overall Radar feels so much better on Lantus than he did on Vetsulin.

 

I too started with vetsulin and my happy bright boy became sad and depressed.
went to pro zinc and he was happy but didn't last long enough....on to lantus and he was a deep diver into very low numbers and thennnnnnn we have been on levemir a while and I like it very much

 

I would try Lantus or Levemir.....both are dosed in the same way and are gentler and longer acting than Vetsulin

They are more expensive though, so if you switch, you may want to do what the rest of us are doing and buy it from Canada. The information on that is in this "Insulin from Canadian Pharmacies" post

I would not suggest dropping all the way back to 1U and starting over. We take into consideration the dose of the other insulin when deciding on a starting dose.

It will depend what dose she's on when you switch, but if you switched today, I'd suggest starting at 2.5U since she's already up to 4U of Vetsulin....starting all the way back at 1U is too much of a reduction and could cause glucose toxicity to set in which may mean fighting even harder to get her under control....and possibly having to go a lot higher in dose to combat the toxicity.

 

Both mine started out on Vetsulin. It didn't work for either of them. Frankie went straight on to Lantus and eventually stopped bouncing and is now regulated. Rom had to go for ProZinc next due to the cascade system in the UK having changed between Frankie and Rom changing insulin. That didn't work either, then I saw a new vet who was more than happy to put Rom on Lantus and Rom has never looked back. Lantus is definitely the way to go.

 

I've had better results with Humilin N than ProZinc.

 

Going to the vet this Saturday prepped with my BG chart and a list of insulins I'd like her to consider, fingers crossed!!!

 

Hi everyone, I wanted to say thank you again for the advice and feedback here. The vet has prescribed Lantus for us to try next, so I'm starting a new thread on that board.

 

Hello, just came across your post as I am also considering switching from Caninsulin as it doesn't seem to working out for us to either ProZinc or Lantus.
Im really not sure which would work better so I just started asking around here on the board for opinions..
How are things working out for you and Abby so far on Lantus?

 

Hello, we are a few weeks into our Lantus journey and Abby continues to fight regulation. That being said though, this insulin has definitely been better for her than the Vetsulin was. I knew it was time to switch when every time we increased her dose, while the nadir decreased a bit, her AMPS and PMPS were shooting up. It was just too short-acting for her. The Lantus gives us a much smoother curve. Every kitty is different, but if you are seeing patterns in your curves like the one I described I think it's worth a try. Best of luck!

 

Hi, thanks for your reply. Yes we've been having odd patterns that make no sense sometimes so I think it's definitely time for us to change! Glad to hear that Lantus seem to be working better for Abby, good luck to you guys a well

 

@Monica Lewis

Hopefully your vet will allow you to go directly to Lantus. With the cascade system in the UK the usual progression is Caninsulin, then Prozinc, then Lantus. If your vet is not willing to go to Lantus, Prozinc is still a better insulin than Caninsulin for kitties that are not responding well to Caninsulin, and generally will give close to 12 hours coverage with many kitties. Also Prozinc has a little more leeway with shot times, since it is an in and out type of insulin and not a depot insulin.

Josie is responding to the Caninsulin in as far as it does bring the numbers down. However the intent is to bring the numbers down and gradually have less spread between preshot and nadir, which does not appear to be the case with Josie. You could try a slightly higher dose, but you would have to be able to test appropriately during the cycle to make sure an increased dose foes not bring her down too far or too fast. My thoughts only.

Good luck


ETA Woops...sorry I didn't notice this was not your thread. Sorry to hickjack Abby's thread.

 

Hello @Tuxedo Mom and thank you for your opinion, it's always nice to hear from an old friend!

My mum is in hospital so have to go abroad but as soon as I'm back we are starting Josie on ProZinc on the 30th of Sept yay!!

Seemed like the sensible option being similar acting to Caninsulin but smoother and more kitty friendly so should make an easier transition than Lantus for all of us!
If no good response we can always move onto Lantus..

In the meantime we are going with a fat 1unit of Caninsulin, was considering 1.25u but vet says might be better staying a bit high and more flat than steep dives midday then back high and it kinda makes sense.. It's only til the end of next week anyway, hopefully all will be good whilst I'm away..

Thanks again for taking the time to give us your thoughts, as always much appreciated!