Questions about preshot tests, and switching to Lantus

Hey guys, just had a couple questions. Oscar's still having a tough time regulating and we're about to be up to 4.5u in a couple days. With my civvie having an emergency surgery 11 days ago things got pretty hectic around here, but now that she's doing better I'm trying to get back to fixing my broken boy lol.

1. How important is it for Oscar not to have any food 2 hours prior to shot time? He gets snacks throughout the day (+2 and +5 on the timed feeder but he free feeds on that throughout the day/night) but like clockwork at 7am every day, he's sitting on my pillow knocking things over and hitting me in the face out of hunger. He can/will/does cause destruction, and when I'm due awake in an hour...it becomes frustrating. We used to T/F/S at 8am, but I started waking up early so we could switch it to 7am....so now he's waking me (and the whole house) up by 6am. Seems like no matter how far back we push his shot (and it really can't go back any farther) he's starving by +10. Any ideas? He already gets larger portions and more food than he should be, as is.

We talked to his vet about switching from ProZinc to Lantus, with the hope he'll do better with a depot insulin. However...my vet knows nothing about Lantus, so I come to you guys with questions we both have.

1. I understand it's better to use pens. How much do you get in each pen, how many pens in a pack? We're going through insulin quickly...at nearly 5u, would it (in this situation) be better to get a vial? Is Lantus typically cheaper than ProZinc? We're looking at around $120 every 2 months with the ProZinc...I'm hoping Lantus may be cheaper than this. With my other kitty's medical bills, this is all becoming really expensive.

2. Since Lantus is a depot insulin...does that mean I should expect Oscar's numbers to be higher than usual for a little while?

3. How long before I'm completely out of insulin should I wait to place an order to Canada for the Lantus? Or in other words, how long does it take to get here so that I can plan accordingly. I live in Michigan, so hopefully that means it won't take too long? But I know customs and all that...

4. I really don't understand what everyone means by "pens". Is it like a small already filled syringe that I would be sticking another syringe into in order to draw up the correct amount?

5. Say Oscar is at 5u by the time we switch, would that make his dose on the Lantus 5u as well?

I think this is all, but I'll let you guys know if I think of anything else to ask lol. I'm becoming really anxious to get Oscar in normal number.

 

Lantus is a lot more expensive than Prozinc if. you purchase Lantus in the US. A box of 5 pens costs up to $500 but they can last a while depending on dose. A box of pens contains 5 pens. Each pen contain 300 units of insulin. A vial of Lantus contains 1000 units. A large number of people here purchase their insulin through Marks Marine Pharmacy in Canada. The price is 1/3 to 1/2 of what it costs in the US.

Just to throw a wrench into the works. Once you're getting to higher doses (i.e., around 5u), Lantus can sting. It's actually acidic. Many people whose cats are on larger doses opt for Levemir. It is also a depot insulin and the same research that was conducted with Lantus included Levemir.

It will take 5 - 7 days for the depot to stabilize. Some cats can have a marked initial response but in most cases, numbers do look a bit worse until the depot is fully formed.

I've not purchased insulin from Canada. I'm tagging @Chris & China (GA) who can speak to how long ordering will take.

We use a pen as a mini vial. The pens were designed to be easily transportable so humans didn't have to rely on bringing a vial and risk breakage. The pens do have a mechanism whereby you can attach a needle tip and dispense insulin directly from the pen. However, you can only inject full units from the pen which makes the needle tip useless for cats. Instead, you can use a syringe to draw insulin from the pen exactly the same way you would from a vial.

When switching from a non-depot insulin to a depot insulin (i.e., Lantus or Levemir), you can switch at the same cost as your current insulin. So if you were at 5.0u of Vetsulin, you can start at 5.0u of either Lantus or Lev. Some cats have a marked response to the switch so an option is to start at a slightly reduced dose.

 

A 5 pack of Lantus pens is $164.99 plus $25 shipping from Marks Marine Pharmacy in Canada (where most of us are buying from since they're 1/3 to 1/2 the price compared to the US). That's 1500 units. At 5U twice a day, that's enough to last about 5 months so it ends up being cheaper than ProZinc.

The first shipment takes a little longer just because they will verify the script first, but once it's shipped, you should have it within 7 days. Refills are usually a little faster. I ordered one refill late on a Monday and it was in my mailbox on Friday. Another nice thing about Marks...Once they have a script on file, they don't need a new one every year like we do in the US. They'll refill it as long as necessary off that one script.

This may help along with Sienne's explanation:


Here's all the information on Buying Insulin from Canada

 

Thanks so much for all this info, between you and @Chris & China (GA) I think I have this figured out. Except now I'm thinking about Levemir instead, I really don't want the insulin to sting Oscar. I'd just been reading more about Lantus and see it talked about probably the most here, so I hadn't really considered Levemir before. I'll talk to my vet about possibly doing that instead. It also comes in pens and can be bought from Marks? Are there any notable differences between the two? And by the way, I'm switching from ProZinc not Vetsulin, not sure if that really matters here anyways though (with the dosing when we switch).

My vet agreed it's up to me what insulin I want to put Oscar on, so they shouldn't have a problem if I ask for a Levemir script instead.

 

Yes, Marks has Levemir too...I think it's about $5 more than Lantus

The biggest difference is the nadir...On Lantus, it's usually around +6, but on Levemir, it can be as late as the next Pre-Shot. If it is, you'll have to learn to shoot low numbers. Also, with Lantus, the onset (where the insulin starts to "kick in") is usually around +2 to +3....with Levemir, it can be +4 or later.

@Wendy&Neko may be able to explain it better. I always used Lantus with China.

 

Typical onset with Levemir is +4 and typical nadir +8, so both a couple hours later than Lantus. My girl was not "typical". Her onset was later, nadir usually around +9 to +12. That means you have to learn to shoot lower numbers. The upside is you have hours where the numbers will rise before next onset. Really handy if kitty is being fussy or off of food. You have hours to get food in. One thing I really liked about nadir at preshot - I was always home for it. Some people find the schedule hard to work around, but not me. Once I switched to Levemir, I could shoot and head out the door for a nice dinner out at night as long as she was high enough. Typical overnight nadir was when I get up for workout anyway. But what I liked best of all, the cycles were flatter and more predictable. I got more sleep with Levemir. Lantus was bugging Neko a bit a higher doses, she would occasionally walk away from the shot. Not with Lev.

Even when Neko was on higher doses, I preferred cartridges (pen insert available in Canada). More convenient to pack around if going anywhere. And if I had dropped it, less insulin going to waste. I never did drop it though. And I did use the cartridge to the last drop, even when she was on tiny doses.

 

Just to underscore Wendy's point, the cartridges are not available in the US. Initially, they were. I used both. I liked the pens better. Basically, the pen is a cartridge that's encased in a plastic housing. I didn't worry about the pen being in a bin in the refrigerator where it might have gotten bounced around.

 

That's interesting, and I like it. I leave for work soon after I give Oscar his shot in the morning, which does make me nervous. He's been in such high numbers lately that it hasn't been an issue, but once we start to make some progress I would feel much better about a later onset and nadir. I think I could schedule around that a lot better. And I am definitely looking for something more predictable. I'm pretty excited about this, I talked to his vet today and she's going to write me a script whenever I'm ready (once this vial of ProZinc is up). Thank you for this info, definitely very useful