Which insulin is best?

My vet wants to give my newly diagnosed cat PZI, how can I find out which is the best insulin to start with? What are the differences between Lantus, Levemir and PZI?

 

Lantus and Levemir work the same way. I think that one of these two is best to start with, because they have been shown to have the highest remission rate in newly diagnosed cats. They are slower acting and work to keep blood sugar levels flatter than other insulins. There is an 80+% remission rate with newly diagnosed cats eating a low carb, canned diet, and using the Lantus dosing protocol with home testing. Here's a copy of the protocol mentioned in the article to give to your vet, http://felinediabetes.com/Roomp_Rand_2008 dosing_testing protocol.pdf, along with this article: http://www.ncbi.nlm.nih.gov/pubmed/19592286.

However, they must be shot strictly every 12 hours. There is no wiggle room. So, if you are unable to adhere to that schedule then PZI is a good insulin choice.

 

Lantus & Levemir: What’s the Difference?

I have used both for my two cats; Shadoe is visibly more tense on Lantus, but Oliver is fine on either. I switched Shadoe to levemir and she was more relaxed and had better numbers.
At higher doses, lantus is said to have a sting to it.

 

The short answer is whichever works best for YOUR cat. ProZinc, Lantus, and Levemir all good insulins.

 

That may be true of Lantus, but I work with Levemir on a changing schedule basis and so does another member on the Lev ISG. I suspect Lantus could possibly be used in similar manner, but have no experience with it. The resulting blood glucose levels may not be perfect, but as someone for whom it is impossible to stick with 12/12 dosing because of my job, I feel it is unnecessary to cause a newbie distress about scheduling when there are possible work-arounds.

I was that newbie at one time and it was very distressing for me to feel that my job interfered with my ability to care for Gandalf as well as I could. So please be careful when making exacting statements like that. Thanks.

 

thanks for bringing this up, vicky. i couldn't agree with you more... for the exact reasons you've described.

julia, there have been others who have used lantus successfully while not adhering to a strict 12/12 schedule.
there are definitely work-arounds available when using either lantus or levemir. :mrgreen:

 

I too have used Lantus on a 16/8 hour schedule on the weekends for over a year with no problems.

 

Sorry, I didn't know that it was as effective as PZI if you shot off schedule. I remember reading somewhere that PZI was the better choice if you needed flexibility in schedule adjustments. Unfortunately, it was a while ago and and I can't recall where the article was, if it was here or someplace else, so maybe I'm remembering incorrectly.

I searched and searched I can't find it anywhere. I do remember it talked about how Lantus requires overlap during the duration of the insulin (meaning it must still be working when the next shot is given), where PZI didn't need the overlap to work. Which is why I assumed that PZI was more flexible.

Looking back, I really should have said "Lantus works best on a 12/12 schedule. There is less wiggle room." I do apologize for being hyperbolic, if that is the issue.

 

Miss Maisey was on PZI for a month then regulated with food/diet change to classic FF and friskie's pate sometimes wellness or BG.

 

I, too, think that all three insulins are good. They work differently (even lantus and lev work differently from each other, but are closer in action to each other than to PZI).

If your cat is one of those who will go into remission with a diet change and a short course of insulin, I really doubt that it makes much difference which one you choose. The key will be in giving exogenous insulin in doses that support and encourage the pancreas to heal and take over again. This means getting the BG numbers as close to "normal" for as much of the day as possible. (And testing BG at home - something to look into if you aren't already).

If remission isn't going to happen fast, as it did for Miss Maisey, then things to consider might be cost and availability. PZI you can only get from the vet and I don't know the cost. Lantus and Lev are available from any pharmacy or ordered on line. Last time I checked the costs were about the same for a package of 5 pens. With lev you can use a pen to the last drops. I go through about 2 per year with Jeddie. I don't know if people are using lantus to the last drop now or not, but they used to not because of thinking it went bad after a month. I don't know how long PZI will last - meaning do you have to buy new every month or two? Someone else can answer that. I ended up choosing lev for cost savings.

 

I purchased a 10ml vial of PZI(compounded) in the middle of May for $52. It has an exp. date of 24 august. In my case I am almost sure it will get used before.then but it will be close and I will order more before then to be safe. As for the original question you can find information on the web that will tell you that each of them is the "best". The only one I have experience with is PZI, so I can't speak for the other two. People have had success with all three. Every cat is different, so your choice may come down to the specifics of your kitty, which one your vet is most familiar with, and your ability to test and treat and fit it into your daily routine. I don't think you can go wrong with any of the three. Each type has its own discussion group on the board so you can find plenty of support and advice from those who use the same type you choose.
Carl