Which insulin should I choose?

Long story short: My vet claims that they will no longer be handling the selling of insulin to patients. I'm supposed to "search around" (in her words) for a place I can purchase insulin for Talley. Then I'm supposed to bring my newly purchased vial of insulin with me to the vet on Friday so they may perform a curve to find out his new dosage.

While this all sounds insane, I'm at a loss. Vetsulin isn't being sold anymore so I need to choose a new brand. Which would you recommend? Talley is currently [officially] on 3u40 vetsulin twice daily. He is reaching 400bg just before meal times. I'm hoping for a new insulin that will transition him smoothly from Vetsulin.

Please answer if you know of where I can obtain the insulin or think a certain brand would be best to start him on next. I'm going to call around pharmacies tomorrow and see if they sell it. My nearest pharmacy thought I was insane for requesting insulin for my cat and didn't seem to understand that cats can be diagnosed with diabetes. As I haven't heard much about any brand besides Vetsulin, I'm at quite a loss now.

Thanks in advance!
~Brigitte & Talley

EDIT: I feel I should add that I live in San Antonio, Texas; if anyone from that area is having similar issues, I would enjoy the company of not feeling alone in this void. nailbite_smile

 

You have until Friday to decide? That doesn't seem like much time. Is your current vial of Vetsulin about to run out? I think others will agree you should take your time. We can help!

First off, blood glucose curves done at the vet's office are often inaccurate because vet stress causes the blood glucose to be higher than it would be at home in a non-stressful environment. You can test blood glucose yourself at home and save the money the vet charges.

We have a tremendous amount of information on the message board, as well as the Pet Diabetes Wiki and the main Feline Diabetes.com website on the basic types of insulin which can be used for cats. Your best choices are the new ProZinc, which your vet should have heard about by now and the human insulins Lantus or Levemir.

Lantus has more information available about its use in cats than either Levemir or ProZinc. It works differently than Vetsulin and would take some study to use most effectively. We highly recommend learning to home test, which sounds like you do already.

Please read the "stickies" (posts at the beginning with the star in front of them) about Lantus & Levemir here: viewforum.php?f=9

Also, feel free to ask questions in that forum. You need a prescription from your vet to buy either Lantus or Levemir from a pharmacy. They are available in vials, but the Solostar pen of Lantus or Flexpens of Levemir are more cost effective.

Here: viewtopic.php?f=24&t=1979 is information about Prozinc or PZI type. Its action probably more closely resembles that of Vetsulin, so you may want to go with that. I'm not sure of the cost. It would be available through a vet however, whereas the other 2 are not.

Hope this helps. Good luck. And let us know what you decide because we can help you make the best use of whatever insulin you choose. Going into the 400s by the next shot time is not the best. Any of these other insulins will do better for Talley.

 

You can't just go out and buy insulin. If you go to another vet, they will want to take you on as a patient and do an exam before selling you insulin. If you go to a human pharmacy, they will need a prescription from your vet to purchase Levemir (my personal preference) or Lantus. You can purchase NPH without a prescription but its a shorter acting insulin and harder to work with.

My advice is to read through Vicki's suggestions, select the kind you want and then call your vet and ask her to call in a prescription for Lev or Lantus. Or change vets to one who will sell you PZIR.

 

You've received good info, so I'll just add my two cents that I think your vet's lack of help is appalling!

 

at least in the US, i think lantus has been used longer than levemir or prozinc (the new form of PZI), so i'd recommend you start with that. if you get a costco pharmacy card (you don't have to be a costco member to use their pharmacy) you'll get a slight discount and should be able to pick up 5 cartridges right away. you may want to get future orders from a canadian pharmacy to save money (it could take up to 2 weeks to get your insulin from there). your vet should be able to call the prescription in to costco. you may want to check a few pharmacies in your area to verify whichever offers the cheapest lantus.

the standard starting dose for lantus is 1 to 2 units every 12 hrs. if you're coming from another insulin you may want to dose closer to your current dose. what concerns me about that is that you're giving 3 units but still approaching 400 each time so you may have missed the optimal dose at some point, so some may believe you should start at 2 units and test for ketones to make sure your cat is doing okay with less insulin. if you can list your recent blood glucose readings for the lantus forum here, they should be able to help you figure out a starting dose. frankly, you're not really going to be able to determine a dose based on one curve at the vet. and the likelihood is that your cat won't eat well at the vet or will have elevated blood gluocose due to stress so you may feel a lot safer/happier doing that first curve at home. your readings are likely to be more realistic.

 

I am sorry that you are having issues with your vet.

However, one thing to note is that there is a problem with vestulin, and while it has not been formally recalled (or maybe by now it has), there are some serious issues with it.

You are now being given an opportunity to try out something else for your cat and you can choose that will work better for your cat.

Personally, I recommend the L insulins (lantus/glargine or levimer/detemir). I used Lantus with Maui and had terrific results.

I suggest you visit the insulin support group forums and read about the insulins. Also look at the daily posts in lantus forum and you will start to see how many people use it and how well it works. Do keep in mind that each cat and situation is different and results vary.

As was already said, you will need a prescription for the human insulins, but that shouldn't be an issue if your vet is directing you to get something else. You may also need a prescription to get the appropriate syringes for the insulins. The L's use U-100 syringes and I highly recommend that you get the ones with 1/2 unit markings. This will help when you need to microdose.

Again,, get the vet to write a script for it.

While the pens or cartridges were recommended, DO NOT USE the needles that can be sold with them. They are fine for humans, not cats. Instead get the script and get U100 syringes. Treat the pens or cartridges like a vial. There are pics in Lantus forum that show you what I mean.

Additionally, the L's are very different from vestulin, from storage to dosage, so again it's important that you read the the starred information in Lantus ISG.

Remember, while change is scary and you will need to relearn about insulin, this is really a good thing. OH and once you get your insulin, please feel free to post in the ISG.

Finally, don't waste your time, money or the cat's nerves by doing a curve at the vet. It won't tell you anything and just give you more reason to get upset.

It's best to start low and go slow at home and when you are ready, like on a weekend, you can conduct your own curve. Meaning, the recommended starting dose on the L's are 1 unit or even 1/2 unit and that dose gets held for 5-7 days. (Details and explanations are on the Lantus ISG).

By the way, are you home testing? And what kind of food are you feeding?

It's vital that you home test, so you know what is going on BG wise at all times. Also if you are feeding dry or prescription foods and want to stop and feed low carb canned foods, this will also affect the BG's and may reduce the amount of insulin you need.

 

I'm back!

I've canceled his appointment for Friday to give myself some time to evaluate and make a decision. I have enough vetsulin to last about two more weeks so I can afford to take my time and make the right choice for Talley.

I have indeed been home testing but my father insists that his first curve on a new insulin be done at a vet (I believe he gets nervous about my brother and my taking control of Talley's diabetes. He's very adamant about the vet knowing more than us.). I've obliged to ease his mind but will continue to home-test him like I always have since he was diagnosed. Fortunately, my father will eventually stop insisting on vet visits because we're not rich and I can go back to handling it myself. After four months of dealing with Talley's diabetes, I've gained a lot of confidence in my ability to home test and am very glad to have learned how to do so from this forum.

Talley eats a mix of Fancy Feast cans (Classic titles - originally Gourmet) and a dry brand called "Chicken Soup for the Cat Lover's Soul" that we found at a local feed store. If it matters, he eats a fish-flavor for breakfast and a meat-flavor each dinner.

We've been testing him each day since we bought a new tester (hooray for grant money paying for diabetic supplies!) and he's back down from 400bg. He's now back to his usual 200-210 pre-meal and 150-180 peak. I'm not sure if his prior illness had any effect on his levels; he had cat flu for about 3 days followed by a cold for 5 days. He's still sneezing. Unfortunately, I didn't get the new test strips until after the illness. His ketone test came back negative as well so he's safe there. On a side note, Talley doesn't appreciate my close proximity to him while he's trying to urinate.

Finally, I think I'm changing vets because I believe my current one has no idea what diabetes is. She stares blankly at me when I ask complicated questions that this forum answers easily. I know she's not a specialist but I have no confidence in her ability to assist me with Talley's needs. There's a small vet office within 10 minutes of my home that I think I'll pay a visit to...

Sorry for the elongated post; I hope I answered all questions that were proposed. I'm off to research these insulins (thank you so much for the info!) and convince my mother that Talley isn't going to die just because I hate our vet. For what it's worth, she's always been excellent with my kitten, Binx.

 

I think you are doing an awesome job!

As for your dad, well, many people have a blind trust in authority figures, so we won't hold it against him :lol:

Your plan sounds pretty solid; only thing I would add is that if you could remove that dry food you might find those numbers improve. Just don't do it unless you are testing frequently

Jen

 

My brother wants me to ask about prices. We're wondering what is the most economically efficient over a long length of time. What's the typical dose for Lantus or Lev? Right now a 2.5mL bottle of Vetsulin is $13 and lasts me about 1-1.5 months. I'm not asking how much *per bottle* but more which insulin is the most cost effective. PZI seems to be the most expensive per bottle at $113.

Please keep in mind that this is not the deciding factor for which insulin I choose to trust Talley's health with, but it is an important factor. Cheap insulin is better than no insulin so I need to be able to afford his medical needs. I started home testing because we could not afford the $90 curves every two weeks that our vet wanted. Before I commit to an insulin, I want to be confident that my budget won't explode.

Again, thank you so much for your hasty replies so far. We've pretty much narrowed it down to one of the Ls.

 

Glad you're back! You've learned a lot in 4 months!

Insulin cost depends on how much insulin the cat needs. In board members' experience both Lantus and Levemir are good in the pens far longer than the manufacturer recommends AS LONG AS EACH IS REFRIGERATED AFTER OPENING. The pens are meant to be portable for human use, humans also use a lot more insulin so room temperature is preferable to inject for people. Cats get so little that it warms plenty well in between the time you draw and inject. The manufacturer information is in regards to leaving open pens out at room temperature. of course the insulin will not last as long if not refrigerated.

One thing to be aware of is that it is not recommended to inject Lantus back in to the pen. You overdraw, then squirt excess in to the sink to get to proper dose, so some insulin is wasted. There is a possibility that lubricants inside the syringe could get mixed with the insulin in the pen if you inject excess back in to the pen.

You use regular syringes with the pens and not the pen needles which the pharmacy may try to sell you. You pierce the rubber stopper part of the pen just like with a vial. Lantus and Levemir are U100 concentration insulins, so you will need different syringes than you use with Vetsulin, which is a U40 concentration. You should not use U40 syringes with U100 insulin as it risks giving far too much insulin.

The following is my experience with Levemir over 2 years using it. I inject excess back in to the pen every single time. It is very little and I have used pens to the end without a decrease in effectiveness. Typically 1 pen lasts me 3 months at just over 1U per dose. You always draw more insulin from the pen than actual dose anyway, because I still squirt some out to get to proper dose. Anytime I have thought problems we had with regulation were due to the pen konking out were not because I opened a new pen and had same issues.

So my cost of Levemir is the following - 5 pack pen $180 from local pharmacy, 1 pen lasts 3 months X 5 = 15 months worth of insulin. $180 ÷ 15 = $12/month. The cost is comparable to what you're using now if you can swing the initial cost. Lantus cost is very comparable, some even say a few dollars less, but again, it depends on the dose.

Perhaps someone else is more informed about ordering Lantus or Levemir from Canada, as I think the rules about needing a prescription have changed, but it's generally cheaper to order them from Canada. Hopefully someone else will address that for you.

I'd also like to recommend reading DVM Lisa Pierson's website http://www.catinfo.org about why dry food is a poor diet for any cat, and certainly not appropriate for a diabetic. But if you take the dry food away, please test because chances are Talley will require less insulin since you're taking away carbs. Look at the first few ingredients on the label - if they are grains, then there are carbs.

Check out the dry food charts here: http://binkyspage.tripod.com/dryfood.html

Canned food charts are here: http://binkyspage.tripod.com/canfood.html

Foods less than 10% kcal from carbs is best for diabetics. Your dry food is 28% kcal in carbs!

Sorry so long and I'm giving you more to read

 

Here's the thread about ordering insulin from Canada

viewtopic.php?f=15&t=2330

New & current info. If you have any questions about ordering, perhaps ask it in that thread.

 

I'm in the same sort of boat. I have enough IDEXX PZI to last six weeks or more. I have read about all the different insulins, but, I am still undecided.

In the meantime I have found this site: http://www.discountpetdrugs.com/prozincinsulin.html

I use a u100 syringe with short needle and i/2 markings and u40 insulin. Bet's doses have increased gretaly because he is on Flovent inhalers which have apparently driven up his BGs. I have been weaning him off pred in unison of using the inhaler. He is up to 2.4 units BID, up a whole unit from previous doses. He has had a full blood panel just a couple of weeks ago with nothing drastic going on. Bert's cough is subsiding nicely.

I have never really understood what good curves do adn sure I read on the FAQs that curves are useless (now don't scream at me I'll try and find it) don't foget I love you all so don't be angry..K? :smile:

Any comments on Prozinc?

Take care everyone!

 

George,

Hope you can find us the place you saw that curves are useless. Think we might want to make a correction there.

It might have said that instead of a curve (especially really early in this process) you can get various readings at different times of day. (like +3 and +6 on one day and then +4 and +8 another day) That works good for people with very busy lives. And we don't advise you doing a curve the day or two after you start insulin because it usually takes a few days for the cat's body to adjust to the insulin. Just the nadirs and before shots.

 

hi brigitte. the cost of lantus and levemir varies from place to place. shop around for the best prices in your area. i've used both lantus and levemir and found lantus to be less expensive here. both of these insulins are excellent choices and can be used for longer than what the manufacturer suggests. for more on this subject, read through this thread from the "old" board: Disscussion: how long does Lantus/Levemir last once opened.

links:
Lantus & Levemir: Info, Proper Handling, & Storage
Lantus & Levemir: More Information

hope this helps...

 

I've found PZI and Levemir to be comparable in cost, both somewhere between $12 and $15 per month. Both insulins have benefits. PZI is a U-40 insulin so it's easy to use U-100 syringes and adjust doses in very small increments (.1 unit). Levemir, for Lucy, gives better duration so I get a full 12 hours of coverage most days. Both insulins are more flexible than what I see being done with Lantus (such as shooting early, splitting a dose, etc.).

 

After looking into it - mostly here at FDMB - I decided to choose Levemir because it is less fragile than Lantus. If you drop a vial of Lantus, it might go bad.

Ask your vet to write a prescription for the 5-pack of 3ml pens (same for either Levemir or Lantus) AND REFILLS! Tell the vet that you heard that you need to open a new 3ml pen cartridge each month, so you need 12 per year. (ask for a 5 pack plus 2 refills)

With careful handling, you should be able to use each cartridge for longer, but getting the prescription written to be valid for one year is just good planning.

I ordered my Levemir from http://www.canadadrugsonline.com It was less expensive than in the US, and at the time, I did not have to fax in my prescription. The rules have changed on that as of 1/1/2010

The 5-pack of Levemir is usually a bit more expensive than the 5-pack of Lantus, but since it is less fragile, the Levemir should last longer.

With my Tiggy, we just started our 3rd cartridge recently -- the first two lasted about 4 months each - he only needs about 0.75 units twice per day. (started using Levemir last April)

For syringes, lancets etc, I recommend ordering from http://www.hocks.com
These are my favorite products, and I order enough to get the free shipping: (about 3 months worth at a time)
http://hocks.com/hocks-healthcare/hocks ... 40030.html Syringes with half-unit markings $17 per 100
http://hocks.com/hocks-healthcare/hocks ... 10030.html Lancets $1.49 per 100
http://hocks.com/hocks-healthcare/hocks ... 83796.html Needle Clipper (for safe used syringe disposal)
http://hocks.com/hocks-healthcare/hocks ... FM-14.html Maxima AST meter (small amt of blood, inexpensive strips)
http://hocks.com/hocks-healthcare/hocks ... MAX50.html test strips $15 per 50 when you buy 6 packs

 

George and Bert, you asked about Prozinc. This is a repeat of a post I recently gave somewhere else...

There is a brand new, FDA approved, PZI type insulin that was released around Thanksgiving 2009. It is called ProZinc. We use it, and I am liking it a lot. It is manufactured, very stable (I've dropped it 2x), and is suppose to be ok to use until empty in most cases ( too new for me to tell on that). Dose is supposed to be very similar to PZI Idexx.

Cody was on vetsulin around 2 years, (but I was never really satisfied with his readings which may have been from other undiagnosed -medical problems). In Nov 09 we switched to compounded PZI and then PROZINC on 12-22-09. The transition has been awesome for us. Wish I had known sooner....

Because it is FDA approved, your vet will/should know about it. It is suppose to act similar to other PZI products, with a slow steady long nadir and a 12-24 hr duration. They say most cats need 12 dosing. I think the web site is prozinc.com

I just started posting online BG so you can't see what his curves were like on Vetsulin, but they weren't pretty. Now things are slowly steadily improving, which is much easier on me and he seems much happier. He is now on 1/2 the dose he got of vetsulin, and his average numbers have steadily dropped over 80-100 points and are still dropping. I'm going slow because his body has had high bg so long, his body resists going lower.

 

Thank you...I am so up in the air about what to use favoring Levimir, but, Prozinc has my attention.

Berts numbers are so high even though i am dropping his does of prednisolone steadily albeit slowly. His numbers are staying hig despite the cut of pred. It sure seems like the astma inhalers (Flovent) are doing it, but, most people say that won't cause high BG's

He has recently had a gamut of tests that show nothing drastic. I'm perplexed and just keep raising his doses. He is not up to 2.8 units BID of u40 PZI

It feels good to see all the familiar names back on this new forum.

I will look for the curve FAQ I saw

 

Brigette, you have the time to make comparisons. The best way to do this is to put in the time to read the insulin support groups forum for each insulin. Follow the posts for a few days to see progress and problems as they develop.

 

Hey Most-Wonderful-People!

I'm back a final time on this thread to give the conclusion of my insane week.

After researching the options, we chose Lantus for Talley and easily got a prescription for it. I made all the preparations for Talley's vet-administered BG Curve and dropped him off this morning. All went smoothly - of course, that's ALL that went smoothly for a while. I went to my college campus and attended class until 2:00 PM; having dropped him off at 7:00 AM this morning, I assumed that the worst was over and everything would end well. Arriving home, I was called and had this lovely conversation with some technician:

Tech: Hi, this is... blah blah blah blah blah... you need to come pick up Talley. He's getting more irritable with each ear-prick and now everyone's afraid to remove him from the cage.

Me: What...does... why?!

Tech: Well, we took him out of the cage in the back and these dogs scared him and he escaped - we got him though! - and now he's trying to kill us.

I arrived at the clinic upset and blatantly dissatisfied. I was silently vowing to never return to that building. I called my father to mock his decision that I can't home-test better than a vet can run the curve. Seeing my utterly bleak appearance, the techs at the main desk looked fearful. I reminded myself to remain calm and stay assertive; I asked to speak to the owner and lead-vet at the vet office.

To make a long story very short, he was appalled at how I've been treated with Talley thus far in my experience. He apologized and said he was going to talk with his underlings regarding diabetic care. He said he would be personally handling Talley's visits and I was refunded for the failcurve. He also approves of home-testing despite his underlings fear of it. Now my visits will be $12 checkups where I present my home-curve and my new vet helps me make decisions based on it [Instead of $90 bg curves that keep ending in frustration].

Happy endings all around! I love my new vet and home-testing coupled with checkups means that my father and my methods can reach a happy medium.

Finally, thank you again for everything you have helped me research. I'm so happy at the moment! I cannot wait until I'm experienced enough to help others on this forum ^^

Oh! And props to Talley for trying to murder everyone at the vet! My mom thinks I channel my anger into him. :twisted:

 

I am so glad to see that you chose Lantus. I would sing the praises of Lantus from the rooftops if anyone would listen. Please come visit us over on the Lantus support group. The folks there are a wealth of knowledge and extremely supportive. Also there are a number of invaluable stickies with important information.

Sounds like your vet might be a better choice than the last one. Here are a couple suggestions from my experience.
1) Vet's for the most part are not specialists and therefore don't know about ALL the insulins out there. Lantus is definitely dosed differently than the other insulins. Print out the stickie about the Tight Regulation Protocol and share it with the vet. This is a step by step instruction on how Lantus is dosed. Usually starting out at 1 unit and working your way up from there.

2) My vet (second one, I also fired the first) is absolutely wonderful, but instructed me to dose the Lantus like other insulins, starting out at 4 units twice a day. I said okay, came home and after a few days of watching Indy's numbers bounce around all over the place, decided to go against the vet's advice and follow the protocol on the Lantus board. I never looked back and on Wednesday of this week, Indy had his OTJ party and is officially a diet-controlled diabetic, who no longer needs insulin injections. I owe it all to changing his diet from dry to 100% canned and to the people on this message board.

3) Sounds like you might have trouble convincing your dad if you need to go against the vet's advice, like I had trouble with my husband. But the proof is in the numbers. Just look at the spreadsheets of some of the kitties that have been there a while. Most switched from other insulins and you can see the positive effect in the way the numbers dropped right off the bat. The other argument for using the folks here as a trusted resource is that each person here deals with diabetes on a daily basis. The vet may only see one or two diabetic cats a year. The people here know what they are talking about.

4) Keep in mind that the numbers you see when testing at the vet will normally be higher than what you are testing at home, unless you are using an animal calibrated blood glucose meter. The Lantus protocol was developed specifically using a HUMAN bg meter. The protocol describes the safe number ranges so your vet can correlate the human numbers to the animal numbers.

I guess I got to do a little shouting from the rooftops after all! :mrgreen: Welcome to Lantus Land and I look forward to seeing you on the Lantus support group board.