Forced to change from prozinc to caninsulin

Discussion in 'Caninsulin / Vetsulin and N / NPH' started by C1gar, Jun 25, 2020.

  1. C1gar

    C1gar Member

    Joined:
    Jun 17, 2019
    Hi

    I’m just wondering if anyone has any knowledge or suggestions on my little cats challenge - prozinc to caninsulin due to the ongoing shortage. She was very stable on prozinc with good control.

    she was on 3.5 units of prozinc, how much difference is caninsulin to prozinc?
    is it stronger? As we have started on 2 units to air on caution.

    Any comments would be greatly appreciated
     
  2. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Usually you don't really change the dose. If you are worried I would start at 3. Do you have a spreadsheet you can share of the BG numbers?
     
  3. C1gar

    C1gar Member

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    Jun 17, 2019
    Thank you for your reply!

    I struggle to get any readings from her so a BG curve is always incorrect.

    I am hiring it to 2.5 tonight as she was on 3 for one day but went into a very very deep sleep
     
  4. JanetNJ

    JanetNJ Well-Known Member

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    Jun 8, 2016
    Please don't give up on testing. It truly has saved my cat's life probably a dozen times in the four years she's been diabetic. The first couple of weeks you do it there will be a lot of failed tests... but then new capillaries will grow and make it much much easier. You could also try getting a meter that only needs .3 size sample. I have a video in my signature showing how I test my cat at home.
     
  5. C1gar

    C1gar Member

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    Jun 17, 2019
    thank you I am going to look in to the .3 size I have the
    AlphaTrak 2 but it seems to want a lot of blood, do you know of the type that requires less?

    Thank you!
     
  6. JanetNJ

    JanetNJ Well-Known Member

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    alpha only needs a.3 sample.... it's what I use.

    Just to clarify, when you try to get a sample, you are DIPPING the edge so the tiny straw protruding from the side sucks up the drop, right? You aren't trying to scoop a drop in top of one of the dots, correct? This is all the blood you should need to get a sample.... It's literally a drop. CD31AF45-7B61-42FE-A19A-DF014280A0FC.jpeg
     
  7. JanetNJ

    JanetNJ Well-Known Member

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    you DIP one of the little straw into the drop.... do you see the straws on the edge? It sucks the blood up into the strip. [​IMG]
     
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  8. JanetNJ

    JanetNJ Well-Known Member

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    This picture is of a ferret getting tested, but it's a good photo to show you the angle you need to use to DIP into the drop. [​IMG]
     
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  9. Deb & Wink

    Deb & Wink Well-Known Member

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    One big difference between Prozinc and Caninsulin (Vetsulin) is the much shorter duration with Caninsulin. Usually only 8-10 hours.

    Was your vet unwilling to write you a prescription for Lantus or Levemir? Those 2 are nice long lasting insulins in cats.
     
  10. C1gar

    C1gar Member

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    Jun 17, 2019

    Thanks for the reply

    They just reccommned to switch to caninsulin we didndt have a say in it really
     
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  11. Deb & Wink

    Deb & Wink Well-Known Member

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    I'm a bit puzzled here. You are the cat's owner. Why wouldn't you have a say?
     
  12. C1gar

    C1gar Member

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    Jun 17, 2019
    Hi

    Thanks for your reply

    We do not have a clue about what is best for a cat with diabetes and take their advice in good faith. We have just spoken to another vet today (same practice) and she says the that caninsulin is stronger than prozinc and reccomend to lower the dose back to 2 - so we really are at a loss.

    We gave her 2.5 units this morning and she seems very sedated - we intend to lower it to 2 and take her to the vet in the morning for a curve.

    It is just such a shame she was doing so well on 3.5 * 2 a day but now all she does is lay around
     
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  13. JanetNJ

    JanetNJ Well-Known Member

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    It's stronger in that it will lower the number quickly but does not last add long.
     
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  14. JanetNJ

    JanetNJ Well-Known Member

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    Did you see the info about using the alpha track I posted above? You may have been trying to get the sample wrong if you were needing a lot of blood. Another thing you can do is scrape the drop onto your nail and test from there.
     
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  15. C1gar

    C1gar Member

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    Jun 17, 2019
    yes thank you

    We tried unsuccesslfy to get readings or we got extemely low which could not be correct as (my cat) was up and around.

    I am going to try the finger nail idea, thank you!
     
    Last edited: Jul 10, 2020
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  16. JanetNJ

    JanetNJ Well-Known Member

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    When you say extremely low what do you mean? My cat had been as low as 37 with no outward symptoms but it's still life threatening
     
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  17. C1gar

    C1gar Member

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    I believe the reader was saying 8

    this happened to the vet as well who got a reading of 8mml but took it again and she was in the 500 mg ml
     
    Last edited: Jun 27, 2020
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  18. C1gar

    C1gar Member

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    Jun 17, 2019
    Just got a true reading

    22 mml - so she is high but the vet maintains to keep her on 2 units *2 a day for three weeks and get a fructosamine test.

    any thoughts would be much appreciated
     
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  19. Deb & Wink

    Deb & Wink Well-Known Member

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    22 mmol/L times 18 = 396 mg/dL
    No too horrible, but could be better. At least it's not in the black color range, over 500 mg/dL (27.7 mmol/L).

    Do you home test the BG levels? It gives you more of a real time understanding of the BG levels.

    It soundslike you do, but you don't have a spreadsheet setup in your signature. That would really help you and us see what is going on. Setup instructions for the spreadsheet (SS) are here >>>>> FDMB Spreadsheet Instructions

    And what it all means is here>>>>> Understanding the Spreadsheet/Grid

    A fructosamine test will give you an average blood glucose over the past 2 weeks. But it can't tell you if your cat dropped really low or was really high, over 500 mg/dL(27.7 mmol/L)

    What food is your cat eating? That can make a big difference in the BG levels.

    Adding information to your user id signature is really helpful too. Editing your Signature, Profile, and Preferences
     
  20. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Hi there, are you in the UK? Just wondering because you're saying you're having to switch to Caninsulin because of Prozinc shortage. ...I'm in the UK, and am waving to you from Surrey! :bighug:

    There are some little differences between Caninsulin and Prozinc.
    Caninsulin isn't 'stronger' than Prozinc (it has the same number of units of insulin per ml as Prozinc), but it 'typically' has a faster action and so can drop the blood glucose faster and more steeply in some kitties. Also, it 'typically' has a shorter duration, and may not last the full 12 hours.

    A lot of UK kitties will probably be switched (by vets) to Caninsulin because of Prozinc not being available at the moment. Hopefully this will only be a temporary issue (fingers crossed).
    If Caninsulin doesn't work well enough for your kitty then your vet can prescribe an alternative insulin. Since Prozinc isn't currently available that would mean switching to a human insulin such as Lantus or Levemir. There are now quite a few UK kitties on these insulins. ....However...since your vet hasn't actually suggested that you switch to one of these it seems reasonable to suppose that your vet has no experience of these insulins. That is not unusual in the UK. A vet's willingness to prescribe human insulins varies a lot. Some vets are keen to prescribe them, some vets totally refuse, some don't even know they have the option to prescribe them...

    Do persist with learning to hometest blood glucose. 'Hometesting' is enormously helpful in managing diabetes. And if you can test at home you will be able to 'see' how the insulin is working in your kitty's body. If it's not working well then that blood test data could be very helpful in persuading your vet to prescribe an alternative insulin.
    Janet has given you some great advice on hometesting (and some fab pics!). In addition to that here are a few things that I wrote for someone else that may be helpful. If you need more help, just shout out!

    HOMETESTING TIPS & TRICKS
    1. WARM EARS. Probably THE most important thing. Warm ears bleed very much more easily than cold ones. You can warm an ear by massaging it, or by holding something warm against it; ie a pill bottle filled with warm water, or a ‘rice sock’ briefly warmed in the microwave.

    2. MASSAGING immediately below the ear prick, with finger and thumb, can ‘milk’ more blood out. I almost always do this, if only for a second or two.

    3. VASELINE. A teensy weensy smear of Vaseline on the outer edge of the ear will enable the blood to ‘bead up’ and stops it disappearing into the fur. This also makes it easier to see the blood droplet if the kitty has dark ears.

    4. RESISTANCE. The lancet needs something to ‘resist’ otherwise it can push the ear away rather than pricking it effectively. Some folks use a piece of cotton wool or folded tissue. I use one of my fingers, but sometimes do accidentally take a blood sample from myself that way.

    5. TWO EAR PRICKS close together can often produce enough blood for a test when one ear prick might not.

    6. SCOOPING THE BLOOD DROP ONTO YOUR FINGERNAIL. Doing this is a game-changer for some people. If you can get that drop of blood on your finger or thumb nail you can then let the kitty go and finish the test without her/him.

    7. TREATS. It is important to reward the kitty for each attempted test, whether the test was ‘successful’ or not. Cats very soon learn to associate tests with treats. And some will soon come running for their tests. A ‘treat’ is usually a food reward of some kind, but some folks reward their kitties with a cuddle or a grooming session. I actually crumble a few treats for my cat and test him while he’s hoovering up the crumbs.

    Remember to reward yourself too. Chocolate is good…

    8. GET COMFORTABLE. If you are physically comfortable you’ll be more relaxed, and also less likely to try to rush the process. Some people like to test their cats on a counter top or a desk, maybe next to a desk lamp. Some people prefer to hold their cats on their laps when they test. Some folks incorporate testing into a grooming session. You’ll find what works best for you. And once you get used to home testing you’ll quite possibly be able to do it anywhere, and maybe even while the kitty is asleep.

    9. RELAX. Cats pick up on our moods. The more relaxed and ‘matter of fact’ we are, the more relaxed and confident the kitty is likely to be. Some people chat or sing to their cats while they test him. Try it. It might help you too.

    10. PATIENCE. Be kind to yourself. You’re learning something new. (And you’re learning something wonderful!)

    For sensitive cats who really resist testing it's possible to use the pleasure association of food to make the process easier. This really good little video shows the principles of 'desensitisation and counter-conditioning'. The vet in the video is getting a cat used to injections, but the same principles can be applied to testing:

     
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  21. Deb & Wink

    Deb & Wink Well-Known Member

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    The "Sticky" or pinned posts at the top of this forum have just been updated. So you might want to take a look at them.
     
  22. C1gar

    C1gar Member

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    Jun 17, 2019
    Thank you all for your guidance! I am based in the uk.

    I am still struggling to get readings from my cat but she has just drunk 10 mins straight - so she must be high and I think I need to higher the dose and pray that she doesn’t go to low

    as living in a water fountain is no life for her.
     
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  23. JanetNJ

    JanetNJ Well-Known Member

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    What size lancet are you using
     
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  24. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Aw, sweetie. Take a few deep breaths... And be kind to yourself. We all understand how difficult and stressful this can seem at first. But it honestly does get easier.

    It can take time to get the hang of testing. And every cat is a bit different when it comes to what works for them.
    I'd been dealing with my first diabetic for 11 and a half years when I adopted my second diabetic. And I thought testing her would be a 'piece of cake' and that I'd be able to do it the same way that I did with my old diabetic boy. But....she was very different, and it was a humbling reminder that every cat has their own specific needs and preferences... I will confess that, even having tested for many years, I felt lost, and I really cried at one point, feeling that I was failing the cat that I'd adopted... But, then I took a step back and re-approached things in a different way....

    My first diabetic (who I initially swore to people here was "impossible" to test) was quite food-motivated. So, I found that I could pop him on a table top, crumble a few treats for him, and then test him while he was hoovering up the treat crumbs. That 'distraction' was key in being able to test him, because he was a big powerful kitty, and there was no way I'd be able to test him if he didn't 'agree' to it.
    My adopted diabetic girl isn't particularly food motivated, so treats didn't distract her sufficiently to be able to test her. But, I found out that she loved to be brushed, and so I managed to sneak tests into a little cuddle and brushing session, and she barely notices the test... She still gets a food treat at the end. But the treat is a small part of the whole thing.

    With both my diabetics I spent quite a lot of time just getting them used to the sensations and sounds involved in testing. So, at various times during the day I'd go to where they were, stroke them, hold or massage an ear for a second or two, and then immediately give them a treat, and just walk away.
    Similarly, I'd rattle the test strip container, or click the lancing device (it can be used a bit like a training clicker), give a treat, and then walk away.
    It's also helpful initially if you can test in the same spot in the house so as to establish a routine. So, I'd pop the kitty on a chair or table top, and give a treat and lots of praise.
    If you can get the kitty to your 'testing spot', hold or massage an ear for a second or two, and then reward with a treat, you are most of the way to being able to test....

    It's also important to remember that cats pick up on our moods. If we are stressed, they pick that up. So, taking time to take a few deep relaxing breaths prior to testing can help a lot. ...Also, and this is probably going to sound really daft, some folks sing to their kitties while they test them. I've done this myself, without even thinking about it! But, strangely, if you hum or sing a tune, it can be relaxing for both human and kitty... Strange but true.... :smuggrin:
     
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  25. C1gar

    C1gar Member

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    Jun 17, 2019
    Thank you all for your input

    she went back to the vets to day her blood sugar was 28mmol so now we are getting into dangerous territory. Frutosemine test done we are awaiting there guideance

    We left her in for 2 sepatre days to get a curve. They said - both times - there were able to get a curve as she is far too stressed to see a correct reading :-(
     
    Last edited: Jul 10, 2020
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  26. Deb & Wink

    Deb & Wink Well-Known Member

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    Do you mean they could NOT get a curve, either of the two times you left Sugar at the vets?
     
  27. C1gar

    C1gar Member

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    Jun 17, 2019
    Sorry, yes they have been unable to get a curve.

    We have left her again today at the vets, for a curve. I pray it goes ok
     
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  28. Deb & Wink

    Deb & Wink Well-Known Member

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    Have you thought about using a CGM (continuous glucose monitor) like the Freestyle Libre? They last about 2 weeks on average but give you data every 15 minutes.

    It's something to consider. Probably no more expensive than having your cat stay at the vet for a curve.
    If I were you, I'd ask my vet about the Libre.
     
  29. C1gar

    C1gar Member

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    Jun 17, 2019
    thank you for your input! I will ask my vet this when they open at 11!!!

    she was in all day again yesterday and the vet was unable to get a accurate reading due to stress.

    so they want us to bring her down every few every hours for a spot check on a day to see if that can get a better reading
     
    Last edited: Jul 10, 2020
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  30. Deb & Wink

    Deb & Wink Well-Known Member

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    That just sounds like she would be stressed again, and again and again from the ride to the vet and back.

    Please, do ask your vet about the CGM. Not cheap, but should be worth it.
     
  31. C1gar

    C1gar Member

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    Jun 17, 2019
    Just a quick update

    Are vet is not being at all helpful with regards to CGM she says her pratice would not consider it - nor change to a new insulin (human one). So regrettably we have taken her down every 2 hours for 2 days now and have a curve of sorts - and need to re up the insulin accordingly and back to praying that it will be ok.
     
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  32. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Hi, Prozinc is currently available at Viovet if you can get a prescription from your vet. :)
    https://www.viovet.co.uk/ProZinc-Insulin/c35418/
     
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  33. C1gar

    C1gar Member

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    ThAnks for the input

    sold out atm :-(
     
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  34. Deb & Wink

    Deb & Wink Well-Known Member

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    Only 2 words for you.

    New vet. Second opinion. Different practice.

    Pray hard. Pray the dose is not too much.

    p.s. Ok, that's more than 2 words.
     
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  35. Pabs&Ro

    Pabs&Ro Member

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    I hope things are settling down for you. My cat was on prozinc and stable at the start of lock down but because of covid the supply dried up in the UK and we went on can insulin. We have tried for four months to get the right dose and still struggling. He was on 2.5 units of prozinc twice a day and we are on 3 units of caninsulin twice a day and it is not enough. Today in the low 20's all day. Also I notice that with caninsulin the effect is great for the first few days of a new vial but thereafter it is not as effective. Vets don't believe me! Also not all companies were storing caninsulin properly and I have been supplied with completely ineffective bottles. It has been a nightmare. I would be interested to know what dose you have settled on in comparison to prozinc dose.
     
  36. C1gar

    C1gar Member

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    Jun 17, 2019
    Hi, we are currently still chasing high blood sugar, unfortunately caninsulin is just simple not working for our cat.

    We were on 3.5 prozinc - we are currently at 4.5 caninsulin and still climbing in dosing. Caninsulin is clearly less affective than prozinc.

    However, our vet is now saying our cat my have become insulin resistance, so comparison might be invalid; but I personally dont beleive it and think its more to do with malpractice, but I need to bite my tounge untill we get our cat settled.
     
  37. Pabs&Ro

    Pabs&Ro Member

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    It seems we are on the same path. We went onto prozinc a few years ago because caninsulin did not work for Pabay and now we are back in the same situation. My vet wants to investigate resistance and or moving onto glargine. The problem I have with the resistance argument is that we get good readings for the first three or so days after opening an new vial. I store it well (having bought a new fridge, insulin wallet and digital thermometer). I have been advised that if we move to glargine I will still need to top up with caninsulin. I really hope humans have better luck with the products they use to control diabetes. How much does your cat weigh as a matter of interest. In march mine weighed 5.3kg but now 4.7.
     
  38. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Sep 6, 2010
    Prozinc is now available in the UK again, the supply has apparently been restored.
    This is from the Boehringer UK website:
    "ProZinc 40 IU/ml suspension for injection for cats and dogs
    Normal supply has been restored – vets can place orders via their usual process (updated 11 August 2020)"


    @Pads&Ro, I also posted this on your thread (enquiry about lantus cost in UK), but am posting here in case others in this thread may have missed this info.
    @C1gar
     
    Last edited: Aug 16, 2020
  39. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    Um, no.... That's just nuts... Sorry... Why does your vet think this is the case...?
     
  40. C1gar

    C1gar Member

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    Jun 17, 2019
    Hey

    our cat is 8kg.

    just come back from the vets and are suggesting 5 units * 2 a day.
    They also say they can’t get prozinc and suggest keeping on cannisulin until there is a steady supply.
     
  41. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    5 units is very high dose of a fast-acting insulin like Caninsulin...
    Are you managing to test your kitty now? What sort of numbers are you seeing before insulin, and at the lowest number of the cycle..?

    And some vets are managing to get stocks of Prozinc... Is it possible that other vets in your area may have some...?
     
  42. C1gar

    C1gar Member

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    Jun 17, 2019
    we were getting to the mid 20's with 4.5 units at its peak.

    So that why we have been pushed again to up the dosage. We have explored all vets within a wide area - they say prozinc is a no go atm :-(

    With 3.5 prozinc we were at 9 at at its peak so there is a huge difference it would seem!
     
  43. Julie & steve j

    Julie & steve j Member

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    Dec 8, 2018
    Hi, we had the same issue with Prozinc in the UK. Fortunately for us, my vet was open to the idea of using glargine as an alternative but after a few days of trying they did manage to get hold of 6 vials of Prozinc that they said were coming from the US. I must have been very fortunate that my vet persevered in his quest for tracking some down. I did see the other day that there was limited supply available from Viovet but didn't try to purchase any as I now need a new prescription.
     
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  44. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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  45. Critter Mom

    Critter Mom Well-Known Member

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    Please can you let us know who advised you of this. Whoever it was is giving incorrect and extremely dangerous - possibly lethal - advice.


    Mogs
    .
     
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  46. Pabs&Ro

    Pabs&Ro Member

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    Hi, It is a specialist vet: specialises in internal medicine in the UK. This is one reason I have been cautious about changing to a long acting insulin. The vetinary advice was that the dose on a long acting insulin must be below what is required to avoid hypo and then top up as required with a faster acting insulin. Vets in the UK do seem to be reluctant to use long acting insulins. Judging by the number of posts it seems that long acting insulins are used more often in the USA.
     
  47. C1gar

    C1gar Member

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  48. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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  49. Critter Mom

    Critter Mom Well-Known Member

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    Vets in the UK are legally required to first prescribe medicines licensed for use in the species they are treating. Only when licensed treatments are proved ineffective are they free to consider prescribing other treatments under drug cascade rules. Currently only Caninsulin and Prozinc are licensed for treatment of feline diabetics. Vets have to treat with these first. They need to have evidence that they aren't working well for their patients (e.g. spreadsheet BG data, adverse reaction to the treatment) in order to issue an Rx for the likes of Lantus or Levemir (although Eliz advised recently that the depot insulins are gradually gaining more traction over here in the UK).

    OK, that's the easy reply done. :)


    Mogs
    .
     
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  50. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

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    I must admit I'm baffled.... And I honestly think you have been misinformed somehow... Perhaps there was some misunderstanding somewhere along the line, because this just doesn't make sense... I've never previously heard any suggestion to use lantus (or any other long-lasting insulin) like this to manage feline diabetes...ever... And I've been on this forum since 2007... This advice seems to relate more to how humans might use insulin... But the metabolism of humans and cats is very different... ...There are certain clinical situations in cats that may, as an emergency measure, require the use of both a longer lasting (basal) and faster acting (bolus) insulin, but these are very specific situations, and nothing to do with the routine management of feline diabetes...

    A number of esteemed vets and researchers have investigated the use of lantus in cats, including some quite recently in the UK. It has a pretty long history of use in cats, and has proved to be a good insulin for them.
    The RVC in London trialled lantus alongside Prozinc, and found that their remission rates were comparable. Some members here have even managed to get help from the RVC in persuading their vets to prescribe lantus in situations where the veterinary insulins haven't worked well for their kitties...

    As Mogs says above, the requirement in the UK is that vets first prescribe an insulin that is licensed for cats. If that's not sufficiently effective they can prescribe an alternative under the 'cascade' system. Those in the US generally have much more freedom to choose what insulin they want. This is why they are used more frequently there... Things seem to be changing here though, albeit slowly; and on feline diabetes forums more UK kitties are using the human insulins now than was the case just a few years ago...
    ...I think the RVC's research may have begun to influence change here. And the more that vets keep up to date with changes in the prescribing guidelines for insulin the more likely they are to prescribe longer lasting insulins. (The international ISFM guidelines recommend the use of longer lasting insulins for cats (Prozinc, lantus and levemir), and with no mention of the need for a bolus insulin to be used as well....) ...Incidentally, my own current (cat-only) vet favours lantus, saying that she considers Caninsulin to be - in her words (and somewhat shockingly) - "not fit for purpose"....

    I should also say (for balance) that there certainly are cats on the forum for whom Caninsulin works just fine. And there are cats who have gone into remission on it too. It even has an advantage that the longer lasting insulins don't have in that it can be used with 'sliding scale' dosage in cats who suit that dosing method.

    Eliz
     
    Last edited: Aug 19, 2020
  51. Pabs&Ro

    Pabs&Ro Member

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    Thanks eliz. This was the advice in 2018. The vet is a clinical director now. Perhaps the situation is changing with more experience being garnered.
     
  52. Critter Mom

    Critter Mom Well-Known Member

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    There have been a few exceptional cases here, Eliz, where the caregiver used a fast-acting in conjunction with the regular insulin but they were cats with major complications, IIRC, and it required the caregiver to be extraordinarly well-experienced. (Posts were by one or more of the uber-experts from L&L, perhaps Wendy or Sienne? Can't remember exactly who it was.)

    As you note above, the only regular use of bolus insulins is in a clinical setting when treating the likes of DKA, a life-threatening emergency. It's only safe then because it's an intensive care setting where sugars can be administered intravenously as needed and the cat is constantly monitored.


    Mogs
    .
     
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  53. Critter Mom

    Critter Mom Well-Known Member

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    Jun 16, 2014
    "... dose below what is required to avoid a hypo ..." - in other words she proposes giving a sub-optimal dose of the long-acting insulin.

    "... then top up as required with a fast-acting insulin" - Then she proposes to add in an insulin more likely to induce a hypo? After every meal???

    Maybe I'm reading it wrong, but to me that is just NUTS. Human diabetics are regulated that way. Cats are not humans.

    For the overwhelming majority of feline diabetics, the advice about topping up the long-acting insuiln with a faster acting insuiln is wrong.* Dangerously so, as I said earlier, if she considers what she proposed to you to be a suitable everyday method of treatment for feline diabetes.

    Most cats only need a small dose of insulin twice daily. A single insulin. Some cats have what are referred to as high-dose conditions (e.g. acromegaly) and may need quite a big dose in cat terms - but of a single insulin. (There are exceptions - as mentioned in my reply to Eliz above - but my understanding is that those cases truly are exceptional.)

    Lantus is a depot insulin. With each successive dose it builds up a store in the body - a sort of 'chemical pancreas' - which gives Lantus its longer duration of effect. For the vast majority of diabetic cats - and in simplified terms - the starting dose of Lantus should be low and the dose gradually increased in small increments until the dose and the size of the depot match the cat's needs. If the cat's needs lessen, the dose is reduced in small increments. Nothing more required - including at mealtimes.

    In all of the professional feline diabetes treatment guidelines I've ever read, not one of them proposed regular treatment of FD with basal and bolus insulins. Not a single one.


    Quite rightly so. I would have been very worried too.


    Mogs


    * Veterinary specialists are humans and, like the rest of us, they are not infallible. Some are fantastic and really at the top of their game. Sadly, some of them are not. The latter do get things wrong at times.
    .
     
    Last edited: Aug 19, 2020
  54. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Erm .. one of them would be me! ;)

    (Thank you, Ruth!)


    Mogs
    .
     
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  55. Pabs&Ro

    Pabs&Ro Member

    Joined:
    Aug 16, 2020
    Thanks all. You have all answered my main concerns. Alarm bells went off when I was given that advice. I did not go down the glargine route because I did not like what was proposed. There is no way I would inject Pabay more than twice a day even on advice with more than one type of insulin because it would stress him out and me and adversely impact upon his quality of life. I am very pleased that the norm as described by you is perfectly feasible and I am cautiously optimistic . Thanks for all of your informed advice.
     
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  56. Elizabeth and Bertie

    Elizabeth and Bertie Well-Known Member

    Joined:
    Sep 6, 2010
    I think it is. And I truly 'hope' it is... However I expect we do get a very particular view of things on feline diabetes forums which may not entirely reflect the situation in the wider world...

    One of the advantages of feline diabetes forums is that people talk about feline diabetes...endlessly, hehe! So there is a huge amount of shared experience. Also, many people here keep spreadsheets with their kitty's numbers on. So this is a truly fantastic resource for really 'seeing' how kitties respond to different insulins. When someone can really see evidence that an insulin isn't working for their kitty then that can give an impetus to try to get the vet to prescribe an alternative, and they have the evidence to show their vet too. It's not always easy. But I'd think that cats on feline diabetes forums are very much more likely to be on insulins that are working optimally for them...

    Many vets don't even seem to be aware of the current guidelines regarding prescribing insulins for feline diabetics. I guess they're busy people and can't keep up to date with everything. But that is another reason for us to be proactive and try to keep up to date so that we can draw our vet's attention to things they may not have had time to be aware of... But, even then, in the UK it ultimately all comes down to what a vet is 'willing' to prescribe, and vets still vary enormously in that regard.
     
  57. Pabs&Ro

    Pabs&Ro Member

    Joined:
    Aug 16, 2020
    Thanks. I have spreadsheets for Pabay but they are not in the form you use but I am changing over. I do take 15 min readings when heading to a nadir that I am worried about so my husband is looking at how I can adapt your template to include more frequent readings.

    I have two vets: general and specialist. I think all of us have been on a learning curve.

    PS - the purina md wet pouches arrive today. Cheers for that.
     
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  58. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Ro,

    Your spidey sense is working very well, Ro! :)

    I can really understand - and I've experienced - the conflicts that may arise when a veterinary professional advocates a particular course of action and a crowd of strangers on the internet call it into question (and scepticism is a vital aspect of interacting with the web in general - there is a lot of absolute bilge out there, some of it toys-in-the-attic, some of it downright dangerous) so I've been thinking about how to better explain the basic mechanics of why a single, long-acting insulin is effective in the management of feline diabetes. I think perhaps taking things back to first principles might be of benefit.

    Put simply, there are two ways that BG levels increase:

    1. When food is ingested.

    2. When the liver releases glucose from its reserves into the bloodstream to provide the body with energy to maintain metabolic processes between meals.

    Humans are omnivores. When we eat, the carbs which form a regular part of our diets spike blood glucose levels for a couple of hours after meals. That's why human diabetics need bolus insulins. (Their basal insulins deal with the sugars released from the liver between meals.)

    Cats are obligate carnivores. Their metabolisms are completely geared towards a high protein diet with moderate fats and negligible carbohydrates. The cat's body can utilise other macronutrients to produce all its glucose needs.

    Feeding a cat a species-appropriate, low-carb wet diet means that it won't get big spikes in BG after meals. (Feeding smaller, more frequent meals also helps minimise food rises.)

    Because the rate at which glucose enters the bloodstream - from ingested food and from the liver - is relatively even in cats fed a low-carb diet, the 'steady trickle' from the insulin depot formed by basal-type insulins like Lantus and Levemir is perfectly adequate to meet the cat's BG regulation needs right throughout the day. A single insulin is all that's needed. (Note: it does take a little while from start of treatment to arrive at the dose which establishes a depot sufficient to meet the individual cat's insulin needs.)

    By way of comparison, intermediate-acting insulins (e.g. Caninsulin/Vetsulin, Novolin N) typically drop BG levels quite hard and fast in the hours immediately following administration but then peter out several hours before the next injection is due. Rather than feeding mini meals throughout the cycle, a substantial feed is given 20-30 minutes before dose administration to 'front-load' the cat with food - essentially forcing up the amount of glucose entering the bloodstream - in readiness for the insulin's most powerful period of action. The rest of the food for the cycle is usually given in the next 6-7 hours before the dose fades. This is sufficient to support normal metabolic functions and helps keep weight on the cat (the body can get the full benefit from nutrients while the insulin is active) but the cat may spend part of each cycle in higher than ideal numbers. Regardless, even here a single insulin is all that's required, you simply adapt the feeding schedule to match the insulin's action profile.

    I hope you find the above helpful.


    Mogs


    (Note: The above is somewhat simplified and ignores factors like bouncing which may temporarily elevate BG - because they are temporary. It applies to the overwhelming majority of diabetic cats, not those with exceptional complications, as briefly touched upon earlier in this thread.)
     
  59. Pabs&Ro

    Pabs&Ro Member

    Joined:
    Aug 16, 2020
    Hi Mogs. V helpful thank you. Pabay is a grazer and i think that's why caninsulin is not working.

    Pabay knows all about the impact of bouncing. He has just hit 33.8 mmol! We know why and just need to get him off caninsulin asap.

    Thanks for all of you valued assistance. Very kind of you.

    Ro is Pabay's sister rona. I am Julie.

    Thanks
     
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  60. Pabs&Ro

    Pabs&Ro Member

    Joined:
    Aug 16, 2020
    Mogs Can i ask your view on this please? My vet advises to do a bg curve not before 7 days after a change in dose. I appreciate caninsulin will have a build up in the system even though its fast acting. Do you think a meaningful bg curve can be done earlier than 7 days? Julie
     
  61. Critter Mom

    Critter Mom Well-Known Member

    Joined:
    Jun 16, 2014
    Hi Julie! So sorry about getting your name wrong. :oops: I'll do better going forward.

    That's fair enough advice from your vet. Julie. It does take a few days for a dose adjustment to 'settle' before you can get a proper picture of how effective it is, so vets normally recommend waiting a week before running a full curve. You can still get your preshot and nadir checks for each cycle as usual to make sure it's safe to give the insuiln injection and that it's not taking Pabay too low. Obviously if you'd feel more comfortable, there's nothing preventing you from doing an additional full curve earlier than 7 days if it would give you more peace of mind.


    Mogs
    .
     
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