New member (24/07) - advice please/switching from Caninsulin to another insulin?

Hello everyone! I'm Jo and my lovely 5-years-old cat Misso was diagnosed FD on the 24th April. Under the advice of my vet, she (my cat) started on Caninsulin with 1.5 unit twice per day. Over the weeks, her dose was increased to 3 units since her BG had not been improved. My concern is that I started to see some blue numbers in Nadir with 3 units, but I got red numbers which I didn't see on 1.5 and 2 units. My vet told me that we are on the right path, but Misso is still lethargic, so hungry and drinks intermittently a lot of water.

After surfing this forum, I found there are many people who don’t recommend Caninsulin because of its slim chance of remission. I was quite shocked, because my vet told that Caninsulin is the best insulin for cat... So, I think of switching to another insulin if it is better for my cat. But, honestly, I’m not sure at all whether I should be more patient with caninsulin before getting a better result or just switch to another insulin (ex. Lantus or Prozinc) before it’s too late. I really want to do the best for Misso, but at the same time, I’m concerned that my decision could worsen the situation... Maybe that's also because I couldn’t get enough information from my vet.

So, I came here to get your advice.

Here is Misso’s spreadsheet. I stayed up all night tapping her BG numbers from the beginning. :’D

https://docs.google.com/spreadsheet...IGHeate_lXydX8EKedMkQmM4F36U4N6z0eB3e/pubhtml

Could we say that caninsulin works well in her case?

I found that the duration of insulin on her ends at about +8 or +7. Since then, her BGs always come back to high until next shot, such as the bounces she got these days (21,22,23 July). I am worried that during this bounce hours her pancreas couldn’t get enough rest. Is it a normal process to remission? Or is there anything that I’m doing wrong? Should I reduce or increase her dose?


(And I already asked about this to my vet, but he told me it’s normal that she got the high number and that simply means she is not yet in regulation. He said that just so I should continue the same dose 3 units until our next test of fructosamine (at the middle of August) and that the only one thing to look after is not giving her a shot when she gets the number under 100mg/dL...)

Or do you think it will be better to switch insulin?

I’m in France, so what I can try to get here is Prozinc and Lantus. I considered Lantus first because it is an insulin depot. But I have heard that it will be better to try prozinc at first before going to a human insulin (Lantus). Is it true?

I can try to change insulin after coming back from a holiday trip (~16 August). If it’s the case, is there something to prepare or to take care of before switching insulin?

Sorry for bringing too many questions here at a time.

Thank you,
Have a nice day, <3

Jo&Misso

 

Hi Jo and Misso and welcome to the forum,
You are absolutely not asking too many questions….it is the way to learn…so ask away.
Caninsulin is a dog insulin so is definitely not the best insulin for cats. I have a friend who lives in France who had a diabetic cat and she said the vets there didn’t know much about diabetic cats and their treatment.
My suggestion would be to definitely swap to lantus which is a great insulin for cats and we have a lot of people who use it here so you will get lots of help and support….there is no need to swap to prozinc before Lantus.
You are right. Caninsulin only lasts up to 8 hours and then the BG shoots back up.
Lantus is a longer lasting more gentle insulin and will last up to 12 hours. And you will get a longer duration. So Misso will be in better numbers longer.
With the caninsulin, are you testing then feeding 30 minutes before you give the insulin.?
Are you giving snacks during the cycles? I would give two or three snacks in the first 7 hours after each dose.

Those BG around 81 on caninsulin indicates the dose it too high. I would reduce the dose back to 2.5 units now before you do the swap to Lantus. You do not want to be dropping under 90 when on caninsulin. The red BGs are indicating Misso is bouncing, most likely from lower BGs as well.
Don’t feed for the 2 hours before the pre shot BG so the BG will not be food influenced.
I hope I have answered all your questions. Please keep asking them, we are very happy to help you,
Bron

 

Yes Switch to Lantus.

 

I totally agree with Bron and Elise switch to Lantus and you will need to get U-100 syringes with half unit markings to use with lantus . What a sweet face Misso has

 

I would go to a generic glargine insulin rather than the name brand Lantus since the generic us a lot less expensive.

 

Thank you all for your reply and your warm welcome!
Your answer is very helpful for me, thank you again!

Ok, I will try to switch to Lantus.

And I do have some more questions :

For the dose of caninsulin, I decreased to 2.5 units from this morning shot. Her BG was 258 at +5, and 341 at +11. Should I continue giving this dose? Or would it be more suitable if I try 2.75 units (or 2.8 units) for PM Shot?

Yes, now I'm testing her BG first and feeding her 30mn before giving the insulin (if her BG is above 260 at+10,+11, I pass the test pre-shot). No food before 2 hours of pre-shot. I'm giving some chicken breast baked in oven as snack after her nadir (+6~+10). Is it okay for her BG?

If I see another vet to buy Lantus in the city where I'm going to stay for vacation, would it be too rash?
In fact, being frustrated about the fact of giving my cat Caninsulin and about my vet who thinks Caninsulin's the best choice, I wish to switch it as soon as possible...


Now I totally understand what your friend has said about the vets in France. I've even seen in my town another vet who states that the diabetic cats, once diagnosted, have very little chance to be in remission... It's quite discouraging being difficult to find a reliable vet for my cat here.

 

Thank you Diane Misso is my first cat in my life and we met in an animal shelter when she was 5 months old. I'm deeply feeling a love in her eyes when she looks up me like that photo in my profile.
I will switch to Lantus as your advice. And I'm already using U-100 syringes with half unit because I can't have found shorter needles U-40 syringes.

 

I didn't know there is a generic glargine insulin which is cheaper than Lantus. What's the name of generic insulin ? How much difference is there in price?

 

Oh my God, I can see the love she has for you in her eyes, I just want to kiss that face Tyler's brother who has passed used to look at me the same way ,I'm not kidding.
When you get the lantus I would post that you have it and the more experienced members will advise what dose to start with. I'm not that experienced when it comes to dosing. You will really like Lantus
My Tyler is in remission since 1-24-21 thanks to the advice the members here have given me. Give that cutie a kiss for me

Don't forget to fill in today's date on your SS

Are you still feeding any of the Roal Canin Diabetic Wet?

 

The generic for lantus is basaglar
You can call some of your pharmacy's and ask
I wouldn't know what the price difference would be in France

I also found this posted by one of our members
Lantus is available in France.
This is the one you want. You use the cartridges the same as you use a vial. This box will last at least a depending on the dose.
https://www.journaldunet.com/econom...ents-les-plus-vendus-en-france/1020139-lantus

We use the pens just like a vial , just stick the syringe in the gray rubber stopper and draw out your insulin
Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen!

 

You would get the cartouches in France
Just keep the 5 of them in the fridge middle shelf
each on should last at least 6 months depending on the dose
Found this too if you ever need it


There is a list of European cat food at the bottom of the UK food list.

• UK Diabetic Cat Food Info (includes some supplies) and UK Cat Food List

A number of people have ordered from zooplus.com. Free shipping to France above 49 euros.



Just be sure you have med and higher carb food in case you ever have to bring her BG up and honey
MC is medium carb - 10-15% carbs
HC is high carb > 15% carb

 

Glargine is the name of the generic for Lantus. The name of the actual generics is Basaglar as Diane mentioned.

This is a link to a paper from the American Animal Hospital Association that recommends either Lantus (glargine) or Prozinc for treating feline diabetes. In the US, vets can't sell drugs that are for humans. Thus, Lantus (glargine) needs to be purchased at a pharmacy. Prozinc is an animal insulin and can be sold by vets.

 

Jo, when did you swap to U100 syringes? Are you aware that the U 40 and the U100 syringes are different sizes and therefore give a different dose of insulin?
If you are giving 2.5 units of caninsulin with a U100 syringe, it is actually 1 unit of caninsulin if you were using a U40 syringe.
This is fine as long as you are aware of this but you do need to be cautious.
When you do the swap over to Lantus, you need to tell whoever is helping you that you are using U100 syringes and the actual dose of caninsulin is 1 unit ( not 2.5 U)
Does that make sense?

 

@Jo&Misso
Important
Please be sure to read Bron's post #13 right above this one
All the post numbers are to the right side of everyone's posts

 

I'm sorry. I should have told you that.
Yes, each shot time, I'm checking the dose based on this chart (I printed it and placed on the wall of kitchen): http://felinediabetes.com/insulin-conversions.htm
I'm giving to her 6.25 units with U-100 (=2.5 units with U-40).
I will put that in my signiture and my SS. And I'll be more careful for my description in the next time. Thank you!

Thank you also Diane and Sienne for informations!<3

 

I’m glad you have the conversion chart and are using it. I was mainly concerned when you do the swap over that there would be a misunderstanding about the correct dose…but all good.

 

Update after vet visit :
I didn't know that changing insulin is so hard here.
I found an another vet who use Prozinc and (occasionally) Lantus, but sadly my try to change the insulin was failed.
The vet didn't want to prescribe Lantus because Caninsulin works pretty well in the case of Misso (vet's thought).
She suggested to continue with 2.5 units of Caninsulin for now. Then she said she would consider of switching to another insulin depending on the number of fructosamine in the next consultation.
I won't to return to that vet. Instead I would try looking for another vet after this vacation.
Therefore I'm obliged to continue Caninsulin until finding a solution.
Before switching, could you give me some dosing advice according to Misso's SS?
I'm giving 2.5 units (=6.25 units with U-100 syringe) and her BG seems not to be regular in these days.

Thank you in advance!

Sorry Diane, I missed your reply...! I'm sorry for Tyler's brother... I can imagine his lovely eyes to you. He must have been the most adorable cat in the world.
For your question about Royal canin Diabetic wet food, I no longer feed that to Misso. I'm giving now Granatapet, Animonda and wild freedom. She loves this.

 

@Bron and Sheba (GA)

@FrostD

@Jo&Misso
I'm glad you are going to look for another vet after your vacation
Who will be watching Misso while you're away, will someone be testing her
Can you add you are from France in your signature
You can just put France just tap on your name above ,then tsp signature and add it

 

That's ok
Here was my Perry

 

His nadirs are right where you want them, so I would hold the dose. I suspect he'll earn a reduction soon by dropping under 90.

He doesn't look TOO bad on Caninsulin, it's hard to say if it's too harsh for him, or if he just needs to get used to it and stop bouncing up to those higher numbers. Did the vet actually look at your spreadsheet? Fructosamine tests are a poor way to judge dose and if an insulin is working "well"....

 

Thanks your reply, Diane. Aww Perry He was really adorable boy. My heart melted with his sweet face
My boyfreind will be here to take care my cat when I'm away. Anyway he is obliged to stick at home because his butt is on fire due to the deadline of his book project.
Ok, I put my location in signature

 

Thanks for reply, Melissa!
Yes, I shown the spreadsheet to the vet in the last visit. But it seems to me that the vet thinks fructosamine is more reliable than "home testing". So I won't to return to there.
About the bounce, the vet suspected "Somogyi effect".
In fact, Misso drank more with 3 units of caninsulin and it decreased after reducing her dose to 2.5 units.
But her bouncing is still returning. She had 415 @AMPM today morning. Would it be possible to have the nadirs too low yesterday night? Do you think I should test after +6 to see the full glycemic curve?
I found that her BG curve of yesterday (2022/08/01) wasn't harsh and then there was no bounce at PMPS. Maybe could I try to reduce her PM Shot dose to 2.25 units? Or should I wait more?
I would like to know how get out of this bouncing cercle...
Thanks again

 

Ah the ol' somogyi myth (the majority of us here consider it to be a myth, as it was never proven in cats and based off a very small study of humans quite awhile ago). The Somgoyi effect, as it was hypothesized, is a dangerously low drop in BG (hypo levels) that occurs at night, at a result of a combination of factors - too much insulin, not enough food, etc. So theoretically would it be possible? Sure, if you're not dosing properly - but then it would be both a day and night problem. But with testing and methodical dose adjustments it shouldn't be an issue.

We prefer bouncing, which by our definition is when they drop lower or faster than they're used to, not necessarily dangerously low as in Somogyi. And it can occur any time of day. Which cats bounce and under what conditions is totally dependent on the individual cat....but it's a pretty safe bet that if you see a drop about 1.5-2 colors (or more) on the spreadsheet or more, you'll probably get a bounce. So a drop from 300 to 100 will almost surely result in a bounce, even though 100 is a perfectly safe number.

The only things you can do to alleviate bounces are (1) wait it out, it takes time for their body to adjust to lower numbers and/or (2) try to tweak the carb amount in the early part of the cycle to slow the bounce. Now sometimes both turn out to be fruitless, especially with an insulin like Caninsulin. But we say give it about 3 months.

For most cats it's best to give the same dose. He did not go much lower than that 123 you got last night, so the dose is still safe.

 

So interesting. Oh, I really learn a lot here! Thanks for your explanation. Now I think I could be more patient about her bouncing. Also I would try to get Lantus as soon as posssible after my vacation...

And fresh news: she got the low nadir number (84 @+4 pm) just now.
I'll check for +6 pm to be sure, but do you think I should reduce her dose for next AMshot according to the BEGINNERS GUIDE TO CANINSULIN?

 

As predicted! Lol I would reduce by 0.25U. That's your new dose for at least a week, unless she drops below 90 again. At the end of the week we can re-evaluate.

As far as the switch, realistically I don't think Lantus will be sustainable long term if you can't source it reliably. When is your vacation?

 

Good luck with the reduction

 

Ok! I reduced her dose from the AM shot in this morning. Looks like she was feeling better today! And I think she did pretty well for the first day of reduction: 316@AMPS, 161 +4, 157 +6, 321@PMPS, 115 +5.
We'll see at the weekend!

I'm now on vacation and will return home on August 16th. I think it wouldn't be difficult to buy Lantus in France if I can get a prescription (impossible to get insulin without prescription). The difficult thing is to find here a vet who can agree with switching to Lantus. Unfortunately the vets I've met here were so stubborn...

I made an appointment with an another new vet (called as a only cat and rabbit specialist vet in my city) on August 24th. I would like to try until I can get the insulin I want. Meanwhile, I'll do my best with caninsulin!

Thanks! I'm crossing my fingers!

 

Hi @FrostD I hope you had a nice weekend.
I wanted to come back here in last weekend but I've been too busy.
If you have time, could you please take a look at Misso's ss ?
I had reduced to 2.25U as advice but from 08/05 PM shot I'm giving 2.3U (about 5.8~5.9U with U-100 syringes) due to increase in drinking and pee.

And her BG numbers was weird today.
This morning I got up early by the crying of Misso. I guess she was so hungry. I gave her some wet food (Granatapet chicken 20g) and I got +11 of PM Shot. It was 151 and 155(26 mn later). I was a little hopeful when I saw that numbers but it didn't last long because her AMPS number rised to 232.
After AM shot, her BG number didn't go down unlike her usual curve. Her nadir was 190 @+8 and then two hours later it was 317 @+10 and the PMPS was 389.
She's now drinking a lot even after PM shot.
Is it a good sign that she got the blue numbers until +11 with caninsullin? Then why her nadir of today is unusual? Should I increase her dose according to the BG numbers of today?
My feeling of day is actually depending on her number and each day I feel really overwhelmed... I'd like to get your opinion or any advice.


Oh and the vet of my town who had prescribed with Caninsulin has just colled me in this evening to know Misso's news. I told him about her numbers of these days and he said Misso looks like to be in the regulation. Is it true what he said?
I asked also if it's possible to change the insulin. He said "yes, but it would be an another veterinary insulin". I asked the name of that insulin but he said he'll tell me at the next visit. Hmm...Anyway I guess it would be Prozinc.
About Glargine, he said he dosen't prefer that because its duration is not really 24h according to his experiences. I was quite disappointed after this call but maybe I would can persuade him if I persiste...? Because I feel he doesn't want to lose us as his customer...

 

Benny's initial vet, who we have used for years and really liked, said that Prozinc was the only thing he would prescribe. He is not stubborn, but was stubborn about this. So we went to another vet. She was just going to continue the Prozinc until I asked her for Glargine. She said yes, and gave us Glargine. Sometimes you have to be very specific with them, in a friendly way.

Lantus is a veterinary insulin; it is sold for humans, but also for pets. Here is a vet pharmacy I use: https://canshipmeds.com/search-3/?drugName=lantus solostar pen for pets (insulin glargine)

Vets have to know every condition in cats, dogs, rabbits, and others. I don't blame them for not knowing it all. But on this board there is a lot of expertise on only one thing, feline diabetes.

 

I guess technically you could consider him "regulated"...but definitely could be much better.
https://www.felinediabetes.com/FDMB/threads/what-is-regulation.214777/

The trouble is all that time above renal threshold (200-300) will wear on her kidneys over time. He actually isn't doing too badly, so I wouldn't push the vet too much just yet.

I would give it another day or so, and if nothing below 130-ish, I'd go back up to 2.5U (or whatever is closest on your syringes...2.6 might be too much though)

Also - I suspect.your vet is misinformed on Glargine. It is dosed twice daily in cats, not once. So not quite sure why the vet mentioned 24h duration... probably thinking of dogs, possibly humans.

 

Hi Catherine. Yes, you are right. They too want to be respect as specialist. It's true that sometimes I was so impatient about the problem of switching with the vets. So, to them, I may have looked very stubborn...
Thanks for the link of pharmacy but sadly we live in France.

Yes! Getting here is one of the best things I did in this year! So precious

 

Thanks again for your reply, Melissa!
I'm scared about the renal issue you mentionned... Sorry for it agaist your advice but in this morning, she got the high number (398 @+11, 376 @AMPS), so I decided to give directly her 2.5 units.
And now her BG is still so high and even rised. I don't know what's going on. Even it was not furshot. The one thing I suspect is the new vial I opend on last Saturday. When I had bought that on July 12th, there is already some white flakes in liquide. I kept this vial because the vet told it was not problem to use.
I'll buy a new vial here in afternoon. I really hope it was just problem of old vial.

 

It looks like she is bouncing, very normal for any insulin, don't be scared!

White flakes are normal with Caninsulin, it is why you have to shake it to mix it up. Are you shaking to mix well before you draw up the insulin? (Note for lurkers, this is specific to Vetsulin/Caninsulin, please follow the directions on the insert for your specific insulin)

If you haven't been, let me know. Will have to be very careful with next shot. If it hasn't been mixed properly, chances are you're drawing up "weak" insulin, and if you mix it then the dose will be too high.

 

I'm sure you don't look stubborn at all! You seem like a very nice person. I hope your next vet listens better to you and Missou!

 

Oh it was scared...! So I don't need to buy a new insulin vial?
Yes! I'm shaking the insulin until I can see the cloudy liquid. But is it still normal even if there is some white flakes in the vial after shaking? (The last old vial I used on July and June wasn't like that.)
And just few minutes ago, I got 298 @+6. It's going down very slowly.

 

No I think the insulin should still be good. Do you have the insert? I think it explains how to tell if it's gone bad. But based on your BG data it's still working just fine

 

You are right. I didn't think of the insert.
That's the photo I taken on July but that vial is still like that even after shaking.

 

There should be no flakes after shaking. The flakes are likely clumps of the insulin particles. Such clumps, if insulin particles, would result in the liquid have less concentration of insulin. Also if you get the flakes in the insulin into t he syringe that could result in injecting more insulin that you measured. Only a s a last resort would I use an insulin with unknown flakes or if the flakes are clumps of insulin.

 

Yeah flakes that size are not normal. Have you checked your fridge temp? I am wondering if perhaps it is a little too cold and it can't fully mix.

Like Larry said, I wouldn't be using it either with flakes/clumps like that.