UK - alternatives to caninsulin?

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highmaintenance

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Newly diagnosed moggy on Caninsulin in Berkshire, and I'd love to hear from anyone in the UK who is using something other than caninsulin such as Lantus or Levemer.

How and where do you source it from?
Did your vet need convincing to provide prescriptions?
Does your pet insurance cover it?

This is as a result from my first thread here: viewtopic.php?f=28&t=81406 which has more info about my situation.

Thanks!
 
Hello Jeremy,

I use Hypurin Bovine Protamine Zinc (Hypurin PZI) for Bertie. He's doing really well on it, but 'every cat is different'. I understand that Lantus (aka 'Glargine') is used in the UK too.

Little bit of history for you... There used to be 2 main insulins used in the UK, Caninsulin and Insuvet PZI. Caninsulin has nearly always seemed to be the one that vets prescribe initially. But Insuvet PZI was preferable for a lot of people for a lot of reasons. Unfortunately, Insuvet PZI was discontinued fairly recently, and now many vets seem to feel that Caninsulin is 'all there is'. Some cats that were on Insuvet PZI have had to go back onto Caninsulin.

My vet wanted me to go back onto Caninsulin too, but I said hell would have to freeze over before that could happen... So I looked around and by sheer good fortune got into contact with a vet who had previously been a chemist working on animal medicines. He told me about Hypurin Bovine PZI. It's made for humans but is actually very close to a cat's own insulin. So I printed off some info from the net and trotted off to my vet with that... He only agreed to get it for me because I was hometesting. Hypurin has a longer duration than Caninsulin and my vet needed to be able to trust that I was sufficiently competent to be able to test before each shot to ensure that my cat did actually need the insulin. In fact, mostly my cat still has his shots twice a day (although through the summer he managed many days on just one shot....)

Hypurin PZI is pricey (our last one cost around £80) but I've found that, properly stored, it lasts a very long time. We had the previous vial for nearly 6 months and it was still effective.

I also considered Lantus/Glargine, but really wanted to stick with a Protamine Zinc insulin if I could.

Is Caninsulin not working well for Tertiary?

If you can show that the Caninsulin isn't working then according to the 'cascade'(?) system of prescribing I think the vet is bound to try to let you try something else....
 
One thing that is important to note with the Bovine PZI is that studies have shown that it's not as effective as Lantus (glargine) or Levemir (detemir) because it does not have a duration of action that is much longer than Caninsulin (lente). Lantus and Levemir should be your first choice insulins, and PZI second. The human recombinant Prozinc that is available in the US has a better duration of action than the bovine PZI (thus offering better control), but still not as long as Lantus and Levemir.

There have been absolutely no studies that have shown bovine insulin works better for cats because it is more similar to feline insulin--in fact, studies have shown the opposite, that long acting human analogs work better because their longer duration of action allows for full, 24 hour glycemic control when given twice a day. There was a theory floating around for a while that cats on human insulins would develop more anti-insulin antibodies than on a bovine insulin, but that theory has been disproven by more recent studies.

Here is a link to the Caninsulin dosing protocol: http://www.uq.edu.au/ccah/docs/diabetesinfo/link2.pdf. Note where it says "Lente is the 3rd insulin of choice and NPH the 4th of choice insulin for control of diabetes mellitus in cats, behind glargine or detemir (1st choice) and PZI (2nd choice), Lente and NPH result in lower remission rates compared to longer acting insulins." I believe vets are required to first prescribe a vet insulin in the UK before they can prescribe a human insulin, but your vet has the option of prescribing Lantus or Levemir if Caninsulin does not work well (and it only works well in about 25% of cats). You may have to do some convincing, or find a vet that has experience with prescribing one of them. I would direct your vet here for more information: http://www.uq.edu.au/ccah/index.html?page=41544

There is a window on remission with Lantus and Levemir, so you want to start them as soon as possible. The dosing protocol I provided recommends staying with Caninsulin no more than 4-8 weeks before switching, because the best results with Lantus and Levemir are obtained when the correct treatment plan (low carb, canned diet/dose adjustments via home testing) is started within 3 months. Cats that begin this treatment within 3 months have an 86% remission rate, but that number goes down the longer you wait to start.
 
Hi Jeremy, can't give you any up to date info on this as I don't have my diabetic cat any more :cry: but will just say a couple of things:

1. yes, insulin should be covered by your pet insurance (if you're worried, ring them and ask, but it should be absolutely fine); and also

2. this whole situation does depend on you having a good relationship with your vet. Some of us here (myself included) actually switched vets when the existing one refused to listen to what we had found out ourselves and requested a different insulin or course of action. The fact is that most vets are like human GPs - trained in a bit of everything. They may have had one or two lectures on FD if they were lucky, yet as you have seen for yourself, FD is a complex and complicated disease that needs better understanding than most vets are able to offer. There is a vast wealth of knowledge and experience on this board and although members here will never take the place of a vet, the accumulated wisdom is worth listening to and then discussing with your vet in a respectful way. A good vet will listen to you; a poor one will try to talk over you and not try to meet you in the middle. Ideally you want to get your vet on side so that he/she, and people here, can work together to give you the very best of help.

Keep going!

Diana
 
Hi Jeremy,

In addition to what I wrote earlier I just wanted to explain my reasoning for wanting to stick with PZI (which actually has excellent duration in my cat, but 'ECID') rather than switch to Lantus/Glargine. I wasn't suggesting that PZI is 'The Best' insulin per se. Different cats do better on different insulins. There are even cats here who have gone into remission recently on Caninsulin... :shock:

Lantus requires (as close as possible) 12 hourly dosing, which is something I'm not always able to do. Also my cat has a pancreas that switches on and off like a light switch and I need the flexibility of variable dosing rather than the fixed dosing usually associated with Lantus.

In the UK, there are some vets with experience of Lantus (I'm sure there are some London folks using it...?) but most vets will be more familiar here with PZI. It may be that it is possible to persuade a vet unfamiliar with Lantus to prescribe it, if that's what you want to do. Or they may want you to go the PZI route first because that's what most of them know.... Have you asked your vet about this yet? If the vet isn't helpful then, as Diana suggests, you may need to shop around for one who is more sympathetic...
 
Here are some Articles for you to print out and take to your vet:

Study comparing Lantus to PZI and Caninsulin:

Study showing safety and effectiveness of Lantus (and Levemir):
 

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Gosh what a lot of information there is about this to absorb!

Tertiary has been on Caninsulin for less than 2 weeks, so it's not really out of necessity that I'm looking at the alternatives, but a combination of wanting the very best for him and picking up on a lot of negativity about Caninsulin. Plus if anything his levels have gone up since injections started, although it is of course early days so who knows...

Although I've seen several different vets (large, busy practice) they are very approachable, and really helpful. (On diagnosis day one of them spent well over an hour with me despite my having the last appointment of the day, and being late for that in the first place thanks to a hiding cat)...

I will see what they have to say on this, and will be very interesting to hear their thoughts. I will update this thread with what they say :)

Thanks again.
 
Yes, Jeremy, you're right, there is a lot of info... Sorry....

I do hope we haven't overwhelmed you. I think those of us who've been at this game a little while sort of 'forget' what it's like to be new to it. We can be inclined to jump in with info without actually thinking about how it's going to be received.... Reading your post just now reminded me of an instance in my early months with feline diabetes when someone more experienced than I was enthusiastically offered the zillionth suggestion about what I might try to do to improve Bertie's numbers (Bert was particularly problematic...). I just burst into tears. I don't expect you'll do that because you're a bloke (unless you're actually a woman called 'Jeremy' in which case I hate to break it to you, Sweetie, but your parents were probably hoping for a boy! :lol: )

Caninsulin was our first insulin. It didn't suit Bertie. Actually he got worse on it, and he often had convex curves (got higher mid cycle between shots). And his mild neuropathy (weak back legs) got worse too. When I started hometesting and realised what was going on I took the results to my vet and persuaded him to let me try a different insulin. He was willing to change insulins because I presented evidence that it wasn't working.

I know that Caninsulin gets a bad press generally. But two UK cats have gone into remission with Caninsulin recently: One of those after just a couple of months. It might be OK for your cat, and it might not. What will help you to work that out is hometesting... Hometesting is your friend. Learn to love it. It will help you to understand your cat's diabetes and will give you valuable evidence - if you need it - to show your vet that this insulin isn't working. If the insulin isn't working then the vet should (as should your GP in a similar situation if it were you) according to the cascade system, prescribe something else.

There are people on this forum who are absolutely passionate about certain insulins. Lantus has a lot of advocates, as does PZI. And ALL the people here really, really, really want what's best for your cat. Ultimately though it's for you to make the choices about what your feel you need to do. People here make suggestions. Your vet makes suggestions. But YOU are the caregiver. You are the one who loves your cat.

Big hugs to you,

Elizabeth
 
hello again, hope that you and Tertiary are doing well.

Just thought i'd say that, for all its bad press, caninsulin did work for our cat, who has now been insulin free for 11 days (diagnosed start sept). That said, it took probably 4-5 weeks for it to really start to take effect (and Monty was regularly posting numbers in the high 20's and into the 30's during that time), so it may be worth giving it a little time to see if it can work for your cat - and if not, I'd certainly be hot-footing it back to the vet and asking to change as I understand that the first few months after diagnosis are the best 'window' for seeking remission. we also found it pretty easy to store and to inject with the needles (though to be fair I have nothing to compare it to)!

I'm not saying its right for all - as Elizabeth rightly says - each cat is different - but thought it worth sharing our experience too.

Happy to help in any way we can. Let us know how you get on.

Catherine, Monty & crew.
 
Jeremy, there is a lot to absorb, yes, but do it in your own time, whatever feels right for you. You might like to print out some of the info and use a highlighter pen on the bits that are specially interesting or important to you - saves wading through reams of other stuff if you don't need to on second or third reading. Glad to hear you have a good vet or vets, that will make all the difference. And it's true - Caninsulin can and does work on some cats, it's just that it's not the absolute ideal in its actual formulation as it was intended for dogs who have a different metabolism.

Remember what we all say to you - every cat is different, and what works for one may not work for another. It's all trial and error, it takes time, it's a labour of love... it's a real test of your bond with Tertiary.

We really are all rooting for you and if only we all lived nearer we'd be popping round with a bottle (or two!) to show our support.

Diana
 
Thanks again everyone - your words are really helpful and informative, it's much appreciated.

Tertiary is now on 3 units of Caninuslin. Unfortunately he seems to be off his food today, so I've not given him his morning shot. He's spent the day camped out next to his water bowl, making the occasional meow (he's quite a vocal cat in general!). Of course the second I got the glucose meter out he disappeared under the bed even though I was hiding it from view! I'll keep a close eye on him and get him to the vet if need be. He always seems to get ill on a weekend - I expect he's heard it's more expensive then!

I am indeed male, Elizabeth, or at least I was the last time I checked :) The only female in this household is Tertiary's sister, Gucci, who is quite the princess :)
 
Just adding my name to the list of UK members who have had some success with Caninsulin.

However, I do believe this has been nearly entirely due to strict diet control. A good, readily available, low carb UK food is the Whiskas Simply and Whiskas Fisherman's Choice pouches (2.4% - 1.8% carbs). On switching over to these we are now six days into an insulin-free trial, with BG numbers staying within normal ranges. Additionally, I have recently been recommended the Bozita range, also available in the UK. This is again low in carbs, and is of a higher quality than commercial feeds, yet cheaper than the Whiskas food mentioned above.

Don't be too disconcerted by what you read about caninsulin. It can work. It's still early days for you and your furry friend, so don't write it off just yet. As already stated, some cats have done very well on caninsulin, even moving into a diet controled insulin-free remission, with correct food and home testing. Hopefully (anti-jinx!) I might be able to add our names to that list soon.

As ever, blood glucose monitoring is absolutely essential, especially when altering diet to a lower carb food. I only realised how successful diet change had been in lowering Cleo's blood glucose when she went into a hypoglycaemic seizure, her insulin dosage having become far too high. Don't make the same mistake as me - home test as much as possible, right from the start.

Edited to add:

On the subject of Tertiary being off his food today - I've just read through your previous thread, where you mentioned that you were using the time when Tertiary was eating to do his insulin shots. I wonder if this negative association is what is making him wary of eating? Until he is used to the routine of the shots, perhaps it would be a better idea to inject him after he has finished eating, and then give him an extra special little post-shot treat afterwards? Especially with a flightly, nervous cat, you want to be wary of any negative associations he might develop, i.e. if he gets scared of eating because this new and slightly unpleasant experience of being given an insulin jab is occurring as soon as he gets his nose into his food. Better to have him associate the shots with a treat that occurs separate from his regular meal routine.

What do others think about this?

H
 
Helene & Cleo said:
A good, readily available, low carb UK food is the Whiskas Simply and Whiskas Fisherman's Choice pouches (2.4% - 1.8% carbs).
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I would dearly love to change Tertiary's diet, but he is on prescription food unfortunately (Hills Science Plan C/D, dry food) due to his recurring bladder problem. It's supposed to keep the acid level up in his bladder to prevent crystals forming which then block his bladder requiring urgent hospitalisation. It was happening every 6-12 months, but we're currently in the longest yet trouble free period. After the last time I started giving him only ever filtered water, so I wonder if this is what's helping - even so I can't quite work out whether it's worth the risk bladder-wise to start giving him a food that would be better for the diabetes. Part of me wonders whether it might have been this prescription food which brought on the diabetes. My vet actually says that she thinks the dry food might actually help as it is slower release than wet food. Anyone got any thoughts on any of these points?

Helene & Cleo said:
I wonder if this negative association is what is making him wary of eating?
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It could be related couldn't it? The difficulty I have is that post meal he's got into the habit of disappearing rather quickly, so giving him the shot during his meal is the only way I can guarantee he is going to get it around about food time. He really is incredibly high maintenance, and if I tried to shut the door to prevent him running off afterwards, he would panic and almost certainly do a protest wee to show how scared he was. :(
 
Poor little chap, I do feel for him.

The issue of food is such an important one so what about giving a mixture of wet and dry, and see what happens...?

Diana
 
highmaintenance said:
I would dearly love to change Tertiary's diet, but he is on prescription food unfortunately (Hills Science Plan C/D, dry food) due to his recurring bladder problem. It's supposed to keep the acid level up in his bladder to prevent crystals forming which then block his bladder requiring urgent hospitalisation.....I can't quite work out whether it's worth the risk bladder-wise to start giving him a food that would be better for the diabetes. Part of me wonders whether it might have been this prescription food which brought on the diabetes. My vet actually says that she thinks the dry food might actually help as it is slower release than wet food. Anyone got any thoughts on any of these points?
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I'm not at all an expert on the subject, but I do know that one of the most important things in respect of renal problems, bladder issues and urinary tract infections is hydration - and dry food will not help keep your kitty hydrated. I think that a switch to wet food could be of benefit to the urinary/ bladder issues also. The use of distilled water is a great move though, as mineral content/ hard water certainly seems to play a big part in the development of bladder crystals and urinary tract problems. Have you considering investing in one of those kitty fountains, to try and encourage Tertiary to drink more water and keep himself hydrated?

I wonder if there is some sort of supplement that could be added to a low carb wet diet which would have the same effect as the Hills prescription C/D dry food is intended to have? Having just read a bit about Hills C/D food, the only thing that really seems to differentiate it from other foods is the fact that it contains a urine acidifying substances, namely DL-methionine, 1.25mg/kg of food. Doing a quick Google search tells me that this substance is available for purchase separately - so in theory it could be added to a more diabetes friendly diet; this is perhaps something that warrants further exploration. I am also aware that you need to be careful with the protein content of a diet for a cat with kidney issues, but am unaware of the exact details of this subject - again, further research needed, but certainly important to bear in mind also.

This info is all just from what I've been reading online, so please do speak to more knowledgable people, and do your own research before doing anything - and also speak to your veterinarian, explaining what you've discovered; vets can be educated too!

I know that there is a type of cat litter available that changes colour depending on the pH of urine, or you can easily get hold of some cheap pH test strips - this could help you keep track of the acidity of Tertiary's urine whilst switching over to a wet food. That, along with regular BG testing, could prove invaluable towards finding a happy medium between caring for both the diabetes and the bladder problems.

Alternatively, and perhaps to be used alongside both the pH and BG testing, I notice that Hills C/D food is available as a wet tinned food also, with an as fed carb content of 6.7%. This would certainly be an improvement on the dry variety at any rate. Although the common consensus seems to be that the Hills prescription diets are pretty much crap, a wet version of a crap food is infinitely better than a dry version of one!

Here are the links for the two varieties of Hills C/D wet food:

http://www.hillspet.co.uk/en-gb/product ... pouch.html

http://www.hillspet.co.uk/en-gb/product ... anned.html

And finally, regarding the part you mentioned about your vet stating that a dry food could be better for diabetes management than a wet food due to it being a 'slower release' food - I'm sure many others will echo my sentiments of utter boll*cks! The amount of carbs contained in the C/D dry food - 40% as fed - is still huge in comparison to a wet food diet; regardless of how slowly those carbs are released, they are still released, and there are still many more of them than there would be in a wet food.

Again, I'm no expert, and I'm not suggesting you make any drastic changes without prior consultation with someone more experienced than me; except perhaps to switch over to the Hills Wet C/D food as long as you are regularly testing blood glucose, and to start testing the pH of Teriary's urine also, for advanced warnings of any bladder issues.

Good luck!

H
 
Just an update from Jeremy and Tertiary. On Sunday, Tershy didn't eat in the morning, and during the day started getting very lethargic. His BG was 21.5 in the afternoon, and he was just getting more and more sleepy. Whisked him into the vet! They are trying to stabilise his levels (currently ranging from 12-35mmol at seemingly random times) and are insisting that 3 weeks is too early to jump to another insulin, but it remains a possibility. In the meantime, he's on a drip, is being constantly monitored and receiving round the clock treatment so at least he is in good hands. I don't want to push the vet as the one we've been seeing seems incredibly knowledgeable (she is aware of everything point I raise, and has even mentioned conferences she's been too on the subject, when for example someone came over for Australia to give a talk on new findings), but I am feeling useless at the moment, and just want to be helping rather than just waiting.

I'm going in to visit him every day, and have taken in bottles of filtered water labeled up with his name.

On the food issue, they have been giving him a mixture of a high protein low carb diabetic diet wet food, and some biscuits.

I've attached a couple of pictures of him. As always, any thoughts about his situation would be most welcome and gratefully received. Thanks all, J&T
 

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Crikey, Jeremy - I wish I had something helpful to say but all I can really say is to agree with you that at least Tertiary is in good hands, and it's excellent that you have such faith in your vet. I'm glad you are going in to visit him. Maybe you could take a little blanket of his, or something of yours - anything that smells and feels of home, it will help it feel less strange for him.

I really do hope for some good news soon. Maybe you could start a new thread asking for positive vibes from others on the board - it has been shown over and over how powerful positive thought can be in making a difference to these dear little ones.

Get well soon, dear little Tertiary!

Diana
 
Oh, Jeremy, poor you; you must be so worried. But you've acted quickly and done all the right things.

We're holding you and Tertiary in our thoughts and hoping that he'll be back to normal really, really, really soon.

(((Hugs))) from Surrey

Eliz
 
Hi,

My cat was on Caninsuline for 3 days and now we are on Humuline 30 (mixtard 30) and in 2 months he has BG values like 100 (from 400), eats wet food. We hope to remit.
I find interest to compare BG spreadsheet and analyze. Keep you updated.
Regards,
Mihaela
 
Just a quick update - Tertiary is now back home and doing ok. 26.5mmol this evening, and he is on 5 units of Caninsulin. Bit of a panic earlier as his reading was 2.8mmol - but he seemed fine, and I think it was just a dodgy reading (the blood didn't properly immerse the corner of the strip).

Still, will be doing another test tomorrow morning, and ringing the vet to discuss before injecting. I think I'm starting to get the hang of testing now, and the vet has coached me to be a bit more committed with the prick as she thinks it's kinder to ensure there's a drop of blood in the first go, rather than having to take several stabs at it :-|
 
Very glad to hear Tertiary is back home, Jeremy, and that you're getting the hang of things. Yes, an unusually low reading is often 'false' for one reason or another so well done for working that one out!

A reading of 26 on 5 units does show that there is still work to be done with the dose/insulin. Did Tertiary have a proper curve done at the vet? You mentioned the other day that his numbers ranged from 12 - 35 at random times - these times should have been plotted by the vet at certain intervals to give a clear idea of how the insulin is working, at which point it's easier to see if the insulin you're using is a) being given in the right dose and/or b) the right one!

Keep at it though, I'm glad you're talking to your vet, and do come back here and let us know how things are or if you want anything clarified.

All the best
Diana
 
Phew - glad that he is back home where he belongs. Sounds like your vet is on board too.

We were able to set up a texting system with our vet so that we could more precisely adjust Mootle's dose of insulin to his BG test score - might be worth discussing if they're open to it.

How long has he been on 5 units?

x
 
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