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Lantus Cats Remission

Lantus And Remission

Lantus And Remission

Our vet says that Lantus is the best bet for remission for our newly diagnosed cat, Sunnie, especially since we caught his diabetes early. Has anyone had remission success with this expensive drug? If so did your cat have to go back on insulin later and did you continue to use Lantus? In my opinion remission depends on the cat. Some respond well to lantus, some don't. Every cat is different. The best way to think of it is humans with medication. What works for some may not for others. It also depends on other things you do to treat the disease. I have no experience with Lantus. Hidey used Prozinc and with Prozinc (costs us about $80) and diet change he went into remission in about a month. We caught his early, started him on insulin, changed his diet, and had his dental done and 2 extractions. DO NOT CHANGE DIET UNTIL YOU ARE HOME TESTING. Diet can drastically reduce bg. If you keep track of numbers by home testing, keep on a low carb diet, know their are no underline causes remission is very possible. Staying in remission depends on the same factors. Once in remission you cant say "lets try this high carb food" Its a lifestyle change. There are clinical research trial that achieved remision in a large number of cats on Lantus. And there is the experience of the members of this board who have achieved remission on Lantus, Levemir, ProZinc, PZI, ... A great deal of it has to do with the availability of the person to do home blood glucose testing on a regular basis and a commitment to making a food change to low carbohydrate canned or raw food. Sometimes, this means going against what your vet recommends and even pushing for something different. We recommend testing with an inexpensive human glucometer and inexpensive test strips, not the expensive pet meters and expensi Continue reading >>

Controlling Diabetes In Cats Is About Quality Of Life, Not A Number

Controlling Diabetes In Cats Is About Quality Of Life, Not A Number

By Elaine Wexler-Mitchell | Orange County Register Ive felt extremely frustrated with the treatment of my diabetic patients over the past five years. I read veterinary journals and go to continuing education programs on feline diabetes, but I dont get the rates of remission or the tight control of blood sugar readings that have been promoted in academia and publications. I spoke about this with another feline specialist, Dr. Gary Norsworthy from San Antonio, at a conference in February, and he agreed with me. I then contacted all of the other American Board of Veterinary Practitioners feline practice specialists there are 87 of us and found that most of them shared my feelings about diabetic regulation. In September, 15 boarded feline specialists got together at the annual American Association of Feline Practitioners conference for a roundtable discussion on the management of feline diabetes. It was a fabulous opportunity for those of us who treat diabetes every day to discuss what is and isnt working. The best part of the roundtable was sharing our practical experiences and pooling data from our clinics. We compiled almost 300 cases and performed statistical analysis to evaluate our findings. We felt that our private-practice patients did not correlate to those seen at university referral institutions and that we deal with more cases of diabetes than the internal medicine specialists at universities do. Almost all of us have been using Lantus insulin, a human type of insulin, to treat our feline patients. When this insulin was first recommended for use with cats, the results from small studies at universities showed some amazing responses and frequent remission of diabetes. The reality is that in practice, we are only getting diabetics into remission about 25 percent Continue reading >>

Feline Diabetes Mellitus: Keys To Remission

Feline Diabetes Mellitus: Keys To Remission

Diabetes mellitus is a common endocrinopathy for middle age and geriatric cats. The majority of feline diabetics develop hyperglycemia due to a combination of both decreased insulin secretion from pancreatic beta cell dysfunction and insulin resistance in peripheral tissues.1 As a result, the presence of remaining beta cell function in most feline patients allows for potential remission if the disease is promptly diagnosed and effective glycemic control is achieved. As the concept of diabetic remission has become more obtainable in many patients, the focus on insulin therapy, appropriate diet, and monitoring have become a mainstay of feline diabetic management. Diabetic remission is euglycemia achieved in a diabetic patient without the need for exogenous insulin. Persistent hyperglycemia results in glucotoxicity to pancreatic beta cells, resulting in continuing dysfunction.2 If hyperglycemia is controlled with long-acting exogenous insulin administration, Beta cells may recover function in some feline patients, allowing for adequate insulin production and secretion endogenously. Clinicians should focus on insulin, diet, and monitoring to optimize the chance of diabetic remission. Insulin Twice daily administration of an insulin with a duration of effect lasting 10-14 hours in cats, such as protamine zinc insulin (Prozinc, Boehringer Ingelheim), glargine (Lantus, sanofi-aventis) or detemir (Levemir, Novo Nordisk) results in improved remission compared to intermediate acting insulin (e.g., lente insulin).3 Bennett et al found that protamine zinc insulin (PZI, Boehringer Ingelheim) treatment in combination with a low carbohydrate-low fiber diet resulted in a 68% remission rate.4 Multiple investigations of glargine on remission rates in feline diabetes have resulted in vari Continue reading >>

Lantus

Lantus

Lantus glargine by Aventis long-acting analog U100 Special, pH 4 Line new molecular entity Also known as Glargine (generic) Similar to Levemir, PZI[1] ultralente, Ultratard (duration) Action in cats varies by animal onset variable, asymmetric peak 5-14h (4-20 h as per Nelson)[2] duration 9-24h (10-16 h as per Nelson)[3] Action in dogs onset inconsistent, peak 0.5 to 6 hours, inconsistent, duration about 13hr but inconsistent-beef/pork PZI has longer duration (10-16 h as per Nelson)[4][5][6] Use and Handling Type clear Shelf Life refrigerate, until date on package When opened 28 days at room temp, up to 6 months when stored in the refrigerator (2C to 8C)[7] In pen 28 days at room temp Notes protect from light and heat do not mix with other insulins do not dilute do not prefill syringe discard if precipitate or cloudiness discard if frozen Do not use intravenously[8] Do not use intramuscularly[9] Lantus is the brand name for insulin glargine, an insulin analog made by Aventis[10]. Lantus is a very long-acting insulin (lasting up to 24 hours in humans) that uses pH reactions to form micro-precipitates under the skin, which create a time-release action. Because of cats' faster metabolism, long-acting insulins like Lantus (and perhaps Levemir) are gaining a good reputation in veterinary research for regulating cats for a full 12 hours at a time, often better than some of their shorter-acting cousins. Proponents of Lantus in feline use point out that it lasts a full 12 hours in many cats, has a very gentle onset, a negligible peak, and (some claim) less chance of triggering hypo or rebound than faster-acting insulins. The famous Queensland University studies[11] showed that a simple protocol (in a 24-hour monitored, veterinary environment, with a Low-carb diet) could bring ma Continue reading >>

Insulin For Cats

Insulin For Cats

Most diabetic cats will require insulin therapy as part of their treatment. Diet is also an important cornerstone of treatment for feline diabetes mellitus, and a few diabetic cats can be managed with diet alone, but the majority will require insulin. There are a variety of types of insulin available. Some are designed for human use but can be useful in pets, while others have been developed specifically for animal use. The natural insulins produced by cat and dog pancreatic cells have slightly different structures than the natural insulin produced by human pancreatic cells. Insulin types made for human use match the natural human insulin, and may not always be as effective in pets. With any insulin, the goal of treatment is to safely reduce or eliminate the symptoms of diabetes (weight loss with excessive thirst, urination and appetite). There is no ‘best’ insulin for all cats, but some are preferable to others. Many veterinary internal medicine specialists recommend glargine (Lantus®, made by Sanofi Aventis) as a first-line choice. Lantus® is a recombinant human insulin which is usually very effective in cats. In combination with an appropriate diet (canned cat food with less than 7% carbohydrates), glargine has the best chance of inducing a remission, meaning that the cat will no longer require insulin. Lantus® is typically dosed at 1 or 2 units twice daily (BID). In some cats it can be used once daily. Once daily administration is not as likely to induce remission—and won’t control the blood sugar very tightly—but is an option for families or cats who can’t do twice daily injections. The glargine product information for human use recommends replacing the vial every 28 days, but if kept refrigerated, the insulin is effective for cats for at least three Continue reading >>

2010 Aaha Diabetes Management Guidelines For Dogs And Cats

2010 Aaha Diabetes Management Guidelines For Dogs And Cats

Renee Rucinsky, DVM, ABVP (Feline) (Chair) | Audrey Cook, BVM&:S, MRCVS, Diplomate ACVIM-SAIM, Diplomate ECVIM-CA | Steve Haley, DVM | Richard Nelson, DVM, Diplomate ACVIM | Debra L. Zoran, DVM, PhD, Diplomate ACVIM | Melanie Poundstone, DVM, ABVP - Download PDF - Introduction Diabetes mellitus (DM) is a treatable condition that requires a committed effort by veterinarian and client. This document provides current recommendations for the treatment of diabetes in dogs and cats. Treatment of DM is a combination of art and science, due in part to the many factors that affect the diabetic state and the animal's response. Each animal needs individualized, frequent reassessment, and treatment may be modified based on response. In both dogs and cats, DM is caused by loss or dysfunction of pancreatic beta cells. In the dog, beta cell loss tends to be rapid and progressive, and it is usually due to immune-mediated destruction, vacuolar degeneration, or pancreatitis.1 Intact females may be transiently diabetic due to the insulin-resistant effects of the diestrus phase. In the cat, loss or dysfunction of beta cells is the result of insulin resistance, islet amyloidosis, or chronic lymphoplasmacytic pancreatitis.2 Risk factors for both dogs and cats include insulin resistance caused by obesity, other diseases (e.g., acromegaly in cats, hyperadrenocorticism in dogs), or medications (e.g., steroids, progestins). Genetics is a suspected risk factor, and certain breeds of dogs (Australian terriers, beagles, Samoyeds, keeshonden3) and cats (Burmese4) are more susceptible. Regardless of the underlying etiology, diabetic dogs and cats are hyperglycemic and glycosuric, which leads to the classic clinical signs of polyuria, polydipsia (PU/PD), polyphagia, and weight loss. Increased fat mobi Continue reading >>

Cvc Highlight: What Influences Diabetic Remission In Cats

Cvc Highlight: What Influences Diabetic Remission In Cats

A look at which factors might make spontaneous normalization of glycemic control more likely in one of your feline patients. A unique feature of diabetes mellitus in cats is that some cats become non-insulin-dependent after treatment has been initiated. From 17% to 67% of cats with diabetes mellitus have been reported to go into spontaneous clinical remission after insulin treatment is initiated.1-4 Diabetic remission is usually defined as normoglycemia that persists for more than four weeks without the use of exogenous insulin,2 although some studies have defined it as euglycemia for only two weeks.5,6 The duration of remission varies, with some cats requiring insulin treatment again within a few weeks to months and other cats remaining in remission for months to years. Factors that have been hypothesized to influence the likelihood of diabetic remission include the duration of diabetes mellitus, whether the cat initially presented in a ketoacidotic crisis, the carbohydrate content of the diet, the type of insulin used for treatment, the cat’s breed, the presence of underlying disease, and how closely the blood glucose concentration is maintained within the normal range with insulin treatment. Stimulation tests with secretagogues such as glucagon and arginine have also been investigated to identify cats that have residual insulin secretion from the pancreas, but the presence of glucose toxicosis in cats complicates the interpretation of these tests, and they have not proved useful in predicting the likelihood of remission.7,8 In a study of factors influencing diabetic remission in cats, remission was found to be more likely with increasing age and increasing cholesterol concentration.2 Overall, 21 cats treated with insulin glargine and 23 cats treated with Lente insu Continue reading >>

Diabetic Remission In Cats

Diabetic Remission In Cats

To grasp diabetic remission in cats, it helps to have an understanding of feline diabetes, so here is a quick review. Diabetes is a complex disease involving a hormone called insulin. When a cat does not make enough insulin or cannot properly use the insulin it does make, diabetes results. Why is insulin important? Insulin keeps the body’s engine working properly. The body is like a well-tuned machine and needs fuel to run properly. The fuel for a cat is food that contains fats, carbohydrates, and proteins. But this fuel needs to be broken down into smaller parts that the body can utilize. One of these usable fuel components is glucose. Without glucose, the body’s engine stalls. Glucose must enter the body’s individual cells to keep the engine running. That is where insulin comes in to play. Insulin regulates the flow of glucose from the blood stream into the cells where it is needed to sustain life. When there is not enough insulin produced by the pancreas, or the cat does not use it effectively, glucose cannot enter the cells and high levels of glucose build up in the bloodstream. This condition is called diabetes. "The common signs of diabetes include increases in appetite, water consumption, and urination, along with weight loss." Without insulin to steer glucose into the cells, the cat's body looks for alternative sources of fuel and breaks down reserves of fat and protein stored in the body. Fueling the body is not efficient without the insulin/glucose team, so the cat loses weight despite eating more. Meanwhile, the accumulation of glucose in the blood stream is eliminated in the urine. The cat urinates more which makes him thirsty and he drinks more water. The common signs of diabetes include increases in appetite, water consumption, and urination, along w Continue reading >>

Many Cats With Diabetes Can Achieve Remission

Many Cats With Diabetes Can Achieve Remission

If your cat seems to be thirstier than usual, is urinating frequently, is hungry all the time but also losing weight, you should have him checked by your veterinarian for feline diabetes. Other signs to watch for include urinating outside the litter box, sweet-smelling breath, lethargy, dehydration, poor coat condition, and urinary tract infections. Left untreated, diabetes can cause your kitty to lose his appetite and a significant amount of weight, and develop muscle weakness. Uncontrolled, the disease can ultimately result in diabetic neuropathy, a condition in which there is profound rear limb weakness and a plantigrade walk, meaning the ankles are actually on the ground as the cat walks. Feline Diabetes Mellitus Diabetes mellitus is a common disease in older cats, and is especially prevalent in kitties fed dry food diets. In fact, a study published in the Journal of Feline Medicine and Surgery concluded that high-protein, low-carb diets are as or more effective than insulin at causing remission of diabetes in cats. The pancreas produces insulin based on the level of glucose in the blood. Insulin is necessary in order for glucose to enter the cells of the body. When glucose levels are high (which normally occurs after a meal), insulin is released. When there is not enough insulin being released from the pancreas, or there is an abnormal release of insulin coupled with an inadequate response of the body’s cells to the insulin, diabetes mellitus is the result. Sugar in the bloodstream cannot get into the cells of the body, so the body starts breaking down fat and protein stores to use as energy. As a result, no matter how much the cat eats, she loses weight. In addition, the glucose builds up in the bloodstream and is eliminated through urination. This leads to exce Continue reading >>

Tilly's Diabetes Homepage

Tilly's Diabetes Homepage

Home Story 6 important factors Blood glucose values The future? Links Guestbook About this site Disclaimer • see your vet and get his or her approval of this protocol before you start!!! • talk to your vet regularly about your cat's progress • see your vet immediately if your cat develops additional problems (e.g. ketones, hypoglycemia, vomiting, fever, bladder infections, etc) Read this first • this protocol was developed by lay people, including myself, who are members of the German Diabetes-Katzen Forum. It has since been published in the Journal of Feline Medicine and Surgery. • the majority of cats do very well on this protocol, some cats do not (generally these are hard-to-regulate cats) • it is more time-consuming than most other protocols, but still definitely doable if you work a regular full-time work week • it is more expensive than most other protocols, but costs can be reduced by e.g. buying glucose test strips from online pharmacies or reputable sellers at eBay • members of the German Diabetes-Katzen Forum buy 3 ml Lantus/Levemir cartridges, refrigerate them after opening and routinely use them for 6 months or more - when refrigerated, opened cartridges of these insulins are extraordinarily stable • you will need to test the blood glucose levels of your cat multiple times per day • you will need to know about hypoglycemia and be prepared to deal with it • you will need to test for ketones regularly to start with and know about ketoacidosis, but be aware that ketones don't occur once a cat is (and remains) properly regulated • you will need a brand-name glucometer made for human diabetics that measures whole blood (not plasma-equivalent) and which uses 0.6 µL of blood per test or less • you will need to use syringes which allow yo Continue reading >>

Giving Your Client's Cat Insulin For Treating Feline Diabetes

Giving Your Client's Cat Insulin For Treating Feline Diabetes

...managing and tracking the cat's progress Giving your client's cat insulin to treat feline diabetes can begin to get difficult as most of the work begins after leaving the practice... Using Insulin to treat diabetes in felines Once you have to give them insulin, if you have an owner who is not terribly confident that they are going to be able to pick up a hypoglycaemic event, then I will use Caninsulin (a mix of porcine insulin’s 40iu/ml) because it is shorter acting and does not build up over the 18 – 24 hour period like the Glargine does (and which often results result in a hypoglycaemic event, that can last for hours). Nevertheless, Marshall and Rand think it is a risk worth taking. The cats usually only end up needing 1 – 4 units of either kind of insulin twice a day – the Glargine especially seems to keep them stable at 2 units twice a day. Once you push up into the 3 or 4 units, you can bring them into remission, but it is often via a sudden hypoglycaemic event, which is unpleasant all round. And is, I guess, the reason that the Glargine insulin protocol recommends treating them in hospital. After giving the cat insulin, the process to stabilise Fluffy at home, usually starts at 1 or 2 units of either kind of insulin twice a day. You need to get the owners to bring the cat in after a couple of days to measure its blood glucose 3 hours after their insulin dose and breakfast. It does not matter about meal-feeding cats, as they do not get the post-prandial glucose spike (ref: The Cat as Model for Human Obesity and Diabetes; Hoenig) – because they are digesting protein and balancing out the glucose release after it has been deconstructed from protein in the liver. It is more natural for a cat to graze-feed anyway, so if that is what the cat wants to do, th Continue reading >>

Isfm Consensus Guidelines On The Practical Management Of Diabetes Mellitus In Cats

Isfm Consensus Guidelines On The Practical Management Of Diabetes Mellitus In Cats

Diabetes mellitus (DM) is a common endocrinopathy in cats that appears to be increasing in prevalence. The prognosis for affected cats can be good when the disease is well managed, but clinical management presents challenges, both for the veterinary team and for the owner. These ISFM Guidelines have been developed by an independent, international expert panel of clinicians and academics to provide practical advice on the management of routine (uncomplicated) diabetic cats. Although the diagnosis of diabetes is usually straightforward, optimal management can be challenging. Clinical goals should be to limit or eliminate clinical signs of the disease using a treatment regimen suitable for the owner, and to avoid insulin-induced hypoglycaemia or other complications. Optimising bodyweight, feeding an appropriate diet and using a longer acting insulin preparation (eg, protamine zinc insulin, insulin glargine or insulin detemir) are all factors that are likely to result in improved glycaemic control in the majority of cats. There is also some evidence that improved glycaemic control and reversal of glucose toxicity may promote the chances of diabetic remission. Owner considerations and owner involvement are an important aspect of management. Provided adequate support is given, and owners are able to take an active role in monitoring blood glucose concentrations in the home environment, glycaemic control may be improved. Monitoring of other parameters is also vitally important in assessing the response to insulin. Insulin adjustments should always be made cautiously and not too frequently – unless hypoglycaemia is encountered. The Panel has produced these Guidelines after careful review of the existing literature and of the quality of the published studies. They represent a Continue reading >>

Lantus Prices Squeeze Veterinarians And Owners Of Diabetic Cats

Lantus Prices Squeeze Veterinarians And Owners Of Diabetic Cats

At more than $200 a 10-ml vial, the world’s most prescribed insulin is priced at or beyond the threshold of what many cat owners are able or willing to pay. Veterinarians are fielding complaints from clients, leaving some practitioners facing the delicate and time-consuming prospect of re-regulating their feline patients on other insulins. Dr. Michael Mihlfried, of Athol, Idaho, has prescribed Sanofi's Lantus (insulin glargine) for the past four years. Licensed for use in humans, a 10-ml vial of Lantus holds 1,000 units of the long-acting insulin. Many veterinarians say it can last a cat owner for months given that a moderate dosage is 2 to 3 units twice daily. “It’s the insulin I reach for when there's a diabetic cat,” Mihlfried said. “Most of my remissions have come by using Lantus. I have one particular owner who has told me he absolutely can’t afford to use it any longer. The cat is 18 years old. We’re going to try ProZinc." Manufactured by Boehringer Ingelheim, ProZinc is one of a couple of insulins licensed in the United States for use in cats. It costs about $100 for a 10-ml vial containing 400 units. Vetsulin, manufactured by Merck Animal Health, is another veterinary-specific insulin. It costs around $40 for a 400-unit, 10-ml vial. How these products compare in price to Lantus can vary depending on the patient. Diabetic cats respond differently to treatments. Some veterinarians find that Lantus, approved by the U.S. Food and Drug Administration (FDA) for use in humans, works best in their diabetic feline patients. “All of my diabetics are on it,” said Dr. William Folger, a board-certified feline specialist in Houston. “It was $82 a bottle when it came out, roughly a decade ago. Then it went to $116 and $128. Now it’s being sold at Walgreen Continue reading >>

Using Glargine In Diabetic Cats

Using Glargine In Diabetic Cats

Rhett Marshall BVSc MACVSc The Cat Clinic 189 Creek Road, Mt Gravatt, 4122 Basic information Glargine must not be diluted or mixed with anything because the prolonged action is dependent on its pH Glargine has a shelf-life of 4 weeks after opening and kept at room temperature. Refrigeration prolongs its shelf-life and allows opened vials to be used for up to 6 months. The manufacturer however recommends discarding opened vials after 4 weeks When performing a blood glucose curve, samples probably only need to be taken every 4hrs over 12 hr in many cats (ie. 0h [before morning insulin], 4h, 8h and 12h after morning insulin) Dose changes should be made based on pre-insulin glucose concentration, nadir (lowest) glucose concentration, daily water drunk, and urine glucose concentration. Better glycaemic control is achieved with twice daily dosing rather than once daily More accurate dosing may be achieved using 0.3ml U-100 insulin syringes Indications for starting glargine All newly diagnosed diabetic cats (to increase chance of remission) Poorly controlled or unstable diabetic cats (glargine’s long duration of action is likely to benefit these cats) When SID dosing is desired or demanded (glycaemic control and remission rates are higher if glargine is dosed BID) Ketoacidosis – replaces regular insulin and can be used IM or IV When corticosteroid administration is required in cats at high risk of developing clinical signs of diabetes or cats in remission. For initial insulin dose, BG > 20mmol/L à start with 0.5U/kg ideal body weight twice daily (BID) BG < 20mmol/L à start with 0.25U/kg ideal body weight BID Blood glucose should be sampled every 3-4hrs for several days, either at home or in hospital. Dose reductions can be made (based on the blood glucose parameters in T Continue reading >>

Research Updates: Giving Glargine Insulin To Newly Diagnosed Diabetic Cats May Increase The Likelihood Of Remission

Research Updates: Giving Glargine Insulin To Newly Diagnosed Diabetic Cats May Increase The Likelihood Of Remission

Diabetic remission, defined as reversion from a hyperglycemic to normoglycemic state in a diabetic patient after discontinuing insulin therapy, has been reported in cats that first present with uncomplicated diabetes mellitus or for treatment of diabetic ketoacidosis. Authors of previous studies have suggested that the success of glycemic control or the type of insulin being administered may affect the remission rate. This study's goal was to determine and compare the likelihood of remission in cats with newly diagnosed diabetes mellitus when treated with glargine insulin, protamine zinc insulin (PZI), or Lente insulin given subcutaneously twice a day. In this nonrandomized, prospective study, 24 cats in which diabetes mellitus had been diagnosed within the preceding 24 hours were enrolled. Initial assessment included performing a physical examination, serum chemistry profile, urinalysis, and urine bacterial culture. Each cat's fructosamine concentration was also determined. All cats with serious concurrent diseases were excluded from the study. Enrolled patients included 21 cats with adequate food consumption and a lack of systemic signs that allowed immediate administration of one of the three subcutaneous insulins and three cats that required treatment with intravenous fluids and regular insulin before subcutaneous insulin administration could be started. Cats were distributed into the three insulin treatment groups with an attempt made to evenly match groups based on breed (Burmese vs. non-Burmese) and whether or not the cats had previously been given corticosteroids. The initial dose of subcutaneous insulin was between 0.25 and 0.5 IU/kg, as determined by the serum glucose concentration (< 360 mg/dl [< 20 mmol/L] vs. > 360 mg/dl, respectively). All cats were fed an Continue reading >>

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