Newly diagnosed....I'm freaked out

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My thoughts on prescription diets (at risk of creating an echo chamber here!) is that the large majority of the time, there is a cheaper and better suited alternative if you look at the nutritional requirements and guidelines for the the condition you're looking to accommodate (e.g. diabetes, CKD, food intolerances/allergies, UT disease, etc.). I would say the only exceptions are the recovery formulas when (temporarily) necessary (Hills A/D, Purina CN) and the kidney diets (K/D NF) conditionally in late/end stage CKD. The only prescription diet that is even suitable for a diabetic cat is Purina DM--all of the others are too high in carbs. And even though it's a good food to feed, since it's pretty much the same thing as Fancy Feast, it's way overpriced.

Bandit used to be obese, back when he was about 5-6 years old. That's what happened from free feeding him Purina dry food. Our vet at the time was one of the creators of Hills Science Diet, so I thought we were consulting with an expert on feline nutrition. He put Bandit on Hills W/D dry, and boy did Bandit lose weight, all right--it caused a severe case of triaditis and subsequent diabetes diagnosis the following year. That's when I finally did research on feline nutrition on my own, and realized what I had been told by my vets all along about feline nutrition was not correct in the least.

I also made the mistake of feeding Purina NF to one of my cats when she was diagnosed with early stage CKD (it was called the unnecessarily scary "Chronic Renal Failure" at the time, and despite my experience with Bandit, the vet talked me into it). Boy, was that a huge mistake. She hated the food so it became a chore just to get her to eat at every meal, she lost a lot of weight and the low protein caused muscle wasting where she barely wanted to move. Based on the vet's feedback, I thought that this was the kidney disease progressing, but all her bloodwork was holding steady. I found some studies online that talked about the low protein/low phosphorus debate and decided to try changing her diet. So I switched her to a low phosphorus commercial diet instead, and her health dramatically improved. Her CKD never progressed past stage 1, and she was on the low phosphorus diet for 2 years before she passed away from stomach cancer.
 
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First, Julia, I'm so sorry for your loss. And that you had to go through all of that. It's reprehensible on the part of the vets (and food companies).

I already started Lamont on Wellness No Grain Chicken, he likes it, it's 4% carbs and low in phosphorous.

So, another question: I just found another vet who, based on the receptionist (and a recommendation) feel would probably be a better fit for Lamont. He makes house calls (!!), believes in administering the fructomine test before starting insulin and most of his patients do home monitoring. He uses Pro Z as the insulin. With the current vet I have, they couldn't tell me the type of insulin (at least the receptionist couldn't) and I feel like I might be in for an argument about the home monitoring.

Should I keep the Saturday appointment, just so I can start Lamont on insulin and then continue with the next guy for everything else? Including the 1 week follow-up? Or should I switch now? I feel it's important to start Lamont on insulin asap.
 
What tests did your current vet perform to diagnose his diabetes? Was it just a blood test, or a blood test an urine test? If he is spilling glucose into his urine, and tests high at home, then it is safe to say he's diabetic and you don't need to spend money on a fructosamine. A Fructosamine gives you an average BG over the last several weeks, and can be used for diagnosis but is not necessary if you confirm the diagnosis with a urinalysis and home testing, which you plan to do anyway. After diagnosis, there is no point in doing a fructosamine if you're home testing frequently enough (at least 3x daily).

Prozinc is not a bad insulin for cats (unlike Vetsulin or Novolin), but Lantus and Levemir have better remission rates (this information is in the second study I attached in my earlier post). Prozinc is good for people who need more flexibilty with their dosing schedule, but if you can shoot regularly every 12 hours, I would strongly recommend Lantus or Levemir, as you'll have the best chance of remission with those. There is a window of remission, and the sooner you start recommended treatment (low carb canned food, lantus or levemir, and dosing based off home tests), the better your odds of reaching remission. If you end up with a script from your vet for Lantus (glargine), you can save a lot of money on it by ordering from an online Canadian pharmacy.

The fact that he encourages home monitoring is GREAT though. Bandit has seen 4 different vet practices since his diabetes diagnosis, and only his current vet has agreed with the treatment guidelines here 100%. The first one had all the right diet (low carb, canned commerical food), and insulin (Lantus) recommendations, and strongly encouraged home testing (I was told that my cat would not get better unless I learned to home test, and they even had a resident cat in the office that they used to show me how to do it and that cats accept it just fine). But she was WAY off in her dosing recommendations (she was having me give insulin once a day, and raising the dose in 1u increments). And then after the argument I got into with her about the dosing protocol (she insisted that she was correct because her two diabetic DOGS were doing great on her dosing protocol) and about Gabby and the Purina NF, I decided to find a vet that was a little easier to work with. The practice I chose didn't strongly enourage home testing, and they prescribed Prozinc and prescription diets, but they were willing to read the information I brought them and try out the new treatment guidelines with Bandit (which, to give them a bit of credit, were still very new back in 2009). Since then, they've changed all their treatment guidelines for their other cats based on their experience with me and Bandit, so I now strongly recommend them to other people in town, and my younger cat still goes to their practice. Bandit's former emergency vet hospital was a nightmare to deal with in regards to his diabetes--they weren't recommending any home testing, and they even called my regular vet practice to tell them that they thought my cat was in danger because I wouldn't start him immediately on insulin (he was in remission, and the only reason why he tested high at the hospital was stress, which is why we home test!:banghead:) or feed him the dry prescription food despite his diabetes having nothing to do with why he was at the hospital (he had an accident with his tail and needed an amputation, and they happened to have one of the best surgeons in the country on call when it happened). Luckily, Bandit's regular vet was able to tell them that we had the diabetes under control, and it would be very nice if they could just focus on Bandit's tail.

When I had to switch Bandit's vet again in March because of a very serious illness his regular vet couldn't diagnose or treat (myelofibrosis), we took him to Cornell. I went in there expecting to fight with the vet once again about something with his diabetes, and he was on board with the right diabetes treatment recommendations 100% from the start, and even was able to give me advice with is dosing in areas that I didn't know about (like making dose adjustments while weaning off steroids)! :) It's been an absolute pleasure working with him with Bandit, and he is definitely the reason why Bandit is alive and doing so well today.

Anyway, my point is this--it's not likely you're going to find any vet that gets everything right and is perfect. It took me four vet practices and having to go to an internal medicine specialist at Cornell to find someone that got everything right. What's most important is to find someone who will work well with you, be receptive to new treatments if you have the evidence to back them up, and most importantly, has your cat's best interests in mind over everything else. So if your current vet is willing to give you what you need (a script for Lantus or Levemir and syringes (u100, 3/10cc, 8mm with 1/2 unit markings), and work with you using recommended dosing guidelines based on home testing, then you might want to keep her for now and find another vet down the road if she gives you trouble later on. If she won't give you what you need, switch to a vet who will.
 
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The vet did a regular blood test that included glucose and a urine test (she said could only do one urine test --not sure if it was the urine analysis cause, frankly, it's been a lot of info to digest--because he acts out at the vet and she just got urine cause he peed out of nervousness.) I don't know what the urine showed. She then did the fructosamine.

Re: the flexibility and ProZinc: I can feed him every 12 hours nearly all of the time, but having flexibility would be a help to me (I live alone with Lamont). Also, he's a grazer and I suspect it's gonna be a long time before I can get him to eat enough to get an insulin inject in the evening. Right now, he only eats a full bowl of food (which is about a 1/4 of a 5.5 ounce can) in the morning and super late at night--like 2am or 3am. At lunchtime, he eats about a 1/6 of the bowl, same with "dinner"--which would be when he gets the 2nd shot.

That said, I want to give him the best chance for remission. He's 15. I hope it's realistic that he has a chance at remission.

I love the fact that the new guy encourages home monitoring and also like that he makes home visits which might be easier for Lamont.

What I didn't like about the current vet is she poo-poo'd home monitoring (except with home urine testing). When I told her I didn't feel comfortable just giving him insulin without knowing what his numbers were, she said it wouldn't be a problem and if he became hypoglycemic I could "tell" by his behavior and I just call the office (which seems NUTS to me. NUTS!!!!!)

So my thinking right now is, if she's willing to change her opinion about home testing, then I might stick with her, but right now, I'm thinking I'll start with her and go to the new guy for the 1 week follow-up and continue with him. He wasn't in the office today, but I might call him tomorrow to ask some of these questions, including the insulin questions--which is better for him, ProZinc, Lantus or Levemir based on his behavior, glucose, etc.)

Again, thank you SO much for all of this information. It's overwhelming but I am starting to feel like I'm getting a better understanding of things.

Next step (tomorrow afternoon: start the home testing, gulp!)
 
Well, a fructosamine does it, then! You don't need the new vet to do a second fructosamine if you already have the diagnosis from the first.

Yikes, yes, that is NUTS. Cats don't typically show symptoms of hypoglycemia until it's reached the point of being life threatening, which is why home testing is so important. It's also nearly impossible to determine the correct dose without daily testing. That's also stated in the AAHA document I linked up above, if you bring it in to her.

You need to choose the insulin that is right for you and Lamont. Lantus and Levemir have better remission rates, and if you can be home usually every 12 hours, they can still work for you if you have rare days when you can't. If you know of the change in schedule ahead of time, you can plan for it by moving the shot time up & down in 15 minutes increments. There are people here that had to shoot Lantus and Levemire off a 12 hour schedule and still was able to make it work. Or, if you feel more comfortable going with the new vet starting with Prozinc, you could always start and switch insulins after a month or two if it's not working well for Lamont. It might slow you down a bit, but I don't think it would impede things too much as long as you don't wait more than a few months to change to Lantus and Levemir if it's not working. So I guess what I'm saying is, I recommend the other two to start if you can manage it, but Prozinc is not a bad choice if you do need the flexibility and some people do have success with it.
 
Regarding your concerns about feeding...with the better insulins, it's not so important that they eat a significant amount before getting their insulin. If he's a grazer, as long as he's eating fairly normally at shot time, it should be fine

We worry when they are refusing to eat, or can't hold food down at all..... or throw up immediately after eating (although that can be "scarf and barfing" and the cure for that is to feed them slower)
 
Thank you Julia & Bandit and Chris & China!!

I feel the first vet is kind of intractable. I'm not crazy about her just prescribing a med without discussing it's merits with me (I was a caregiver for 10 years for both of my parents who were ill and I learned the hard way that you HAVE to be on top of everything, especially meds.)

I put in a call to the current vet today (she wasn't in the office) to find out what insulin she was choosing.

Do you think I should call up the 2nd guy, say the fructosamine was already done a few days ago (which it was--from blood from last Wednesday) but discuss Lantus with him and if he's willing to start Lamont on Lantus and give me an appointment to start, just go there on Monday and start him with the new guy? If would mean delaying his insulin for one or two more days (I would start insulin on Sunday with the current vet and hopefully Monday night or Tuesday with the new one--unless I can see him on Saturday as well.)

Or is it better to just start with whatever med the current vet gives and then just switch when I start with the new guy? Can I switch insulin after a week?
 
LamontsMom said:
Or is it better to just start with whatever med the current vet gives and then just switch when I start with the new guy? Can I switch insulin after a week?
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First...insulin isn't cheap, so if you can get either vet #1 to prescribe Lantus or convince vet#2 to use it instead of ProZinc, you're better off. Lantus (if you buy it in the US) is around $250 for a 10ml vial (1000 units) or around $450 for a box of 5 3ml pens (1500 total units) ProZinc runs about the same when you figure that a 10ml bottle is around $90 (but only holds 400 units)

Most of us are buying our Lantus from Canada due to the crazy prices here in the US....the last post in the "Insulin from Canadian Pharmacies" has the information about where we're buying it. Unfortunately, it will take about a week to get it

ProZinc can only be bought from your vet or a veterinary pharmacy

You wouldn't want to switch after just a week....it can take several months (no matter which insulin) before you'll really be able to tell how well it's working for Lamont.

A few days more without insulin isn't usually something to worry about....as long as Lamont has no history of ketones. A lot of times we'll suggest that people take a few days to a week transitioning their cat onto low carb food first before starting on insulin (If they have no history of ketones!)
 
Lamont started low carb Monday-ish (a mix of wet & dry Monday and Tuesday, since yesterday all wet). He's still drinking more than usual but not excessively. Thinner, but not super skinny and his affect is fine (and his fur is MUCH softer than it was a couple of days ago and looks better).
I'm going to call the first vet again (I know they think I'm a pain in the butt but hey, it's my cat) and find out about Lantus (I already mentioned ProZinc to her receptionist--I'll call in the morning and tell her that I meant Lantus. And see. I can also call the second vet and see if he's open to Lantus. After reading the attaching and doing some googling, Lantus DEFINITELY seems the way to go.
Re: the ketones. I have no idea if his urine showed ketones. Should I buy the urine strips and test it myself here? Then, depending on the insulin choice and home monitoring, I'll be able to make a good decision.

Again, THANK YOU! It's a relief to know I have a good choice of insulin that (hopefully) will bring good results.
 
Testing for ketones is always a good idea....they're much easier to deal with if caught early...and just knowing he's not throwing ketones will be a relief ...especially if you want to wait a little while to start insulin (or have to wait for shipping if you buy from Canada)

Here are some Urine Testing Tips for you to try!!
 
In a perfect world, once a day....but as we all know, it's not always a perfect world!...and a lot of it depends on the cat and how secretive they are about their litter box habits!

Once you're actually on insulin, it's still a good idea, but then we generally worry more about the high numbers....it'll depend a lot on how Lamont responds
 
I'm going to go out any buy aquarium gravel tomorrow and the strips and a collection device. You know, the more I think about it, my gut is just telling me to start Lamont on insulin by Sunday, Monday at the latest and I really want him on Lantus. I still will do the ketone testing, but I can see he's under the weather and I'm not comfortable with it. I REALLY hope this initial vet complies and gets the Lantus. I'm not up for a debate with someone. If she does, I'm just going to find someone who will write me a prescription, I'll pay the money for a starter kit and least get him on his way.

Thanks again, Chris & China!
 
You might start calling around now and see if you can find a pharmacy that will break open a box of pens and sell you just one (it's almost impossible to find one, but you might get lucky!)

We've seen Target stores be ones that tend to be willing to do it more than a lot of others, but it varies from store to store. Also hospital pharmacies and pharmacies that deal with nursing homes are other possibilities....or you might just get lucky and whatever place you call first agrees to do it!

If you can find one, you'll need one script for just 1 pen....and if you want to save the money by buying from Canada, get another script for a box of 5 Lantus Solostar pens to send to Marks

One pen is enough to last most cats several months

If you get the pens, don't listen if they tell you that you have to use the special needles that are designed to come with them. We use plain insulin syringes and draw the insulin out of the pen instead of using the "special" needles
 
So should I ask the pharmacy if I can get one Lantus Solostar pen? If they'll break open a box of 5 to sell me? I live in NYC. Hopefully, I'll find one. My vet did say she was ordering an insulin "starter kit". If it's not for Lantus, I don't want it. What type of syringes should I get? (I'm actually petrified of needles and have never given myself or anyone (!) a shot--don't even really know how to use a syringe.)
 
You'll want the vet to give you a script for 3/10 cc, 8 mm, 31g syringes with half unit markings. Walmart has them cheapest...about $14 for 100. The needles are so tiny on these...don't worry. :-)
 
Here's what the Relion syringes look like...and if they try to tell you they don't come with half unit markings, they're wrong!
relion syringes.png
 
Thanks!! I just looked for Keto-Diastix and so far, everything is mail order, which sucks. I was hoping to walk in somewhere tomorrow and pick them up to test him.
 
Walmart has these Ketone Test Strips ....they should be available at the stores but sometimes they don't carry them

Again, call around...diabetic supplies are everywhere these days....someone should have some in stock somewhere! You only need the ones that are for ketones (they make them that test for lots of other stuff too)
 
Thanks! I'll check (I was looking for Keto-Diastix--hopefully I'll have more luck with just Ketone Test Strips). There isn't a Walmart near me. I'm going to look online tonight to see if anything's in stock. If not, I'll order it online tonight.
 
Hey Everybody--Again, thanks so much for your help.

I did find out from the original vet she uses Lantus, which is a good thing, she also uses the thin gauge needles (31), but vs a pen she thought the syringes and bottle were better and she's going to show me how to do it tomorrow. She's also going to walk me through the home testing (I told the receptionist if she didn't feel comfortable with me home testing, I would find another vet.)
And I did speak with my neighbor whose cat is diabetic and has been for years. She *doesn't* home test, but invited me over to show me how she shoots the insulin and that's right after the vet.
So tonight, I'm reading the manual for the glucometer and will practice on him tomorrow after the vet shows me how.
Also, this is day 4 of wet food and I see a big difference in his demeanor and coat. He's more alert, jumping higher, seems back to normal and his coat is shiny and feels silkier!

Will let you guys know how the vet meeting goes.

Thanks again.
 
Your vet probably just isn't familiar with the pens....the only difference (it's the EXACT same drug) is the pens come in 3ml sizes instead of the 10ml vial

With the vial, unless Lamont ends up being on a very high dose, you're going to end up throwing away at least half of it. Most cats end up somewhere between 1-2 units twice a day....the vials (if cared for properly) will only last about a MAX of 6 months.....on 1.5 unit twice a day, IF your vial lasts a full 6 months, you'll be throwing away about half...if it doesn't last the full 6 months, you'll throw away even more!

At about $280 for a 10ml vial, that's throwing away a lot of money! A 10ml vial holds 1000 units of insulin

The pens are just like "mini-vials" that hold 300 units each....and because you don't open each pen until you're ready to use it, all the pens will last until the expiration date on the box...usually at least 2 years away

Also...if you drop the vial, it's going to break (and take it from experience...they're easy to drop!)

Here's pictures to show your vet
syringe in pen pic.jpg
syringe in pen close up.jpg
 
LamontsMom said:
Hey Everybody--Again, thanks so much for your help.

I did find out from the original vet she uses Lantus, which is a good thing, she also uses the thin gauge needles (31), but vs a pen she thought the syringes and bottle were better and she's going to show me how to do it tomorrow. She's also going to walk me through the home testing (I told the receptionist if she didn't feel comfortable with me home testing, I would find another vet.)
And I did speak with my neighbor whose cat is diabetic and has been for years. She *doesn't* home test, but invited me over to show me how she shoots the insulin and that's right after the vet.
So tonight, I'm reading the manual for the glucometer and will practice on him tomorrow after the vet shows me how.
Also, this is day 4 of wet food and I see a big difference in his demeanor and coat. He's more alert, jumping higher, seems back to normal and his coat is shiny and feels silkier!

Will let you guys know how the vet meeting goes.

Thanks again.
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Great news! Good to stick to your guns. Also, when the vet shows you how to test at the office, the number will be higher due to stress. You will get a lower number at home when kittie isn't stressed out.
 
Thank you SO much! I think she put in the prescription already, but she can always change it to the pen. She said she was concerned about dosing and "never heard of anyone using the pen with a cat". I will bring the print-out and say I definitely want the pen. I feel more comfortable that way anyway....
 
LamontsMom said:
Thank you SO much! I think she put in the prescription already, but she can always change it to the pen. She said she was concerned about dosing and "never heard of anyone using the pen with a cat". I will bring the out and say I definitely want the pen. I feel more comfortable that way anyway....
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I am using the pen with lantus. Walmart Pharmacy will sell one pen for 84.70. Next time I need it, I will order from Mark's Marine Pharmacy from Canada, much cheaper!
 
I wish I lived near a Walmart. I'm going to demand the pen and buy the 5 pack here. It'll probably last a year or two. Then, buy from Mark's. I called every pharmacy in my area and none would break up the 5 pack.
 
Bobbie And Bubba said:
I am using the pen with lantus. Walmart Pharmacy will sell one pen for 84.70. Next time I need it, I will order from Mark's Marine Pharmacy from Canada, much cheaper!
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PS: My vet said, "oh you don't want to use the pen, I understand they are awkward with the screw on needles". I told her I wouldn't be using a screw on needle that I would use the U100 syringes and draw from the pen. Just like the picture Chris sent to you. It taught her something new.
 
About 45 minutes to an hour. I'm ok with putting out the big amount of money initially, since it's going to last a long time. It's $365 for 5 pens in my neighborhood.
 
LamontsMom said:
About 45 minutes to an hour. I'm ok with putting out the big amount of money initially, since it's going to last a long time. It's $365 for 5 pens in my neighborhood.
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It might be worth the drive. Have her write it for one SoloStar pen 3 ml and the dosing, then order from Mark's next time.
 
I don't have a car right now---in NYC, mostly we use the subway, cabs or walk. I'd have to rent a car.
 
For sure... I'm resigned to knowing I'm just outlaying a lot of $$ right now. But to me, it's a matter of life and death for Lamont so I'll do it. At least the pens will last a long time. I don't know why they don't have a Walmart in NYC.
 
So, back from the vet. She didn't want to commit to pen. She couldn't understand what I was talking about even though I showed her the diagram, etc. She also felt it was crucial to only have him eat 2 times a day--no more. I pointed out that the AAHA guidelines say 4 times a day for diabetes and she didn't want that. She said she wants to "research" the lantus pen and start him on it on Tuesday. And suggested I get a second opinion. So I am going to the second vet--the one that just sees cats. I'm hoping it's a better experience. He uses ProZinc but they're open to doing Lantus. They said they find it's easier to use and has a better result. The vet's cat went into remission on it.

Lamont freaks out so much at the vet and part of it is dog who try to come up and smell him in his carrier. He's in a state of hysteria. The new vet will do housecalls, which, if need be is a good thing, I think.

When I go on Tuesday, any compelling reasons to say Lantus vs. ProZinc? After doing a little research, I like the flexibility with ProZinc (which also fits Lamont's personality better...) I've heard they have pretty much identical remission rates.

Again, thanks you guys for all of this!
 
Just found out new vet charges $95 for ProZinc for a vial that lasts about 6 months (400 units per vial...) Which is actually cheaper than Lantus if I bought it locally (though not through Canada. I can handle that....
 
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