? 4/27 Elsie; AMPS: 259; +2: 283; +3: 293; +5: 297; +7: 334; +9: 290; Insulin lost potency? Shortage?

https://www.felinediabetes.com/FDMB...-need-help-finding-a-new-vet-x-posted.288962/

Alright guys. I've gotten back on track with testing, including some overnight as best I can. I'm trying so hard to give Elsie what she needs. I'm still tracking down a new vet. I believe I've found a feline only clinic that is a member/certified from the Cat Friendly Practices website, do they generally tend to be on board with the TR protocol? I did call, and they are booked out until June to get Elsie in as a new patient. I asked the receptionist if home testing with a human meter was something they allowed there, and she wasn't really in a postition to fully answer that question. I haven't had a chance to email them my question yet, I plan to do that tomorrow.

In the meantime, I'm very concerned that my insulin may have lost potency. It does not seem cloudy at all, it's perfectly clear and has not left the refrigerator (except for the short time it takes to shoot the cat). But Elsie's numbers sometimes start creeping up as I finish a pen, then come back to normal when we start the fresh new pen of insulin. However, this time, they have gone high and stayed high, it's like we're back to square one now after doing so well for so long. I made a note on the ss but the situation is this:

I usually use a local Rite Aid pharmacy for our human meds. When Elsie was first diagnosed, they were out of stock, but Walgreens across the street had some, so I took her Rx to them. A couple months back Walgreens was *also* out of stock at refill time, but Rite Aid had it, so I transferred the Rx since all our other information was already with Rite Aid anyway. From talking to the pharmacists, it started to sound like it was not always reliable that anyone in the area would have it as needed. I had previously only been getting 1 pen at a time, but the pharmacist told me that I could get more than 1 at a time if I so chose. I was concerned about the shelf life of adding an extra pen and waiting so long to use it; the pharmacist told me that as long as it was unused/unopened, it would be good in the fridge until (November? I don't recall the exact date at the moment, but it was a very long time beyond when I would've needed to use it.) So just in case of "out of stock" issues in the future, I went ahead and tried getting 2 pens.

The first one was fine, everything as normal. The numbers started to tick slightly upwards as I've noticed they do as I'm finishing off a pen, but not anything crazy. But pen number 2, the extra that had been stored unopened/unused in the refrigerator (I keep them in the coldest spot in the fridge, never in the door where temps can fluctuate) doesn't seem to be doing anything at all. I have continued to give the insulin from this pen, since I'm not 100% certain that is the issue, and because like I said it doesn't look bad at all. It's also all I have at the moment.

When I started to suspect this might be an issue, I called in a refill on the Rx, to see if a properly fresh pen would make a difference in the numbers. However, as I feared, they're out of stock again. They've tried ordering it 3 times now and they don't know when they'll be getting more. I'm not sure if I can transfer the prescription again to somewhere else, nor do I really want to have to keep transferring every time I need a refill. Is there a glargine shortage in the US right now?

I can't take Elsie to the vet to be evaluated for other possible causes of number spikes, because I haven't been able to get in with a new doctor yet. She seems fine and her usual self, there are no other red flags that would make me think something else has gone amiss to cause the number spike. That means I also have no doctor currently to write a new prescription, so I could establish with a reputable Canadian pharmacy.

I increased the dose as well based on her numbers, which I also noted in the ss. Am I crazy for thinking it's the insulin that's the issue? Am I totally screwed here until months from now when I might be able to get in with a new cat doc? Of course this all happened within weeks. The vet, the glucose spike, the insulin, the kibble raids (she's determined). The existing prescription should be good for a while yet, but it doesn't matter when my pharmacy doesn't have the meds. I just pray every day I'll get a message from Rite Aid saying they finally got some delivered.

Sorry again for the rambling. I'm getting overwhelmed.

 

@tiffmaxee
@Bron and Sheba (GA)

 

Are you looking for Lantus, or generic glargine at the pharmacy? Any particular brand of glargine? There are several out there, maybe they can sub in another manufacturer's glargine?

Part of your problem with increasing BGs is that you are holding doses way too long for TR. That is allowing glucose toxicity to develop - where she gets used to higher numbers. I'm glad you increased recently. Keep increasing every 3 days if she's not seeing anything under 200.

 

I was just looking for any kind of generic "insulin glargine" since I believe that's what the prescription says. Would Lantus have to be written specifically on the prescription? Can the pharmacy make substitutions like that without the approval of the prescribing vet? I'm still learning.

I must have misunderstood about when to change the doses. I've read over it again now multiple times and will be better about posting here with more regularity. Life just...got in the way for a while, which made it difficult for me to check in here & focus on the cat as much as I should've been. I thought since she was mainly in the green for so long, it was going alright. It's only within this last month that things have gone higher again, which is why I was suspicious of this batch of medicine. It was a lot happening all at once, so I waited probably longer than I normally would've to increase the dose, thinking it may have been other outside factors causing the numbers to start going up out of the green; I wasn't sure if it was a bounce I somehow missed during the time I was less able to test, or if it was from the overnight kibble stealing (which we have since resolved), or if it had to do with the medication itself, since the numbers got higher faster after starting the new batch.

I will go 3 days at this new dose and see what happens.

 

I've seen people have substitutes given at the pharmacy, so I imagine it's what they have in stock for generics. If the script says "insulin glargine", that should be enough.

 

I just found the copy of the prescription, and it does say substitutions are permitted. I wonder if they'd be able to substitute the name brand, even. I'll have to ask them more about it.