At emergency vet.

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trudy66

trudy66

Member Since 2022
We are at the emergency vet. Everything has been going good, just BG numbers still high. Yesterday evening checked urine trace to maybe small. Gave lots of food and water. She ate good. Played with toys. Groomed herself.
Had to work today. Came home she would not eat, lethargic. I checked her urine large ketones. Waiting to see vet now.
What happened? Did I do this by lowering her insulin?
I'm so frustrated and so sad for her.
 
Her numbers have been ok, don't beat yourself up...you've been increasing and adjusting as quickly as you can. Some cats are just very prone to ketones. Just be glad you've been testing enough and were able to act quickly and take her in. Hopefully she just needs some fluids!

While you're there, I'd really see if they'll prescribe lantus or semglee.

Shes not getting the duration she needs with Vetsulin, and with these ketone issues it's time to switch. Most cycles she fizzles out about +7, leaving basically 5 hrs each cycle she's not getting help from insulin. You could keep trying Vetsulin in the hopes that when you get to a good dose she gets more duration ....but with the ketones you're fighting the clock a bit
 
Also try to rule out/pinpoint underlying issue like UTI, pancreatitis, etc while you're there!
 
FrostD said:
Also try to rule out/pinpoint underlying issue like UTI, pancreatitis, etc while you're there!
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They are doing a full lab, urine, fructosamine workup. Make sure she's not DKA. The vet said she really needs a different insulin. She told me vetsulin is for dogs. I told her I tried to get the vet to do the prozinc but he wouldn't. She told me "well we can take care of that" and we will send him a note saying she needs different insulin, especially after having to go to emergency vet. Thank God. I will be interviewing new vets tomorrow.
 
Oh my she sounds like a godsend! Just sorry it takes an emergency trip to get it.

ProZinc is good, based on how she's doing on Vetsulin she'd probably do ok on ProZinc but hard to predict. Honestly I'd go semglee if you can, or Lantus from Mark's Marine, as it ends up being same cost as ProZinc I believe
 
If she is having ketones again at the moment, Prozinc would be better than Lantus until the ketones are under complete control, because Prozinc is an in and out insulin and you are getting the full effect of the dose from the beginning. While you have ketones you don’t really want a depot insulin that has to build up the depot and the kitty is not getting the full effect of the dose for 3 days. I’d go with Prozinc
 
Bron and Sheba (GA) said:
If she is having ketones again at the moment, Prozinc would be better than Lantus until the ketones are under complete control, because Prozinc is an in and out insulin and you are getting the full effect of the dose from the beginning. While you have ketones you don’t really want a depot insulin that has to build up the depot and the kitty is not getting the full effect of the dose for 3 days. I’d go with Prozinc
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I had thought about this, but then you're buying multiple insulins (not cheap here). Can always stick with ProZinc til it runs out I guess.

Based on SS the Vetsulin isn't completely horrible, likely a few more increases probably get in the green to yellow range. So would you say stick with Vetsulin and stay on top of increases til ketones gone then possibly switch to depot? (if depot is the end desire, not sure) or still go to ProZinc
 
FrostD said:
Oh my she sounds like a godsend! Just sorry it takes an emergency trip to get it.

ProZinc is good, based on how she's doing on Vetsulin she'd probably do ok on ProZinc but hard to predict. Honestly I'd go semglee if you can, or Lantus from Mark's Marine, as it ends up being same cost as ProZinc I believe
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She does sound like a godsend.
I hope she can get Kloey on one of the longer acting ones. I will ask about the lantus or semglee.
She seemed ok with her being on Fancy feast. I told her the vet wanted her on glycobalance but she wouldn't eat it. She said yes I don't know many that do eat the glycobalance. I also told her about the Dr Elseys. She said she hadn't heard of that one. But she would check it out. She was very receptive about me testing. She asked me how her BG had been and I told her mid to high 300s and nadir around 200's. She said wait how do you know that word. LOL. I have learned some things.
I think she is going to be a big help to us.
 
trudy66 said:
She does sound like a godsend.
I hope she can get Kloey on one of the longer acting ones. I will ask about the lantus or semglee.
She seemed ok with her being on Fancy feast. I told her the vet wanted her on glycobalance but she wouldn't eat it. She said yes I don't know many that do eat the glycobalance. I also told her about the Dr Elseys. She said she hadn't heard of that one. But she would check it out. She was very receptive about me testing. She asked me how her BG had been and I told her mid to high 300s and nadir around 200's. She said wait how do you know that word. LOL. I have learned some things.
I think she is going to be a big help to us.
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Ha!

Bron made an excellent point, so I think you'll have to decide what you want to do. From where I sit you can probably "make do" with Vetsulin until ketones are gone again, then make the switch (but very curious what Bron has to say). Option 2 is switch to ProZinc (which to me is more ideal than Vetsulin for the ketone issue) get ketones under control, then either wait til vial runs out or switch. Just keep in mind the Lantus/semglee are U100 and need the U100 syringes. ProZinc is still U40 and you can use the syringes you're currently using (if that nightmare ever got sorted out...)
 
FrostD said:
Ha!

Bron made an excellent point, so I think you'll have to decide what you want to do. From where I sit you can probably "make do" with Vetsulin until ketones are gone again, then make the switch (but very curious what Bron has to say). Option 2 is switch to ProZinc (which to me is more ideal than Vetsulin for the ketone issue) get ketones under control, then either wait til vial runs out or switch. Just keep in mind the Lantus/semglee are U100 and need the U100 syringes. ProZinc is still U40 and you can use the syringes you're currently using (if that nightmare ever got sorted out...)
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Ok thank you. I might go with the prozinc for now to at least get her on a longer acting and it will be better for the ketones.
If I leave here without getting on one that vet may not put me on one if I went back to him.
These ketones are awful and scare me. They can jump up so quickly.
Yes I got those syringes straight. I still haven't received the new batch they were supposed to send me. I may have to call back.
 
Glad you caught the ketones & glad your switching insulin. I've not heard alot of good about vetsulin. My boy is on prozinc switched from novalin in June of last year, he's doing really good just need to find a knowledgeable vet o_O Sorry you had to go to the ER hope your baby feels better soon, looks like some good is going to come out of it though. I've heard Lantus is really good too. Good luck to you & your girl we will be watching for updates :cat:
 
Chrispooky12 said:
Glad you caught the ketones & glad your switching insulin. I've not heard alot of good about vetsulin. My boy is on prozinc switched from novalin in June of last year, he's doing really good just need to find a knowledgeable vet o_O Sorry you had to go to the ER hope your baby feels better soon, looks like some good is going to come out of it though. I've heard Lantus is really good too. Good luck to you & your girl we will be watching for updates :cat:
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Thank you
 
I would switch to prozinc if you can to get longer duration, and it’s an approved insulin for cats, which vetsulin is not. You can see how you go with that until the bottle runs out and then either stay with it or switch to Lantus.
 
Patty, make sure you are feeding Kloey lots of food, add extra warm water to the food if she will let you, test daily for ketones and don’t skip any doses of insulin. Kloey seems to be one of these kitties that are very prone to ketones so if you can make sure you are doing all of the above, you will minimise the risk of them occurring.
And once you have swapped to prozinc and can see how she is reacting to it, increase the dose (safely) so you are in good numbers.
 
Well, they kept her for overnight. I fluids and some insulin regular to get her BG down. She looked ok when I left but I'm sure it was vet stress. I will go pick her up or see how she is doing tomorrow afternoon. Thank you all for the recommendations and encouragement. I'll update tomorrow.
 
The emergency vet decided to keep her again. They will recheck ketones at 9p. She was still positive today.
They are starting her on Lantus tonight and will place a Freestyle libre. Hopefully tomorrow morning she will be home. I was able to see her she looked good. They said she was a spunky little girl who did not like the iv.
I asked about the prozinc and they said they really preferred the lantus. Much better chance at remission.
Lantus is ridiculously expensive. I had to go buy it for them to administer tonight. Did not have a chance to investigate best price. So I will be doing some investigation on pricing.
Just wanted to update everyone on her and how she is doing. Thanks again for all the help.
 
trudy66 said:
The emergency vet decided to keep her again. They will recheck ketones at 9p. She was still positive today.
They are starting her on Lantus tonight and will place a Freestyle libre. Hopefully tomorrow morning she will be home. I was able to see her she looked good. They said she was a spunky little girl who did not like the iv.
I asked about the prozinc and they said they really preferred the lantus. Much better chance at remission.
Lantus is ridiculously expensive. I had to go buy it for them to administer tonight. Did not have a chance to investigate best price. So I will be doing some investigation on pricing.
Just wanted to update everyone on her and how she is doing. Thanks again for all the help.
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Thanks for the update!

Since she is getting it at the vet it is more than likely ok, they'll probably use a fast acting insulin to keep her numbers down. It may be a little funky though when she gets home. ..I just hope each vet she sees there is as good as the one last night.

Most of us order from Mark's Marine Pharmacy in Vancouver, much cheaper. Or some choose to use semglee, but I'm not sure where the best "deal" is on that
 
FrostD said:
Thanks for the update!

Since she is getting it at the vet it is more than likely ok, they'll probably use a fast acting insulin to keep her numbers down. It may be a little funky though when she gets home. ..I just hope each vet she sees there is as good as the one last night.

Most of us order from Mark's Marine Pharmacy in Vancouver, much cheaper. Or some choose to use semglee, but I'm not sure where the best "deal" is on that
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The ones I talked to today were not as good as the one last night. I wish she had been there. That lady was awesome. They said she is off till this weekend. But the vet today did tell me she told them what she wanted to put her on and to get a internal medicine
vet involved in her care. They are supposed to give me some recommendations for one.
They were starting the Lantus tonight to see how she does.
If they give the lantus will she have any effect from it, if it is a depot Insulin?
 
trudy66 said:
The ones I talked to today were not as good as the one last night. I wish she had been there. That lady was awesome. They said she is off till this weekend. But the vet today did tell me she told them what she wanted to put her on and to get a internal medicine
vet involved in her care. They are supposed to give me some recommendations for one.
They were starting the Lantus tonight to see how she does.
If they give the lantus will she have any effect from it, if it is a depot Insulin?
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I'm not sure what you mean by your last question. Some cats take awhile to hit a breakthrough dose on Lantus and then get better numbers and come down in dose, so you'd just have to continue to methodically increase as quickly as is safe. Or you may see a similar pattern as the Vetsulin, just more duration. Or maybe the switch - at the same or similar dose - is good to go. Hard to say. It is a depot insulin so we wait 5-7 days for depot to build up.

But the real mystery is how she'll come out of the vet...meaning at what Lantus dose, what on earth they may do with the fast acting insulin, etc. Before she gets discharged, push to get a full report of what exactly was given when, and at what doses. I've seen some...interesting ...things done and it'll help us sort out how to get back on track.

Don't forget the U100 syringes
 
FrostD said:
I'm not sure what you mean by your last question. Some cats take awhile to hit a breakthrough dose on Lantus and then get better numbers and come down in dose, so you'd just have to continue to methodically increase as quickly as is safe. Or you may see a similar pattern as the Vetsulin, just more duration. Or maybe the switch - at the same or similar dose - is good to go. Hard to say. It is a depot insulin so we wait 5-7 days for depot to build up.

But the real mystery is how she'll come out of the vet...meaning at what Lantus dose, what on earth they may do with the fast acting insulin, etc. Before she gets discharged, push to get a full report of what exactly was given when, and at what doses. I've seen some...interesting ...things done and it'll help us sort out how to get back on track.

Don't forget the U100 syringes
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My understanding is since it is a depot it won't help her for 3-4 days until the depot is built up. Is that correct? So during those 3-4 days what will help keep her BG down?
They are starting her on 2 units.
 
trudy66 said:
Lantus is ridiculously expensive. I had to go buy it for them to administer tonight. Did not have a chance to investigate best price.
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Ask or price out semglee- it’s bio identical glargine and we were shocked by how cheap (relatively speaking) it was. Two pens for 60$.

edited to add: we fully believe in glargine for remission in our house (on basaglar 11/2019-2/2020, then OTJ. On semglee 1/2022-2/2022, now OTJ for 16 days).
 
trudy66 said:
My understanding is since it is a depot it won't help her for 3-4 days until the depot is built up. Is that correct? So during those 3-4 days what will help keep her BG down?
They are starting her on 2 units.
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The Lantus will help her; it just won't have its full effect at your starting dose for 3-4 days or longer. The depot is a very small portion of the total dose, so it isn't like the insulin won't be helping! Oh gosh, I hope that makes sense.
 
Patty, since they are starting her on Lantus at the vet, they will hopefully monitor the ketones and add some faster acting insulin if needed.
That is correct that the full effect of the dose will not be felt until the depot is full. So make sure the ketones are under control before she is discharged. And make sure you have plenty of Ketostix to test the urine and plenty of food options for her to choose from in case she is picky with the food when she comes home.
When she comes home you will need to feed her more than she normally eats (this will help keep the ketones away). Feed her small amounts and often.
If she is not eating well when discharged, ask for some ondansetron antinausea medication.
Don’t skip any doses of insulin. If the BG is lower than normal, stall and post and ask for help.
Add a teaspoon of warm water to her snacks.
 
trudy66 said:
My understanding is since it is a depot it won't help her for 3-4 days until the depot is built up. Is that correct? So during those 3-4 days what will help keep her BG down?
They are starting her on 2 units.
Click to expand...
Kloey will get the benefit of the Lantus insulin from the beginning but not the full dose, because the depot needs to fill for that to happen.
So you need to be aware of that and check frequently for ketones. As I said above, the vets will monitor the ketones and can intervene if necessary.
They are starting her on a slightly higher dose than she is on now so let’s see where that takes her.
Please keep us posted.
 
WilburCat said:
Ask or price out semglee- it’s bio identical glargine and we were shocked by how cheap (relatively speaking) it was. Two pens for 60$.

edited to add: we fully believe in glargine for remission in our house (on basaglar 11/2019-2/2020, then OTJ. On semglee 1/2022-2/2022, now OTJ for 16 days).
Click to expand...
Thanks for the info.
I had to buy the Insulin this afternoon and unfortunately they would not sell just one pen. I had to buy the whole box of 5. Whew about blew my socks off price wise. 500.00.. At least it will last for a while.
 
Bron and Sheba (GA) said:
Kloey will get the benefit of the Lantus insulin from the beginning but not the full dose, because the depot needs to fill for that to happen.
So you need to be aware of that and check frequently for ketones. As I said above, the vets will monitor the ketones and can intervene if necessary.
They are starting her on a slightly higher dose than she is on now so let’s see where that takes her.
Please keep us posted.
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They stopped her CRI when they gave the lantus. But still have if needed. Got her BG to around 200. Still getting fluids.
I just spoke with night vet she said at 9pm she still had some ketones but she was comfortable where they were. They would monitor her thru the night and assess in the morning and see how she is doing. The are feeding her glycobalance in there and said she is eating it very good.
I guess we will see how she is in the morning. Thanks for all the info and help.
 
If you need more insulin in the future
Here is a coupon below for semglee
Just call any pharmacy to see if they have the 5 pens, they will last you a year or more
Type in where you live and you will see where you can buy it
The 5 pens should last you about a year
Lantus is expensive if you live in the US
https://www.goodrx.com/semglee?dosa...rride=Semglee&quantity=1&sort_type=popularity
Semglee, it is a generic Lantus, and was approved by the FDA last June
About the same price for 5 pens from Canada or cheaper

Or from Marks Marine ,Canada
https://canshipmeds.com
Lantus Solostar For Pets from Canada
Insulin Glargine
Manufactured by Sanofi Aventis
Select product strength & quant 100U/mL - 3 mL - $49.99 100U/mL - 15 mL - $164.99

@trudy66
 
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Sending positive vibes for that cutie of yours.
When she comes home and you start the lantus be sure to change that in your signature
Something like Started Lantus and the date, and also do that on your spreadsheet, add a blank line above when you started lantus and just put Switched to lantus so members know

Yes lantus is crazy expensive, but it will probably last you a year, don't forget to get the U-100 syringes. We prefer to buy the ones with half unit markings since we adjust the doses by 0.25 units.
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You can get them here
https://www.adwdiabetes.com/product/5739/ulticare-u100-vet-rx-half-unit-syringes-31g-3-10cc-60ct

adw-coupon-dia10.jpg


@trudy66
 
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trudy66 said:
Thanks for the info.
I had to buy the Insulin this afternoon and unfortunately they would not sell just one pen. I had to buy the whole box of 5. Whew about blew my socks off price wise. 500.00.. At least it will last for a while.
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Pharmacies used to be able to split boxes of pens but (due to some shady dealings of a well known chain and large settlement) the FDA disallowed box splitting in 2019. However Semglee is approved in “single pen carton size.” I realize this doesn’t help you now and that box of Lantus will last you some time. But I wanted to post this in case someone else finds this post via a websearch.
 
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