Generic insulin?? Switched pharmacies...

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Teya and Tweety

Teya and Tweety

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Hi all, I finally got the spreadsheet attached, but have yet to understand it. Thank for bearing with me.

We used Lantus Insulin Glargine since August for 90 days at at time in the fridge.

Recently I was informed, it should NOT be used for 90 days and to boot should not be refrigerated.

Anyway, I changed to Walmart Pharmacy from Walgreens today. I was shocked to hear I can get 5 pens for the price of 1. In my delight and haze of many things happening in life right now I did not ask WHY.

I picked them up, got them home and see they are generic brand called Mylan Insulin Glargine. I emailed the vet but they are closed. Walmart said I basically was an idiot for not realizing the reason why it was so cheap and to contact the vet if I have concerns. Which I do... generic anything is somewhat different than brand names.

Anyone know anything about generic vs brand name insulin? I Googled and got scary top of the heap articles about how it is not the same and is not a good idea/not real insulin. Anyone else here change from Lantus to generic?

NOTE my new plan is to use the pens for 30 days, room temperature and discard the rest. LANTUS says you can use them in or out of the fridge after opening. Says it right on the website... so interesting conflicting info out there.
 
Lantus came out in generic/biosimilar form a couple of years ago. That same box of pens used to cost between $400 - $500 when paying retail in the US. Many, if not most members here purchased Lantus from a pharmacy in Canada for about a third of the price. The FDA approved Semglee -- the first of the glargine biosimilars -- in 2021. There are any number of members here who use the biosimilar.

We recommend keeping your insulin in the refrigerator. I would get approximately 3 months of use from a pen. There is no need to discard the insulin after a month. Keep in mind that most humans require a substantially larger dose than a cat. Since Lantus was only approved for human use, the drug company only tested it for the same amount of time they assumed a human would use a vial or pen. Again, most people here are able to use a vial or pen pretty much to the last drop without any change in potency.

The issue with refrigeration is more a concern if you are using the needle tips and dispensing directly from the pen. As long as you are using a syringe, it's fine to keep the pen refrigerated. The pen mechanism doesn't like temperature changes.
 
Sienne and Gabby (GA) said:
Lantus came out in generic/biosimilar form a couple of years ago. That same box of pens used to cost between $400 - $500 when paying retail in the US. Many, if not most members here purchased Lantus from a pharmacy in Canada for about a third of the price. The FDA approved Semglee -- the first of the glargine biosimilars -- in 2021. There are any number of members here who use the biosimilar.

We recommend keeping your insulin in the refrigerator. I would get approximately 3 months of use from a pen. There is no need to discard the insulin after a month. Keep in mind that most humans require a substantially larger dose than a cat. Since Lantus was only approved for human use, the drug company only tested it for the same amount of time they assumed a human would use a vial or pen. Again, most people here are able to use a vial or pen pretty much to the last drop without any change in potency.

The issue with refrigeration is more a concern if you are using the needle tips and dispensing directly from the pen. As long as you are using a syringe, it's fine to keep the pen refrigerated. The pen mechanism doesn't like temperature changes.
Click to expand...
Thank you so much for all the information. Tweetys vet has conflicted opinions on generic vs staying where we are. One called me not knowing the other had and said it was ok to use generic and the other said it can change her numbers, etc. so it is best not to change. So I am not changing. I think I will just get a new Lantus pen and change it every 30 days.

I do not use syringes, but am considering doing so. Her current pen is 2 months old exactly. She is also very all over the board in her readings, so I was worried the pen lost potency from being int he fridge 60 days. We always recap it and keep it away from other things/in a bag. But since we use needles I am just so unsure. SO much conflicting info out there it is hard.
 
I use the Mylan generic for Spot. I think it works better than Lantus at keeping him regulated but you’ll want to monitor closely when you switch to make sure she doesn’t have any wild swings. Also as long as you’re monitoring, you can tell when the insulin loses potency… which I’ve not had an issue with in the last year that spot has been using it.

At $75 for a pack of 5 pens it’s hard to argue that it’s not worth a try.

Edit: Lantus is meant to be used by a human who keeps it in a pocket or purse for 30 days before discarding. Keeping it in the fridge will ensure it lasts the entire time you need it to.
 
Tootsie778 said:
Tweetys vet has conflicted opinions on generic vs staying where we are. One called me not knowing the other had and said it was ok to use generic and the other said it can change her numbers, etc. so it is best not to change. So I am not changing. I think I will just get a new Lantus pen and change it every 30 days.
Click to expand...
@Tootsie778

Just my 2 cents there are many many members here that use the generic lantus, or did start out with Lantus and switched to the generic with no problem at all. Just keep the 5 pens to in the fridge middle shelf.
Depending on how many units you are shooting they should last you a year.
We do suggest using U-100 syringes with the half unit markings because we adjust the doses by 0.25 units at a time.
If you are using the needle tips and dispensing directly from the pen like Sienne said you can only adjust the pen by whole unit's, which is not good at all.
With getting a new lantus pen every 30 days you are wasting good insulin, but that's up to you.
On your previous post I mentioned to you where to get the syringes

Most vets don't have the U-100 syringes with the half unit markings when using lantus, You can get them at Amazon without a script from your vet
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO


This link will also give you a list of syringes from other places but you might need a vets script to get them
https://felinediabetes.com/FDMB/thr...info-proper-handling-drawing-fine-dosing.151/
 
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Tootsie778 said:
Hi all, I finally got the spreadsheet attached, but have yet to understand it. Thank for bearing with me.
Click to expand...
@Tootsie778

Here is the link explaining how to use the spreadsheet, it's really very easy to use :cat:
https://felinediabetes.com/FDMB/threads/how-to-use-the-spreadsheet.241653/ :cat:

I notice on your spreadsheet you are using the Freestyle Libre , but the spreadsheet you set up is for a pet meter. The last 2 color coding up top need to be changed to reflect a human meter
The dark green should be 50-99
The lime green should be BG <50

Can you add Freestyle Libre to your signature also please

I don't know if you can change it yourself so I will tag Bhooma for you and she can change it for you
@Bandit's Mom

Thanks Bhooma
 
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Diane Tyler's Mom said:
@Tootsie778

Just my 2 cents there are many many members here that use the generic lantus, or did start out with Lantus and switched to the generic with no problem at all. Just keep the 5 pens to in the fridge middle shelf.
Depending on how many units you are shooting they should last you a year.
We do suggest using U-100 syringes with the half unit markings because we adjust the doses by 0.25 units at a time.
If you are using the needle tips and dispensing directly from the pen like Sienne said you can only adjust the pen by whole unit's, which is not good at all.
With getting a new lantus pen every 30 days you are wasting good insulin, but that's up to you.
On your previous post I mentioned to you where to get the syringes

Most vets don't have the U-100 syringes with the half unit markings when using lantus, You can get them at Amazon without a script from your vet
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO


This link will also give you a list of syringes from other places but you might need a vets script to get them
https://felinediabetes.com/FDMB/thr...info-proper-handling-drawing-fine-dosing.151/
Click to expand...
I am not sure if I already asked... Tweety uses a 5 MM - 31 G pen needle. Isnt 8MM a ton longer and might hurt more? We go to the vet tomorrow and I am not comfortable with pen needles anymore. I feel like the dosage is too strict being unable to offer her half doses. She went hypo Friday night and it was the scariest thing. I cannot help but wonder if my husband accidentally gave her 3 units and not 2. As all other 2 unit doses seemed fine the last few weeks. We were getting lower for sure, but nothing like 30 and 40. Plus the drop was very fast as well. VERY fast... within 3 hours she went from 312 to 45.
 
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Tootsie778 said:
Tweety uses a 5 MM needle. Isnt 8MM a ton longer and might hurt more?
Click to expand...
It appears you are using pen needles with the glargine pen vice drawing out the insulin from the end of the pen using an insulin syringe. This is because I think the shortest syringe needle is 6mm. 8MM is 5/16 inch. I have used ½ inch length needles in the past but prefer the 6 or 8 mm ones.
 
8 mm (aka 5/16 inch) needles aren't much longer than 5 mm ones. You can get 8 mm needles that are 31 gauge which is super thin and cats don't notice it.

Use the insulin pen just like an insulin bottle: uncap, stick the needle end of the syringe into the rubber stopper, draw up a dose, and remove the syringe from the rubber stopper.
 
@Tootsie778

You can order the U-100 syringes with half unit markings from Amazon without a doctors script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO

@Tootsie778
Can you add Freestyle Libre to your signature please and what food you are feeding , members need to see that :cat:. Just tap on your name up top then tap on signature and add the 2 items

Here is the link to read all about Lantus/Glargine , Especially the 2 dosing methods to choose one and add it to your signature and your Spreadsheet up top where it asks you.
The dosing methods will let you know when you need to increase or decrease the dose. Please read all the yellow stickys ,a lot of important information there :cat:
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

I see you said in the remarks section on your spreadsheet
we see vet tomorrow 1/30/24 then I will ask to be shown how to use a syringe

Very easy
Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there
syringe-in-pen-pic-jpg.45006
 
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Larry and Kitties said:
It appears you are using pen needles with the glargine pen vice drawing out the insulin from the end of the pen using an insulin syringe. This is because I think the shortest syringe needle is 6mm. 8MM is 5/16 inch. I have used ½ inch length needles in the past but prefer the 6 or 8 mm ones.
Click to expand...
Did you kitty notice at all? I am afraid of it hurting.
Diane Tyler's Mom said:
@Tootsie778

You can order the U-100 syringes with half unit markings from Amazon without a doctors script
https://www.amazon.com/UltiCare-31-Gauge-Veterinary-Insulin-Syringes/dp/B009LTE0DO

@Tootsie778
Can you add Freestyle Libre to your signature please and what food you are feeding , members need to see that :cat:. Just tap on your name up top then tap on signature and add the 2 items

Here is the link to read all about Lantus/Glargine , Especially the 2 dosing methods to choose one and add it to your signature and your Spreadsheet up top where it asks you.
The dosing methods will let you know when you need to increase or decrease the dose. Please read all the yellow stickys ,a lot of important information there :cat:
https://felinediabetes.com/FDMB/forums/lantus-levemir-biosimilars.9/

I see you said in the remarks section on your spreadsheet
we see vet tomorrow 1/30/24 then I will ask to be shown how to use a syringe

Very easy
Just take the cap off the pen and use a U100 syringes and pull the insulin out of the pen! You will see a small gray rubber stopper, insert the syringe there
syringe-in-pen-pic-jpg.45006
Click to expand...
Super helpful!! I was thinking we had to draw back and check for blood in the syringe and have to double poke, etc. Also, do you tap the syringe and squirt some out to test/prime? So if Tweety gets 2 units daily, would I draw to 3 and push out to 2 to make sure it is working? Or draw 1 unit and empty to make sure it is working? We are supposed to do that with pen needles.

Another crazy thing I noticed this morning! Some of the needles will squirt a lot quickly and other needles just have this super slow drip. It is all making me wonder if the dosages are not the same. It seems like a lot that comes out with the squirt and not as much with the slow drip with these pen needles. So weird. I am glad we are going to the vet today. Tweety is staying in the 250-400 range on 1 unit (we went down to 1 after the hypo episode Friday night.)
 
Tootsie778 said:
Super helpful!! I was thinking we had to draw back and check for blood in the syringe and have to double poke, etc. Also, do you tap the syringe and squirt some out to test/prime? So if Tweety gets 2 units daily, would I draw to 3 and push out to 2 to make sure it is working? Or draw 1 unit and empty to make sure it is working? We are supposed to do that with pen needles.
Click to expand...
You don't have to prime the pen when using syringes
 
@Tootsie778
Hi I see on your SS in the remark section you wrote

Utterly frightening night - Hypo out of nowhere Vets disagree on dose but I am going with 1 until we see vet tomorrow 1/30/24

We don't go by the pre shot numbers when deciding on how many units of insulin to give, we go by how low a cat is dropping which is called the nadir. That's where the 2 dosing methods come in to play
That's why you need to choose one to follow

I'm going to tag a few members to take a look at your SS and see if they have any advice on the dose you should be giving
@Wendy&Neko
@Suzanne & Darcy
@tiffmaxee
@Marje and Gracie

Do you think she should start posting on the Lantus board ?
Previous post
https://felinediabetes.com/FDMB/thr...h-ibd-daily-prednisalone.285698/#post-3147812
 
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Hi, we started on Lantus then switched to a generic from Mark's Marine in Canada, it was much cheaper. I got a 5-pen pack for under $200

The generic we switched to was Basaglar, and Hendrick didn't have so much as a blip in his numbers. Stayed the course and he is now in diabetic remission!
 
Hendrick Cuddleclaw said:
Hi, we started on Lantus then switched to a generic from Mark's Marine in Canada, it was much cheaper. I got a 5-pen pack for under $200

The generic we switched to was Basaglar, and Hendrick didn't have so much as a blip in his numbers. Stayed the course and he is now in diabetic remission!
Click to expand...
Oh I love this for you guys!!!! How amazing. How long did it take?
 
Diane Tyler's Mom said:
@Tootsie778
Hi I see on your SS in the remark section you wrote

Utterly frightening night - Hypo out of nowhere Vets disagree on dose but I am going with 1 until we see vet tomorrow 1/30/24

We don't go by the pre shot numbers when deciding on how many units of insulin to give, we go by how low a cat is dropping which is called the nadir. That's where the 2 dosing methods come in to play
That's why you need to choose one to follow

I'm going to tag a few members to take a look at your SS and see if they have any advice on the dose you should be giving
@Wendy&Neko
@Suzanne & Darcy
@tiffmaxee
@Marje and Gracie

Do you think she should start posting on the Lantus board ?
Previous post
Click to expand...
Oh... well maybe that is why the one vet wanted to keep her at 1 unit. As sometimes she gets to 100 but not regularly. I have so much to learn. I honestly feel like we were diagnosed, sent to get insulin (WITH NO NEEDLES and I had to go back and ask for what to use) and sent on our way. Thankfully her primary sent links, but there are things not covered.
 
Diane Tyler's Mom said:
Looking at this link it looks like the Fancy Feast Gems are high in carbs. 27.3 percent carbs You can save them for your hypo kit
https://www.catfoodadvisor.com/reviews/fancy-feast-gems/
@Tootsie778
Click to expand...
I am so confused this stresses me out if that is true then this is why she is hovering all day since Saturday in teh 300s. I have been giving her those since she went Hypo as she would not eat anything else.... here is the link I use to calculate https://caticles.com/carb-calculator-for-cat-food/ and once done it was 1.5% carbs and 8.8% Dry Matter

Guaranteed Analysis on package...
Crude Protein 8.0% min
Crude Fat 3.0% min
Crude Fiber 1.5% max
Moisture 83.0% max
Ash 3.0% max
Taurine 0.05% min
 
using another calculator I came up with 11.9% calories from carbs, per 100g of food. Not great but not terrible -- however just going by the ingredients on the Gems I would not give this to a diabetic cat. Or any cat really.

Guar gum? Tapioca starch? no thank you.

upload_2024-1-30_10-48-48.png


Regarding Hendrick going into remission, it took about 6 months of insulin therapy but that doesn't mean anything to you and your cat, every cat is different. Some cats have taken 3 years to go into remission, some 3 months. Some never.
 

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Tootsie778 said:
I am so confused this stresses me out if that is true then this is why she is hovering all day since Saturday in teh 300s. I have been giving her those since she went Hypo as she would not eat anything else.... here is the link I use to calculate https://caticles.com/carb-calculator-for-cat-food/ and once done it was 1.5% carbs and 8.8% Dry Matter

Guaranteed Analysis on package...
Crude Protein 8.0% min
Crude Fat 3.0% min
Crude Fiber 1.5% max
Moisture 83.0% max
Ash 3.0% max
Taurine 0.05% min
Click to expand...
When it comes to calculating carbs on a calculator I'm lost
I just go by Dr Pierson's food list

http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf

For your hypo kit
Fancy Feast Gravy Lovers Gourmet Beef Feast in Gravy 20% High Carbs

Fancy Feast Gravy Lovers Gourmet Chicken Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Turkey Feast in Gravy 15% Med Carbs

Fancy Feast Gravy Lovers Chicken and Beef in Gravy 15% Med Carbs

Good idea to mark the cans with magic marker how many carbs

Or any on the food chart. Doesn't have to be Fancy Feast just an example about the med and high carb foods


https://felinediabetes.com/FDMB/threads/dr-pierson-new-food-

10% and under is low carb
11% -15 is medium carbs.
@Tootsie778

You can even feed the Fancy Feast Roasted/Flaked/Chunky
The are either 4%, 5% , and 6% which are also ok to feed if you need a higher
low carb food
 
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Tootsie778 said:
I am so confused this stresses me out if that is true then this is why she is hovering all day since Saturday in teh 300s. I have been giving her those since she went Hypo as she would not eat anything else.... here is the link I use to calculate https://caticles.com/carb-calculator-for-cat-food/ and once done it was 1.5% carbs and 8.8% Dry Matter

Guaranteed Analysis on package...
Crude Protein 8.0% min
Crude Fat 3.0% min
Crude Fiber 1.5% max
Moisture 83.0% max
Ash 3.0% max
Taurine 0.05% min
Click to expand...
I should add... my plan was not to keep her on the Gems anyway, but to get her back to Classic Pat
Diane Tyler's Mom said:
When it comes to calculating carbs on a calculator I'm lost
I just go by Dr Pierson's food list

http://catinfo.org/docs/CatFoodProteinFatCarbPhosphorusChart.pdf
Click to expand...
Yes I use an online calculator... https://caticles.com/carb-calculator-for-cat-food/
 
Hendrick Cuddleclaw said:
using another calculator I came up with 11.9% calories from carbs, per 100g of food. Not great but not terrible -- however just going by the ingredients on the Gems I would not give this to a diabetic cat. Or any cat really.

Guar gum? Tapioca starch? no thank you.

View attachment 68978


Regarding Hendrick going into remission, it took about 6 months of insulin therapy but that doesn't mean anything to you and your cat, every cat is different. Some cats have taken 3 years to go into remission, some 3 months.
Click to expand...
Well that is good to know! I heard somewhere that if they do not go into remission within 6 months they never will. :(

As for those ingredients... wow. What a bummer. I was in such a haze/craze/fear state I just needed to get her to eat and it was "low carb" based on the calculator I use online https://caticles.com/carb-calculator-for-cat-food/ and the food label. So, I intend to get her back to her Classic Pates... her appetite is finally coming back to normal after Fridays horrible hypo night. THANK YOU for your insight.
 
Tootsie778 said:
Well that is good to know! I heard somewhere that if they do not go into remission within 6 months they never will. :(

As for those ingredients... wow. What a bummer. I was in such a haze/craze/fear state I just needed to get her to eat and it was "low carb" based on the calculator I use online https://caticles.com/carb-calculator-for-cat-food/ and the food label. So, I intend to get her back to her Classic Pates... her appetite is finally coming back to normal after Fridays horrible hypo night. THANK YOU for your insight.
Click to expand...

statistically, remission is far more likely if insulin therapy is started quickly after diagnosis, and while the *chance* of remission is lower the longer a cat is diabetic, it is not impossible. Take Diane for example -- her Tyler took almost 2.5 years to go into remission.

Figuring out the calorie load delivered by carbohydrates is very tricky especially because the cat food companies give you estimates or minimums. Calculations cannot be accurate if the source data isn't! So many members resort to both doing a calculation and also scouring ingredient lists. At my house, we feed our 7-cat clutter almost exclusively Tiki, Weruva, one flavor of Fancy Feast sparingly, and I also make the clutter a completely raw meal every night for dinner. Depending on how invested you are in feeding a low carb, clean diet you may want to look into it. I use a food processor and to make sure they are getting all the nutrients and minerals they need, I add Food Fur Life E-Z Complete powder

That is not a cheap option though, I am lucky I can afford it.
 
Hendrick Cuddleclaw said:
statistically, remission is far more likely if insulin therapy is started quickly after diagnosis, and while the *chance* of remission is lower the longer a cat is diabetic, it is not impossible. Take Diane for example -- her Tyler took almost 2.5 years to go into remission.

Figuring out the calorie load delivered by carbohydrates is very tricky especially because the cat food companies give you estimates or minimums. Calculations cannot be accurate if the source data isn't! So many members resort to both doing a calculation and also scouring ingredient lists. At my house, we feed our 7-cat clutter almost exclusively Tiki, Weruva, one flavor of Fancy Feast sparingly, and I also make the clutter a completely raw meal every night for dinner. Depending on how invested you are in feeding a low carb, clean diet you may want to look into it. I use a food processor and to make sure they are getting all the nutrients and minerals they need, I add Food Fur Life E-Z Complete powder

That is not a cheap option though, I am lucky I can afford it.
Click to expand...
Thank you for the info - Weruva and definitely Tiki are more fish based and due to her IBD we have to eat that sparingly. I used to feed her the very pricey ZiwiPeak so I am open to costs. We have a place in MN that makes food for you. Either raw or gently cooked and at this point I am thinking of trying it. I am worried about bones though. Here is who they are: https://www.woodyspetdeli.com/ I just know there are many options, opinions AND outcomes based on each cat. Every body (literally) is different. So what works for one may not for another, etc. I know many people who do great on Fancy Feast Classic Pate, but I would love to offer her a variety and making food sounds good, but so does having someone else do it who can add the nutrients, etc. We make our dogs food, just hamburger or boiled chicken and rice with a tough of kibble. Anyway I can see I am rambling. Thank you for the info!!
 
Tootsie778 said:
Well that is good to know! I heard somewhere that if they do not go into remission within 6 months they never will. :(
Click to expand...


:bighug::bighug: Remission is the ultimate goal but not every cat gets there. It's not that you're doing anything wrong. It's just how the cat is responding to insulin and diet. Squishy Merlin never went into remission in the 4 years (I think? It's been over a decade since he passed away). He had times when he was tantalizingly flirting with greens and blues but then go back up to yellows and pinks. He was otherwise happy and healthy and that was what was most important.
 
Max had chronic pancreatitis that probably helped him to be one diabetic but he was also eating high carb wet food. He never went into remission but was tightly controlled.

I think using syringes to draw up the insulin which will enable you to increase and decrease in smaller increments will really help. Two units was too much insulin and 1 unit is not enough. You will then be able to use each pen to the last drop. I started with a vial which I had to discard more than half of the bottle after 5-6 months. Get pens.

Keep asking questions and read the stickies. There’s a ton of information but I was on overload at first when I started reading which made me very fearful. No need for pthat. The people here will keep your cat safe. Low carb food is your friend. High carb and medium carb if the bg drops and Karo or honey will prevent symptomatic hypos.
 
The goal should absolutely be regulation first, not remission. You can get a cat into remission if it's not regulated.

I agree with Elise, once you get the syringes we can talk about dose. For now and with pen needles you have to stick with the 1 unit.
 
Hendrick Cuddleclaw said:
using another calculator I came up with 11.9% calories from carbs, per 100g of food. Not great but not terrible -- however just going by the ingredients on the Gems I would not give this to a diabetic cat. Or any cat really.

Guar gum? Tapioca starch? no thank you.

View attachment 68978


Regarding Hendrick going into remission, it took about 6 months of insulin therapy but that doesn't mean anything to you and your cat, every cat is different. Some cats have taken 3 years to go into remission, some 3 months. Some never.
Click to expand...
@Tootsie778
Remember there is no calculator which will accurately show the % calories from carbs using the Guaranteed Analysis values. Dry matter basis has to come from the food manufacturer. You can’t “convert” to it using GA values either.

Also, if you are now using a Libre, I need to update your SS and change the formatting. Please send me a private message by clicking on my user name to the left and then “start a conversation”. Thanks!
 
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