Hello (again)...I need info on current insulin and BG/ketone meter recommendations

[Sandi and Toby]

Short Version:

1. Can we use Basaglar, Semglee or Glargine for a kitty currently on Lantus?
2. What new human meter(s) is being recommended commonly now and is working well?
3. Which blood ketone meter is being recommended now?

Longer Version:
I don't know if anyone here remembers me, but I was here with our older cat Brady that became diabetic in 2009 until 2014 (but I was only a lurker then and not posting), and then again (actively this time) from 2015-2021 with a senior diabetic that we adopted named Whispy. Both are sadly gone now, but I treasure every day that I had with them.

I found out today that I may be coming home with a diabetic cat in about 8 hours that has been surrendered to our vet. It's about 2am now, but if this happens later today I will do a proper introduction of "Maxine" and a quick catch up, but for now I need help on what I have missed in the feline diabetes world since Whispy passed on 3/15/2021.

Whispy was on actual Lantus (using the 3mL pens), and that is what Maxine is on now, but I don't know if I'll be receiving a vial or pen from them along with Maxine. But from what I saw quickly reading threads, it now looks like Basaglar, Semglee, and just "Glargine" are now readily available in pens at lower costs. When I left in early 2021, a few people were just starting to dabble with testing them out. It appears that they are basically interchangeable, but I didn't really stumble upon anything that said that outright. But is that true? Are all of those biosimilars for Lantus being used commonly here now with good result such that I can just request them to write a script for whichever one I find cheapest?

I still have my ReliOn Confirm meter (3 of them, actually), which I love, and although they were supposedly being discontinued in 2021, the strips are still available today for $14.98 for 50 strips on walmart.com (I never was fond of my ReliOn Prime which required more blood, I only used it in the winter if Whispy was roasting himself in front of the woodstove and his ears were going to be generous with their blood!). I will probably go ahead and buy those ReliOn Confirm strips, but if they were to become scarce, what is the consensus on the "best" BG meter to use now?

And Maxine apparently had DKA, I'll get more details I hope, so I am going to want a ketone meter this time around. Neither of my boys ever had DKA but I'm very familiar with all of that from reading posts here when Whispy was around.

That's it for now, I reallly need to get some sleep but I am hoping that I can get some responses by the time I head to the vet at 10:30am (which is actually an appointment for our oldest girl) but I might be bringing Maxine home with us after that. I donated all my U-100 syringes so I'll have to get those too, but I'm hoping that you all can help me out with the biosimilars in case I am frantically insulin shopping tomorrow afternoon!

THANK YOU, and here is a pic of Maxine to pay the Cat Tax:

 

[Bron and Sheba (GA)]

Hi Sandi,
I’m just about to serve dinner but as soon as it’s over, I’ll answer your post

 

[Bron and Sheba (GA)]

Hi Sandy, I remember you and Whisper. I’m sorry he has gone to the rainbow bridge.
And Maxine is a beauty! I’m so glad you are going to take her…thank you.

Can we use Basaglar, Semglee or Glargine for a kitty currently on Lantus?

Yes you can. The biosimilar insulins are cheaper than glargine.

What new human meter(s) is being recommended commonly now and is working well?

I would stick with the ReliOn meters. They are cheap to run and that is what you need. One of the latest ones is the ReliOn premier.
Don’t forget to get the lancets size 26 or 26 gauge.

Which blood ketone meter is being recommended now?

Do you need a ketone meter, or do you want to use the ketostix dip sticks?
Novo Max Plus, Procision Xtra Blood and Ketone meter, and Abbott has a blood and ketone meter as well.

And Maxine apparently had DKA,

If Maxine has DKA there are things you will need to do when she gets home. Often the vets don’t give any special care instructions for when they come home but there are several things you will need to do to ensure she recovers well. We get a lot of post DKA kitties arrive here and we find the following helps them recover well.

• you need to give one and a half times as many calories as she normally eats. Offer snacks every couple of hours during the day and evening as well as the 2 main meals. Food is like a medicine and helps keep ketones away. If Maxine won’t eat the low carb food, feed her whatever she will eat as eating any food is better than not eating. Buy a selection of foods including some higher carb foods to tempt her. I’m

• Don’t skip any doses of insulin as insulin helps keep ketones away. If the BG is not high enough to give the dose…stall, dont feed and test again in 20 minutes and post and ask for help.

• Test daily for ketones. Put the results of the tests into the remarks column of the SS so we can see. Please report any trace ketones at all.

• Give antinausea medication if needed. Ask the vet before she is discharged for some cerenia and Ondansetron. Cere is is given once a day and Ondansetron can be given three times a day. It is a human medication and the vet may need to write a prescription and you pick it up from a human pharmacy. Ondansetron is better for nausea than cerenia.

• Give appetite stimulant if needed after the antinausea medication

• Give extra fluids. If Maxine will tolerate warm water in the food, put a teaspoon into each snack..

• Ask the vet about doing subQ fluids at home

• Set up a spreadsheet and test the BG frequently. We can help you set it up if needed.

• Post daily with updates and ask for help as often as needed

When you get the U 100 3/10 insulin syringes make sure they have 1/2 unit markings.
I’m going to tag @Diane Tyler's Mom as she can help you with getting cheaper bio similar insulin.
Please let us know how you get on. Looking forward to meeting Maxine!
Bron

 

[JL and Chip]

Hey Sandi!
Bron already covered everything so I’ll just say “heck yes” I remember you and welcome back!

I picked up a Relion Premier a while back and, even though I still use primarily my OTU (old habits die hard), the Premier has been very good. If you like your Confirm, you can always use it but also pick up a Premier and do some comparisons over time to develop comfort with it and be able to quickly switch over if you can’t get the Confirm strips. Or maybe you’ll find you like the Premier better, who knows.

Kudos for potentially stepping up for Maxine. She’ll be in excellent hands with you. I’ll be looking for an update!

 

[Sandi and Toby]

Maxine is here now. She came with a partial vial of Lantus insulin from her owner, so I didn't have to rush around today to find insulin. I was able to find a really good price on Semglee pens at Costco ($75/box of 5 pens) this evening, so that is where I will be getting it from.

She had DKA in September 2022, and her 91-year old mother had a stroke in October, and Maxine has been boarded at our vet since then. Maxine recovered well from DKA, has gained over a pound up to 9.0lbs, and has been stable on 2U Lantus. She is said to be an "eager eater" on Purina DM wet food. Her bloodwork from November looked good but we had more drawn today for a full panel. I tested her in the office and she was 247, but she was also stressed.

Thanks @JL and Chip I actually bought a Premier back when I thought the Confirm was going away (I forgot until I looked for them this morning to take along), I also found a full 100 count box of my favorite Walgreens 1/2 unit U-100 syringes that I must have kept "just in case", and she bled like a champ for me today with my 30gauge lancets. We are long time foster parents, so I do have plenty of Ondansetron, Mirtaz, and fluids on hand at all times thankfully @Bron and Sheba (GA), and the vets are willing to prescribe anything I need in the future. Because I knew nothing about her I figured blood ketones would be better/easier, but I will minimally get ketostix on hand tomorrow and see if I want to get a blood ketone meter in the future.

I am 15 mins from our first shot in two years, so I need to get started! Thanks all, I've never been a daily poster because I'm very comfortable with making adjustments per protocol and with handling hypos, but I'll do an official Intro post for her next week once we get back in the groove and I figure out more about her. Right now she is isolated from our other 9 cats in a guest bedroom, and she is hiding in a heated bed that I put in the back of the closet. But I'll be sleeping in there with her tonight so we will see if maybe she sneaks out to give me the once over while I sleep

Thanks for quick help!

 

[Bron and Sheba (GA)]

Wonderful Maxine is home with you. She sounds like a sweetheart. Everything will be new for her, but I’m sure she will settle in and live a happy life with you.
Sounds like she is over the DKA which is good.
I would still always make sure she eats well and keep an eye on ketones, especially if she is off colour in any way and not skip any doses of insulin.
If you need any help with the spreadsheet @Bandit's Mom can do it in a couple of minutes.

 

[Liz & Minnie]

You are such a great cat mama!

My Minnie had a few DKAs at the beginning. I use the Novamax meter for testing blood ketones and also for BG. One meter, different strips (blue strips for BG amazon $50 for 250 strips, green for ketones $25 for 10 strips). It needs a little more blood for ketone readings than for BG.

I like that the blood ketone strips show any increase in ketones sooner than the urine strips (though they are a LOT cheaper!). Fortunately I've got a much better handle on her diabetes and she's been healthy so I only check her ketones when her BG is running high (>300) for a longer period and/or if she's off her food.

Best of luck with Maxine. She's a lucky girl.