? Is this true with Vets and what should I do?

[rbrumbaugh82]

Okay so I got off the phone with my current VET. She was a bit distraught on how I am handling doing this without bringing Pooper's in much for checkups. She wants to do the fructosamine test for whatever reason even though I said that I test him often daily and have a record of his glucose numbers. What is the key benefit for a Vet to use the Fructosamine test? When is it not valuable to use that test if you are testing him daily? I'll have to google it. In addition, she'll prescribe me just 1 pen only but wants me to bring him in when he is about to run out because she wants to test him on that. She said that with diabetic pets they see them often but not with Pooper's. I just don't see the point in making Appt's often so they can charge me $30 for office visit and do other things as needed when I test him at home and bringing him to the office would probably cause his numbers to rise due to being stressed out. So wondering if I should just get ready to switch Vets or to someone closer to home and maybe one that doesn't want to do these tests or want to see Poopers often to rack up money. As for the insulin, as you can see with Pooper's SS, he isn't fully regulated and seeing many 300s so not sure if new fresh pen will drop numbers more or if he needs more than 5.25 units. Should I increase at all to 6 units or just stay at where I am at with new pen and see what happens? What do you guys think with it all?

 

[Nancey]

I can't say much on the amount of insulin to give Pooper's, but I do notice a difference in Frodo's numbers when going from the older bottle to a new one. I figure that is the older bottle has lost it's strength compared to that of a new one.

But I can tell you my vet point blank told me she just does not see the usefulness of a Fructosamine test espeically when the cat is being home tested daily. If she has someone that can't/won't home test then she will do a Fructosamine, as well as checking urine and other blood levels. I take Frodo to the Vet maybe twice a year, more if we start having issues. But he stresses out BIG time just being put in a carrier, so by the time we get to the vet he is to stressed out for much of anything. She know how we are with out critters, and is very happy with seeing Frodo's spreadsheet and getting updates on how he is doing from me. I know I am lucky to have a vet like this, they don't try to nickel and dime you on everything and really take into consideration how much it upsets the animals.

 

[Lori & Lulu]

My vet did do a fructosamine test when Lulu had a full blood panel done, she was due for one. That is when the diabetes diagnosis was confirmed.
This is part of an email she sent me explaining Lulu's lab results: "...Her 14 day sugar average (Fructosamine) was 543 with cat normal being 191 - 349..."
It follows that if we are home testing regularly, we should be able to get a pretty good idea of these averages. Like Nancey, my vet confirmed that if I am daily home testing, fructosamine tests are not necessary.

 

[Julia & Bandit (GA)]

There is no reason to do a Fructosamine if you are testing daily. Your vet can get a 2 week average by looking at your spreadsheet. Have you showed her your spreadsheet? I share Bandit's spreadsheet with his current vet, and he'll check in on it every other week or so and leave comments in the spreadsheet if he has any thoughts or suggestions.

Bandit now has a secondary condition where his medication is causing his diabetes this time around so he goes in for bloodwork every 3-4 weeks (to test his red blood cell count, not his BG), but back when he was on insulin in 2009-2011 and the diabetes was the only condition we were dealing with, he only went to the vet twice a year for regular checkups. That was it. No fructosamines, no BG tests, no bloodwork (he wasn't a senior cat yet, so we weren't yet doing senior blood panels). His vet at the time would watch his spreadsheet and we would do phone consults every two months or so between exams. If I needed a script for more insulin or syringes, I would give her a call and pick the script up at her office.

I would point out to your vet that you need a script for a 5 pack of pens, because most places won't sell you a single pen, and the price of insulin is far too expensive now to buy it piecemeal like that. You'll end up spending $100 bucks for a single pen when you can get the five pack from Canada for $133. It should be more important to your vet that you be able to afford to continue treating your cat, and if it isn't, it may be time to look for a new vet.

 

[manxcat419]

My vet asked me 3 or 4 times about doing a fructosamine test even though I'd been sending them Rosa's spreadsheet every 2 weeks. I refused, politely, and the last time they asked pointed out that it wasn't going to tell them anything at all as her numbers had at that point been in normal or close to normal range for weeks.

However, all vets are different and I had been keeping my vet up to date on Rosa's progress regularly and I was using their first choice of insulin. With Poopers changes in insulin they may feel there's some benefit to seeing him for a check up, though you can still refuse the fructosamine test if you don't want it done. Did you ever manage to get a prescription from your vet for Lantus - I seem to remember that being something you weren't sure about getting when you were sent the pens? If you did, then now might well be the time to use that. If not, then they can refuse to write a prescription for a medication that's different from the one they wanted him to have the last time they saw him (our vet won't even prescribe worming pills unless the cat's had a standard health check in the previous 6 months). It sounds as though they're prepared to write you a prescription for a single pen which helps for now, but with Poopers being on his third insulin in 6 months, it's possible they're not going to be happy letting you have more than that at the moment.

 

[Lisa and Witn (GA)]

The only time I ever had a fructosomine test done was when they were first diagnosed. After that, I refused to have one since I was testing daily. I had one vet in the office try to refuse to give me a script to refill my insulin. I gladly supplied my testing results to both her and the owner of the vet practice and was able to get my refill. At the time, I could download the results directly from the meter I was using and not only did the software show the daily readings, but it also provided averages and all kinds of graphs. I gave a lot more detail then their fructosomine reports.

 

[rbrumbaugh82]

I can't say much on the amount of insulin to give Pooper's, but I do notice a difference in Frodo's numbers when going from the older bottle to a new one. I figure that is the older bottle has lost it's strength compared to that of a new one.

But I can tell you my vet point blank told me she just does not see the usefulness of a Fructosamine test espeically when the cat is being home tested daily. If she has someone that can't/won't home test then she will do a Fructosamine, as well as checking urine and other blood levels. I take Frodo to the Vet maybe twice a year, more if we start having issues. But he stresses out BIG time just being put in a carrier, so by the time we get to the vet he is to stressed out for much of anything. She know how we are with out critters, and is very happy with seeing Frodo's spreadsheet and getting updates on how he is doing from me. I know I am lucky to have a vet like this, they don't try to nickel and dime you on everything and really take into consideration how much it upsets the animals.

I will switch vets soon and hopefully the new vet will be like yours! That is how I feel with Pooper's and him getting stressed out once put in carrier and taken to the Vet. Its about 20-25 mins to the Vet now but when I switch to the new one it will be more like 5-8 mins away.

 

[rbrumbaugh82]

My vet asked me 3 or 4 times about doing a fructosamine test even though I'd been sending them Rosa's spreadsheet every 2 weeks. I refused, politely, and the last time they asked pointed out that it wasn't going to tell them anything at all as her numbers had at that point been in normal or close to normal range for weeks.

However, all vets are different and I had been keeping my vet up to date on Rosa's progress regularly and I was using their first choice of insulin. With Poopers changes in insulin they may feel there's some benefit to seeing him for a check up, though you can still refuse the fructosamine test if you don't want it done. Did you ever manage to get a prescription from your vet for Lantus - I seem to remember that being something you weren't sure about getting when you were sent the pens? If you did, then now might well be the time to use that. If not, then they can refuse to write a prescription for a medication that's different from the one they wanted him to have the last time they saw him (our vet won't even prescribe worming pills unless the cat's had a standard health check in the previous 6 months). It sounds as though they're prepared to write you a prescription for a single pen which helps for now, but with Poopers being on his third insulin in 6 months, it's possible they're not going to be happy letting you have more than that at the moment.

Yes I managed to get 1 fill for a Lantus Pen but she told me that she wanted to see him when the Pen was about out because she wanted to do the Fructosamine test and whatever else. I understand them wanting to see him and to show the Vet how his numbers are but don't need to get these glucose tests when I test daily at home. I am going to switch Vets anyways to hopefully someone that cares more and will pay more attention. Just seems like I take Pooper's to the Vet and 10 mins later I am out the door. They give more attention to dogs then they do to cats. Plus if I need something in a hurry its closer going to the Vet I am looking into then going to the current one that is 20-25 mins away.

 

[rbrumbaugh82]

The only time I ever had a fructosomine test done was when they were first diagnosed. After that, I refused to have one since I was testing daily. I had one vet in the office try to refuse to give me a script to refill my insulin. I gladly supplied my testing results to both her and the owner of the vet practice and was able to get my refill. At the time, I could download the results directly from the meter I was using and not only did the software show the daily readings, but it also provided averages and all kinds of graphs. I gave a lot more detail then their fructosomine reports.

What meter are you using to show those kinds of results?

 

[manxcat419]

I had one vet in the office try to refuse to give me a script to refill my insulin.

I agree, with a standard refill that's not really acceptable. However, this looks like as though the initial prescription has been written without Poopers having a vet visit for them to prescribe the Lantus - they weren't obliged to even provide a prescription for 1 pen, never mind refills. And legally they can't prescribe without a vet-client-patient relationship. All you have to do is agree to a standard check-up but refuse the fructosamine testing. By all means change vets if you're not happy with them overall, but a new vet is equally unlikely to provide you with a prescription without at least doing a standard health check.

Oh, and in Ohio, just like here in Washington, vets aren't actually required by law to write a prescription at all. Most will, and for something like Lantus I don't see it being a problem once they're happy that it's a good insulin for him, but that initial prescription has to be done by the rules.

 

[rbrumbaugh82]

I agree, with a standard refill that's not really acceptable. However, this looks like as though the initial prescription has been written without Poopers having a vet visit for them to prescribe the Lantus - they weren't obliged to even provide a prescription for 1 pen, never mind refills. And legally they can't prescribe without a vet-client-patient relationship. All you have to do is agree to a standard check-up but refuse the fructosamine testing. By all means change vets if you're not happy with them overall, but a new vet is equally unlikely to provide you with a prescription without at least doing a standard health check.

Oh, and in Ohio, just like here in Washington, vets aren't actually required by law to write a prescription at all. Most will, and for something like Lantus I don't see it being a problem once they're happy that it's a good insulin for him, but that initial prescription has to be done by the rules.

I have no problem bringing Pooper's in so that they can see him, get to know him and do the usual office vet exam. However, I don't want the extra tests done such as the Fructasomine when I test daily and can provide test results.

 

[manxcat419]

That's fine - or should be. Just tell them "no" to the fructosamine and show them the numbers you've been getting. If, at that point, they refuse to prescribe Lantus when it clearly is reducing his numbers, then you definitely go look for another vet.

 

[rbrumbaugh82]

Well I'm going to go to a new Vet regardless. I see a different Vet there each time I go and the main Vet that has a better handle on Pooper's is hardly there and I hate somoene new seeing him because they don't know the full history. Just like if you went to a human doctor and yet each time you went you seen a new doctor, I don't like that but what can you do? I just hope the insulin is the right choice for him. Yeah he gets numbers into the 200s but from time to time this insulin seems to work like that Bovine insulin did. I wonder if I should go ahead and get the new pen and see what it does or go back to Bovine? He just has a tough body to crack. Some days he'll only drop 30 points in 4 hours and next day he could drop over 150 points in 4 hours.

 

[manxcat419]

That's the way of it unfortunately - I much prefer to see the owner at our vet practice...she seems to understand better what I'm doing with Rosa. But getting an appointment with her is difficult - usually I finish up with one of the other vets who just questions everything.

Insulin doesn't have the same effect even at the same dose in the same cat every day - because it's a hormone they use it a little (or a lot) differently each time. What you should be able to see, over time, is a gradual trend downwards with numbers overall. I'd stick with the Lantus for now - give it a bit longer to work. As this is Poopers' third insulin, you don't want to run out of options by switching over too quickly until there's nothing new left to try. I'd get the new pen - or, as I said, if you want a try with what I've got left over from Rosa's treatment, you're welcome to that - shipping should be cheaper than the cost of 1 pen and it certainly worked for her!

 

[rbrumbaugh82]

But getting your insulin would it still be safe given that you have used a lot of it and is it a vial or pen? Plus, I'd be worried with the whole shipping of it and if it stays cold enough since it has been used. I just get paranoid over those things and don't want to end up with something a dear friend gave to me to use but the handling of it made it ineffective now. I do have the prescription at the Walmart. How many units do you think is left of yours? I only have like 2 days left of the pen I have now.

 

[rbrumbaugh82]

April, did I say that I am jealous that your Rosa is OTJ? I only can wish Pooper's can get there. I know him being overweight and older doesn't help either and him wanting to sleep so much. Maybe God will give me a blessing one of these days and can start to see him get numbers down into the low 100s and stay there throughout the day versus being in the 300-400s by evening. I have noticed though that here lately his NADIR has been happening at +6-8 hour mark.

 

[manxcat419]

Mine is a vial - so started at 1000 units. There has to be over half of it left easily. I'd have thought it should be safe to use - it's still refrigerated even though Rosa's not had a shot in a few weeks. The only thing with it is that it's been open for about 4 months so might only be good for another 2. But I can understand your concern...and getting a new pen from Walmart would guarantee that the insulin would be good. That's completely up to you - I just wanted to make sure that you know the offer is still open if you needed more Lantus now while you waited for an order from Canada or similar.

April, did I say that I am jealous that your Rosa is OTJ? I only can wish Pooper's can get there.

I understand that only too well - when I was first here and seeing kitties who were diagnosed after Rosa going OTJ before her...of course I was happy for them, but also a little jealous that it wasn't Rosa's turn. I really hope that Pooper's can get to OTJ as well - but don't give up hope...there was a cat here earlier this year who went OTJ after 5 YEARS on insulin, so there's always hope.

 

[rbrumbaugh82]

Yeah I see that the mark's pharmacy in Canada sold the box of pens for like $100 something. It would be nice though if your vial would still be very effective for more than 2 months and it would work wonders for Poopers'. I guess it would be a iffy situation

 

[BJM]

Refrigerated and stored on a stationary shelf in the refrigerator, the Lantus can last up to 6 months.

 

[manxcat419]

Last I heard, yes they were around $133 for a box of 5 pens at Mark's. It'd be a good deal if you had more time for them to get it to you.

I know people have been able to use Lantus beyond the 6 month mark, but of course I can't promise it would be good for that long - and I won't promise you something that might not work. I was originally hoping someone fairly local might want it - that way it could have gone straight from the refrigerator here into their hand, which of course would be a better situation with it being open already but I've had no interest in that so far.

If only my vet had prescribed the pens - then I'd have had 3 untouched ones still here I could have sent you...and those would have been definitely good for longer, but they didn't so I've only got what I've got unfortunately.

 

[rbrumbaugh82]

Last I heard, yes they were around $133 for a box of 5 pens at Mark's. It'd be a good deal if you had more time for them to get it to you.

I know people have been able to use Lantus beyond the 6 month mark, but of course I can't promise it would be good for that long - and I won't promise you something that might not work. I was originally hoping someone fairly local might want it - that way it could have gone straight from the refrigerator here into their hand, which of course would be a better situation with it being open already but I've had no interest in that so far.

If only my vet had prescribed the pens - then I'd have had 3 untouched ones still here I could have sent you...and those would have been definitely good for longer, but they didn't so I've only got what I've got unfortunately.

That thought counts and I appreciate you wanting to give me them. I'll just have to buy a pen and hope maybe along the way I'll switch vets and they can see him and Ok getting further scripts and then I'll try to buy more for a better deal.

 

[Lisa and Witn (GA)]

I will switch vets soon and hopefully the new vet will be like yours! That is how I feel with Pooper's and him getting stressed out once put in carrier and taken to the Vet. Its about 20-25 mins to the Vet now but when I switch to the new one it will be more like 5-8 mins away.

Make sure you have a complete copy of your records to give to the new vet. Otherwise, they may also try to have another frutosomine test done.